Developments in the trans-tibial prosthetic socket fitting process: a review of past and present research

A revolution in trans-tibial prosthetic design began at the end of World Wa r II with the development of new materials and a dramatic improvement in th e understanding of biomechanics. Early research was based mainly on the imp rovement of existing prosthetic design practice. Today, research has been f ocused on providing a better understanding of stump/socket interface biomec hanics and improving socket fit by attempting to quantify the normal/direct stresses at the interface. The purpose of this review paper is to question whether research and prosth etic education/training to date has significantly improved our understandin g of what makes a good socket. Although there is no doubt that advances in socket fitting techniques have been made what is not clear is the actual ex tent to which these advances have improved the quality of sockets fitted. It is suggested that a new approach is needed which can overcome some of th e inherent problems of designing and manufacturing a comfortable high quali ty socket. It is also suggested that current research and education/trainin g in the fields of pressure/interfacial interaction measurement and Finite Element Analysis techniques have limited potential to address many of these problems. There is also little evidence that current computer aided design systems offer any significant advantages over more conventional techniques .