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Prosthetic Socket Alignment: Front to Back

Posted by Bryan Potok, CPO on

You just received from your prosthetist a prosthetic socket that fits amazingly well. So, why is it uncomfortable to walk? In our new Prosthetic Socket Alignment series, we explore the ideal balance and alignment for your prosthetic leg. We begin this three-part series by focusing on your prosthetic socket and its relation to the rest of the prosthesis when viewed from front to back.

An illustration of a residual limb attached to a below-the-knee prosthetic leg to illustrate the ideal prosthetic socket alignment viewed from front to back. 

Ideal prosthetic alignment

A prosthetic leg is a complex system that requires your entire prosthesis to be in balance. This means that everything needs to be ideal, from suspension to alignment. If your prosthesis feels uncomfortable when walking, here’s an alignment test that you can do at home.

Take a photo of your leg from the side. Then, use a ruler to draw a line from your hip to your foot. Prosthetists refer to this reference line as the trochanter-knee-ankle (TKA) line. Based on its name, the line should go from the trochanter (femur bone) and fall through the manufacturer’s prosthetic foot reference point, which is typically the center of the foot.

Ideal front to back alignment

If you suspect that there’s something off about your prosthetic alignment, the easiest and quickest way is to stand tall and look straight ahead with equal weight on both legs. Then, have a friend twist or rotate your prosthetic foot. When your friend is trying to turn your foot, make sure to keep your gaze in front of you. If your prosthetic heel and forefoot move the same amount, then your front to back alignment is ideal.

An illustration of a residual limb attached to a below-the-knee prosthetic leg to illustrate the ideal prosthetic socket alignment viewed from front to back.

Prosthetic alignment issues  

However, if your friend tells you that the heel or toe was easier to move, then you have an alignment issue. It’s best to schedule an appointment with your prosthetist.

Too much weight on the forefoot 

If the heel was easier to rotate, it means you have too much weight on the forefoot of your prosthetic leg. This also means that your socket was attached too far forward in relation to your foot. You can experience a bunch of issues from this, including discomfort along the front bone and a lack of toe resistance regardless of the type of prosthesis you wear.

Fixing this issue can be a little difficult, and it may require a special part that realigns your socket backward so that the TKA line falls correctly through the trochanter and navicular areas of your foot.

Too much weight on the heel

If your friend finds that your toe was easier to rotate, it means that you bear most of your weight on your heel. This also means that your prosthetic socket is positioned too far back in relation to your foot. If this is you, you might experience discomfort along the back of your socket and a generally mushy feeling heel of your prosthetic foot.

Fixing this issue requires the same solution mentioned above: using a special part that realigns the socket forward. But for mild cases, your prosthetist will make a few changes using the alignment screws.  

Get your alignment fixed asap

If your prosthesis is new, it’s easy to shrug off a bit of discomfort and chalk it up to “adjustment discomfort.” However, if your prosthesis’ front to back alignment is off, it can have a profound negative impact on your walking comfort. And it can make a well-fitting socket feel less than ideal. So, we highly recommend getting your alignment fixed by your prosthetist as soon as possible.  

If you have any questions for us regarding socket alignment, please don’t hesitate to contact us or leave a comment below. We’d love to help you out.

Link to this page
<a href="https://amputeestore.com/blogs/amputee-store-blog/prosthetic-socket-alignment-front-to-back">Prosthetic Socket Alignment: Front to Back</a>

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4 comments


  • I have a new prosthetic leg with the knee, but when I try to walk, the leg goes too far and hits the bottom of the prosthetic, thereby causing pain just above were the leg hits the bottom. It is like the socket is pressing on a nerve and causing pain on the left side of the socket. Do you have any suggestions?

    Myrtese on

  • Great advice! Going to get my son to help check this out. I’ve been a black since o2. Was 54 when accident happened.

    MArleta BInninger on

  • Help Please,
    I am in need of a new insert for my artificial right leg below the knee. What I am looking for is a silicone insert covered with leather. I am going to Hanger Clinic (Good People) but they can’t seen to find where to have it made. My last leg was made by Tom Haslem in TX but I can’t find him (Might be closed). If anyone can help please contact me. The reason for the silicone w/Leather is that it has worked for me for over 40 years. I have a lot of scare tissue in the weight bearing area of my stump and this works to keep it from rubbing blisters. I have tried a few different inserts but none of them stopped the blisters. Please Help.
    Thank You,
    Roy Horn

    Roy Horn on

  • I’m finding that when I put my pros ethic on my below knee I’m finding slight discomfort on the front knee bone .. I’m using the salve and fitting lotion of yourself I’m putting shrink sock on ,with liner socks ,, I’ve had my pros ethic now for 3 mths and had various adjustments ,, thanx

    Barry on

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