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Transtibial Socket Pressure


Understanding troubleshooting techniques is crucial both in the real world and for examination purposes. You must know how to properly question a patient in layman terms. If a patient presents with anterior distal redness and you are to find the source of the discoloration you should not immediately answer “an excessively flexed socket is the reason”. Not properly interviewing the patient will cause you to miss some important facts.

This particular patient may have simply changed shoes to a pair with a higher heel height. By answering with “excessive socket flexion” despite being plausible, the answer would be incorrect. So no matter how blatantly obvious the scenario may seem, do yourself a favor and continue to question the patient on recent changes, times of the day the pain presents, and if certain activities cause the discomfort. Please review the following scenarios below and please see the “Tips and Tricks” section for tricks to help you figure out confusing biomechanics on the fly while taking the actual exam.


prosthetic socket-2

(Numbers relating to socket order, i.e. question 1 relates to socket picture 1).

  1. Lateral and distal redness
    • Socket too large
  2. Proximal lateral and Distal medial redness:
    • Adducted Socket
    • Socket M/L too large
  3. Pt. Bottoming out secondary to:
    • Decreased residual limb volume, Pt. not donning appropriate amount of socks, socket initially made too big.
    • Lack of distal end contact causing verrucous hyperplasia (caused by greater proximal pressure than distal pressure) Fibular head redness:
    • Adequate relief not made for the fib head
  4. Anterior proximal and Posterior distal redness:
    • Insufficient initial socket flexion.
    • Shoe change with decrease heel height?
    • Heel lever too short, or heel bumper/cushion too soft
  5. What causes anterior distal tibial pressure?
    • A/P to big
    • Post-brim too low
    • Insufficient relief
    • Excessive use of knee extension
    • Heel lever to long
    • Excessive initial socket flexion


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