To Sock or Not To Sock?
By Raymond Francis, CP Its been a common refrain of amputees for years,
even in todays world of gel liners and total surface weight bearing
sockets: "When my leg shrinks during the day, I just put another
sock on." But is applying sock after sock after sock really the
best way of adapting to volume change?
 Consider this: when a limb loses volume, the bony
prominences of the limb are not going to shrink. The loss happens
entirely in the soft tissue areas. And since the soft tissue itself
is not dispersed symmetrically throughout the limb, any volume loss
that happens will not be symmetric either.
So what are we doing when we apply a sock (or two or five or
more)? Were increasing the volume of the limb by the same amount
everywhere. For a typical transtibial socket, imagine how much the
condylar area gets squeezed in that scenario.
If the socket started out with a total surface weight bearing
design, it certainly doesn't meet that description any more. And
any type of liner that is worn with that socket is going to be
subjected to those uneven pressures, too. A liner designed to
accept even pressure across its entire surface is not going to last
nearly as long when it is forced to take all of the pressure in one
or two small areas.
The Solution
The solution is to add volume only to the areas where it has
been lost. Fortunately, many manufacturers today offer gel pads for
the purpose of accomplishing this exact goal. The pads can be
easily applied by the patient when volume is lost, and easily
removed when the limb returns to its original volume. The key is to
make sure that the patient understands exactly where to
apply them.
Be sure to explain to the patient that, although volume loss
will sometimes result in discomfort on the limb, the area where
discomfort is felt is usually not the area where volume
has been lost. A pad will only be effective if it is
placed onto the area where volume has been lost. For
example, for transtibial amputees, explain to them that the area
most likely to lose volume is the area at the back of the leg, even
though the looseness may be felt on the front of the leg at the
tibia.
Benefits of Selective Padding
By adding pads in this manner, the total surface weight bearing
design can be preserved, the gel liner will not be subjected to
undue stress, and - most importantly - the patient will continue to
experience the comfort of equal pressure across the entire limb,
instead of discomfort across the bony areas. Socks (or any other
products that apply an equal thickness around the entire limb)
cannot achieve these goals. Using selective padding to replace
volume in the exact area where it was lost is the most
effective way of addressing the volume fluctuation that all
amputees experience. Raymond Francis, CP, is a certified prosthetist with over 40 years of experience. He is the chief prosthetist for Ohio Willow Wood and works extensively on research and product development. 
Table Of Contents - January 2005
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