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Your Skin and Prosthetic Socket's Intricate Relationship

Posted by Bryan Potok, CPO on

Our bodies are constantly adapting to environmental changes, as well as the foods that we consume. Prosthetic sockets, including adjustable sockets, require constant adjustment to change in unison with changes to our bodies. For a prosthetic user to efficiently use his/her prosthesis, it needs to fit well. 

Improving socket comfort means taking good care of your skin

If your body has experienced a significant change in weight from either a new medication or a change in activity, it's important to make sure your socket is still sized properly. The goal is to stay within a weight range to avoid friction and pressure issues that can lead to various skin problems like blisters, sores, rashes, and even serious ulcers.  

Elements of a Good Socket Fit

Maintaining socket comfort can require time and effort. It's suggested that a schedule of prosthetic appointments is kept to periodically review your socket fit and revisit prosthetic alignment to prevent poor habits or issues from developing. Most common poor habits related to alignment involve compensatory movements such as side bending or vaulting from leg length discrepancies. 

Make sure to follow a prosthetic skin care routine that stresses residual limb hygiene and preventing skin damage from friction and rubbing. This last element, skin care, doesn’t have to be an elaborate routine to be effective.

How to Avoid Prosthetic Skin Problems

Begin by making sure to wash your residual limb at least once a day. If necessary, you can increase the frequency using prosthetic wipes, especially after working out. Make sure you wash everything that comes in contact with your skin—gel liners, sockets, nylon sheaths, prosthetic leg sleeves, and socks—with a pH-balanced cleanser. Medi USA makes a great shrinker and prosthetic sock detergent you can find here

Avoid shaving your residual limb as this can cause ingrown hairs that lead to infected hair follicles. Consider using a prosthetic moisturizer at night before bedtime to prevent dry and cracked skin. Don't forget to check the ingredient list of every skin care product that you use on your residual limb to avoid any known allergens. 

Limit the use of alcohol-based products as they can significantly dehydrate your skin. This includes alcohol-based skin care products and hand sanitizers. Recently published studies are now creating a link between hand sanitizer use and hypothyroidism. For those above-knee suction socket users who prefer using hand sanitizer as a lubricant, you may want to consider a different donning aid.  

If you must cover a cut or abrasion, use the thinnest dressing possible. Spenco Second Skin works great and stays in place without adding bulk typical of wound dressings.

More often than not, abrasions are caused by weight changes that alter how your limb fits inside the socket. Weight loss or gain further accelerates skin issues by causing the body to sweat more inside the socket leading to greater friction. 

Be conscious of the fit of your prosthetic socket. If needed, adjust your sock ply. We've created a list of when to adjust your sock ply here. Don't hesitate to visit your Prosthetist if you're unable to adjust your socket comfortably.

Common Prosthetic Skin Problems

In this section, we’ll discuss the most common skin problems experienced by amputees. Involve your prosthetist as well as your dermatologist if skin issues persist because often a socket adjustment or medication can quickly solve an issue. 

Prosthetic users often experience the following types of skin issues: blisters, a local infection, rashes, ulcers, or a verrucous (wart-like) hyperplasia.

To further understand these common skin issues, please refer to the chart below:

 

Skin Problem

What is it?

How to Avoid It

How to Treat It

Rashes

Caused by an allergic reaction to your own sweat or a fungus that is similar to athlete’s foot. 

 

Often, it affects people who perspire heavily and use gel/silicone liners. 

Wash and rinse your residual limb and liner every day. 

 

 

Apply a light film of diaper rash cream, such as Balmex, at night.  

 

 

If the rash does not respond to the treatment within 24 hours, seek medical help. 

Blisters

Caused by abnormal pressure or friction.

Maintain a good socket fit at all times. 

 

Maintain your body weight within 5lbs.

 

In hot and humid weather, blisters can form along high friction areas, use a prosthetic salve or balm to reduce friction.

Leave a surface blister intact. If it opens, keep it clean and cover it with a Spenco Blister Pad.

 

 

Verrucous Hyperplasia

An itchy, red, raised, circular area on the bottom end of a residual limb caused by a lack of contact.

 

It usually associated with a strong odor. 

 

It's typically related to an overly tight socket fit and/or weight gain.

Maintain “total contact” between your socket and residual limb at all times. If the end of your residual limb is not contacting the bottom of the socket, use a silicone pad to fill in this void and contact your Prosthetist immediately. 

Routinely visit your prosthetist to ensure your socket fits well.

Excessive Sweating

Profuse sweating of your residual limb.

Reduce excessive sweating by using a strong prosthetic antiperspirant on your residual limb. Use before applying your prosthesis in the morning. Make sure to allow it to completely dry before applying your prosthesis.

 

If there are any open wounds on your skin, consult your physician immediately.

 

Have you experienced any of these skin issues? Share your solutions by commenting below.

Avoid prosthetic skin problems with these tips

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