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Peer-reviewedCC BY-NC-NDBMC musculoskeletal disorders

The relationship between in-socket mechanics and patient-reported comfort and function, a randomized crossover trial.

  • Goeran Fiedler1
  • Tom Gale2
  • Paige Paulus2
  • Gina McKernan3,4
  • William Anderst2
4 affiliations
  1. 1Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, 6425 Penn Ave, Suite 403-2, Pittsburgh, PA, 15206, USA. [email protected].
  2. 2Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, 3820 South Water Street, Pittsburgh, PA, 15206, USA.
  3. 3Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 3471 Fifth Ave, Suite 910, Pittsburgh, PA, 15213, USA.
  4. 4VA Pittsburgh Healthcare System, 6425 Penn Ave, Suite 400 #4126, Pittsburgh, PA, 15206, USA.
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Abstract

Background

Lower limb loss presents significant challenges, resulting in chronic health issues and impacting the quality of life. Prosthetic socket design is crucial for optimizing comfort and function in individuals with limb loss.Methods

This study aimed to determine the relationship between in-socket mechanics and patient-reported comfort and function, hypothesizing that residual femur motion, skin strain, and pressure distribution correlate with these outcomes. Ten individuals with transfemoral limb loss participated, with modifications made to personalized prosthetic check sockets to assess these variables, and data from eight subjects were included in the analysis. Data collection included CT scans, dynamic biplane radiography, in-socket pressure measurements, plantar pressure assessments, ground reaction force analyses, conventional motion capture assessments, and patient-reported outcomes. Generalized estimated equations were used to examine the relationships between peak skin strain during gait and patient reported outcomes and correlation matrices were constructed to explore relationships between static imaging, skin strain, residual bone motion, and gait kinematics.Results

Our findings indicate that the combination of skin strain metrics significantly predicts variability in comfort, while the overall model was not significant with respect to function. Significant correlations were also observed between static imaging and dynamic residual bone motion.Conclusions

These results suggest that minimizing and monitoring skin strain, particularly in the anterior central socket region, can enhance prosthetic fit and patient satisfaction. Additionally, static imaging under different loads effectively predicts dynamic displacements, offering a less invasive method for clinical assessments. These insights highlight the need for integrating objective in-socket measurements into clinical practice to improve prosthetic socket fitting, ultimately enhancing the quality of life for individuals with lower limb loss.Trial registration

ClinicalTrials.gov NCT05041998. Date of registration: March 9, 2021.

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Cite

BibTeXRIS
BibTeX
@article{fiedler2026relationship,
  title = {{The relationship between in-socket mechanics and patient-reported comfort and function, a randomized crossover trial.}},
  author = {Goeran Fiedler and Tom Gale and Paige Paulus and Gina McKernan and William Anderst},
  journal = {BMC musculoskeletal disorders},
  year = {2026},
  month = aug,
  doi = {10.1186/s12891-026-10313-1},
  url = {https://europepmc.org/article/MED/42958202},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The relationship between in-socket mechanics and patient-reported comfort and function, a randomized crossover trial.
AU  - Goeran Fiedler
AU  - Tom Gale
AU  - Paige Paulus
AU  - Gina McKernan
AU  - William Anderst
PY  - 2026
DA  - 2026/08/03
JO  - BMC musculoskeletal disorders
DO  - 10.1186/s12891-026-10313-1
UR  - https://europepmc.org/article/MED/42958202
AB  - Background  Lower limb loss presents significant challenges, resulting in chronic health issues and impacting the quality of life. Prosthetic socket design is crucial for optimizing comfort and function in individuals with limb loss.Methods  This study aimed to determine the relationship between in-socket mechanics and patient-reported comfort and function, hypothesizing that residual femur motion, skin strain, and pressure distribution correlate with these outcomes. Ten individuals with transfemoral limb loss participated, with modifications made to personalized prosthetic check sockets to assess these variables, and data from eight subjects were included in the analysis. Data collection included CT scans, dynamic biplane radiography, in-socket pressure measurements, plantar pressure assessments, ground reaction force analyses, conventional motion capture assessments, and patient-reported outcomes. Generalized estimated equations were used to examine the relationships between peak skin strain during gait and patient reported outcomes and correlation matrices were constructed to explore relationships between static imaging, skin strain, residual bone motion, and gait kinematics.Results  Our findings indicate that the combination of skin strain metrics significantly predicts variability in comfort, while the overall model was not significant with respect to function. Significant correlations were also observed between static imaging and dynamic residual bone motion.Conclusions  These results suggest that minimizing and monitoring skin strain, particularly in the anterior central socket region, can enhance prosthetic fit and patient satisfaction. Additionally, static imaging under different loads effectively predicts dynamic displacements, offering a less invasive method for clinical assessments. These insights highlight the need for integrating objective in-socket measurements into clinical practice to improve prosthetic socket fitting, ultimately enhancing the quality of life for individuals with lower limb loss.Trial registration  ClinicalTrials.gov NCT05041998. Date of registration: March 9, 2021.
SN  - 1471-2474
ER  -