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Prosthetic Socket Alignment: Ideal Rotation

Posted by Bryan Potok, CPO on

You just received your new prosthetic socket, and it fits amazingly well. So, why is it uncomfortable to walk? In our Prosthetic Socket Alignment series, we explore the ideal balance and alignment of your prosthetic leg. So far, we have discussed socket alignment from front to back and side to side. In this article, we discuss the rotation of your socket and its relation to the rest of your prosthesis.

How to determine the ideal prosthetic socket alignment and rotation using your phone's measuring or photo editing app.

If you find yourself comfortable in your prosthesis until you start walking, your socket rotation may be slightly off. Here’s how you can determine if your suspicions are correct.

Ideal prosthetic alignment

First, you need to be able to tell what the ideal prosthetic alignment is. You can do this by taking a photo of yourself from the front while standing tall and wearing your prosthetic leg. Then, using any measuring or photo editing app on your phone, bisect your socket in half, and draw a line down to your foot through your prosthetic toes. This line should fall between your prosthesis’ big toe and second toe. 

How to determine the ideal prosthetic socket alignment and rotation using your phone's measuring or photo editing app.

Prosthetic alignment issues

If the line falls to the inside of the big prosthetic toe, then your foot’s “toe-out” or internal socket rotation is significant. This is usually true if you feel like you’re stepping into a hole or sense too much pressure over the cut end of your bone.

However, if the line falls too far to the outside of your prosthesis’ big toe and closer to the third and fourth toes, your socket is rotated externally, creating too much “toe-in.” This also creates the sensation of continually walking uphill, along with excessive knee stability.

Thankfully, both cases can be solved by consulting your prosthetist, who will perform a quick gait analysis. Then, he or she will take a 4mm wrench and rotate your socket, either internally or externally, depending on the issue. This will make you feel more comfortable and walk more efficiently. 

If you have questions about socket alignment rotation, please don’t hesitate to ask us. You can leave your questions in the comments section below.

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  • Can you email me this. Thank you.

    William Studer on

  • Can you email me this. Thank you.

    William Studer on

  • I desperately need some advice on this subject. I am a June 30, 2018 traumatic AK left leg amputee and i received my ottobock c-leg 4 in Dec 2018 and to this day I haven’t found anyway to keep my residual limb from turning inward to wear I am walking extremely bow legged. I have tried sucksion systems, pin systems and I’m currently using a lanyard system now and none of them have worked. I’ve also tried applying numerous socks and different plies of socks to all the setups I listed above. I’m to the point now where it has affected me so bad mentally that I’m to the point where I want to give up, this has me not even wearing my brand new c-leg 4 and not at a very good place in my life right now. Can anyone please help me and offer any advice, I’m willing to do or try anything to gain some quality of life. I need to for my two boys 14 and 17, please if anyone could help.

    Philip Arrant on

  • Don’t understand how outside of the big toe can be
    Closer to any other toe. Shouldn’t thus apply to the inside statement

    Jose Luis La Regina on

  • Does it go for all , prothesis, single axis knee and foot

    Emmanuel Bassey on

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