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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.

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  • I am an above knee amputee, the lower portion os my stump is grafted. I still feel uncomfortable walking. Can’t walk for long cause my stump sweats a lot and as a result gets shrunk. Due to this my whole socket gets loose. If there is a better solution, Id love to explore!!

    Khushboo surana on

  • Please note if the amputee has a hip flexion contracture, Then the plumb like can not go through prosthetic middle or ankle middle many times. It has to be accommodated in the socket first and parts come down off that underneath.

    Angela Morgan on

  • I like to see a post on height alignment. Thank you!

    Ruth Belmonte on

  • I’m lak on my very first knee that’s still my balance knee..I know I’ve shrunk so I need socket adjustment but even when I get it to fit snuggly all the way around when I take a step it swings in so far that I’m literally kicking my right ankle.. In the beginning of I rotated the socket outwards a hair it would stop this but now no matter what I do it’s still swinging.. Any ideas

    Melissa Malonson on

  • Gracias Bryan por estos interesantes articulos, un saludo desde medellin, colombia

    Daniel Restrepo on

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