Mechanical testing of transtibial prosthetic sockets: A discussion paper from the American Orthotic and Prosthetic Association Socket Guidance Workgroup.
Francesca Gariboldi, Andrea Giovanni Cutti, Stefania Fatone and 5 others
PMID 36763513WHAT IT FOUND
Current standards do not test the whole prosthetic socket, so new designs cannot be checked for strength before use.
A workgroup identified four key gaps in testing methods and proposed consensus and new research to create a standard that prevents overfabrication and failure.
Key findings
01Existing ISO standards for prosthetic components do not include the socket in testing, leaving structural strength and fatigue durability unverified for custom devices.
02Without standardized testing, manufacturers overfabricate sockets to ensure safety, which increases weight, cost, and patient discomfort from heat and poor fit.
03The workgroup identified four key domains needing research or consensus to define socket testing: mock limb design, alignment coordinates, specimen components, and loading conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The paper is a discussion and recommendation document, not a study that tests a specific method or compares outcomes. The scope is limited to transtibial (below-knee) sockets; transfemoral (above-knee) and upper limb sockets are not addressed. It does not consider clinical factors like comfort or pressure distribution at the limb-socket interface, focusing only on structural strength. The recommendations are based on expert consensus and identified gaps, not on new experimental data generated by the workgroup itself.
Declared interests
Funding was provided by Innovate UK, the Royal Academy of Engineering, The Alan Turing Institute, and VA-DoD Joint Incentive Funds. The authors disclosed no potential conflicts of interest.
The easy way to misread this
Do not interpret this paper as providing a new, validated testing standard or a set of specific load limits for clinical use. It identifies what is missing and proposes how to find it, but it does not yet offer a ready-to-use protocol for verifying socket strength.