Custom Silicone Sockets: The Ultimate in Comfort and ...
If you’ve ever worn an upper limb prosthesis, you understand that a comfortable, well-fitting socket is essential. When the socket doesn’t feel right, when it irritates or hurts your residual hand or arm, it’s easy to predict what will happen next: You’ll stop wearing it.
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It’s like walking around in a pair of great looking, expensive shoes that are so uncomfortable you can’t wait to get them off your feet. After a couple of outings, and maybe a blister or sore toe, those shoes end up in the back of the closet.
Of course, it’s a much bigger deal with a prosthesis, where the whole point is to make it easier for you to get things done. That’s why Arm Dynamics prosthetists are focused on creating customized upper limb devices that help people thrive.
Our sockets are designed to conform perfectly around the unique shape of each person’s residual limb. While sockets are usually made from thermoplastics, a more advanced material — silicone — provides an intimate, cushioning socket that helps increase wear-time and improve control of a prosthesis.
Thermoplastic is still a good material for test sockets, diagnostic fittings and people who require more rigidity around their residual limb. But for advancing the comfort and use of a prosthesis, custom silicone sockets are superior.
Advantages of Silicone
Silicone sockets are significantly more comfortable than thermoplastic sockets due to the soft and supple texture of the material. It naturally accommodates the complex limb shapes of people with upper limb loss or limb difference.
Mandie Tavares is a congenital amputee who had a thermoplastic test socket before receiving her rolled silicone socket. That’s her in the photo below, making pizza with her daughter, Scottie.
“There was a big difference in how the two sockets felt,” she said. “The rolled silicone is much more comfortable and flexible. It helps me be able to wear my prosthesis longer. On the days that I’m out and about, I wear it all day long.”
Silicone mimics the properties of human skin. To get an idea of what it feels like, press on the bare skin of your arm or leg. Notice how it’s cushiony and moves easily and naturally beneath your touch. In much the same way, your shortened upper limb moves smoothly against the flexible inner layer of a silicone socket. There’s no friction or discomfort.
Fire Chief Joe Yeakley of Lindale, Texas, pictured below at the fire station, said that silicone is easy on his scars. "It's worked out really well for me. When I'm teaching new firefighters, I'll wear the prosthetic for eight hours or more," he said. "I don't have a lot of fatty tissue on my hands and the silicone provides some additional cushioning and comfort in those bony areas."
Because silicone is hypoallergenic and biocompatible, it’s especially beneficial for people with burns, scars or sensitivity to synthetic materials like plastic. It even has healing properties that, over time, promote the growth of new skin.
Silicone sockets feel lighter and cooler, and patients sweat less inside the socket. They’re easy to clean and more durable for the long run than plastic sockets.
Bilateral, below-elbow amputee Jason Koger was surprised at the big differences between thermoplastic and silicone sockets.
“Even though my first arms made by my prosthetist were comfortable, once I got into the rolled silicone, it was almost a game changer,” he said. “The main reason was because of the weight. Even though it’s not actually lighter, it feels 10 pounds lighter, and it’s much cooler too.”
Silicone sockets like the ones pictured above can be tinted to just about any color. Being able to choose a custom color lets you make your prosthesis more unique, which adds a little fun factor — especially for kids who wear a prosthesis.
Fitting and Fabricating Silicone Sockets
Silicone is made from a naturally occurring chemical element called silicon. Most of our sockets incorporate two types of silicone: a soft, cushioning inner layer that’s in direct contact with the residual limb, and a firmer outer layer of rolled silicone for the socket’s exterior.
Silicone sockets can be made for any level of upper limb loss, from partial finger to shoulder. Making a socket involves multiple steps and takes a specially trained silicone technician several days of careful work.
Fitting begins with the prosthetist casting the person’s residual limb and using the cast to create a plaster model of the arm or hand.
The inner layer of silicone is injected around the plaster model of the residual limb. Additional layers are applied to the areas that need extra cushioning, like bony prominences or scars.
While the softer silicone is drying, the firmer silicone is milled with an automated silicone roller. When it becomes soft and pliable, pigment is added to create any color the patient chooses.
The rolled silicone is carefully applied by hand on top of the injected silicone and trimmed to create the durable, outside structure of the socket.
The two-layer socket is placed in a curing oven for about 16 hours to bond the two silicones. After it has cooled, the socket is removed from the model, trimmed and polished, and is ready for the patient to try on.
Custom silicone sockets offer enhanced comfort and function for people who rely on an upper limb prosthesis.
If you've experienced the benefits of a silicone socket, please share your story in the comments below. If you'd like to meet with an Arm Dynamics prosthetist to discuss silicone, please complete the form at the bottom of the page and someone will contact you.
The video below explains more about the advantages of silicone and lets you meet people who are living active lives with custom silicone sockets.
For more information, see related articles and resources here:
What Is a Prosthetic Socket: Function & Fitting
Prosthetic sockets are devices that join your residual limb to the prosthesis. Each prosthetic socket is unique as it is made for the individual who will be wearing it. As you can imagine, one of the most important parts of a prosthetic socket is ensuring that it fits comfortably so that it helps amputees and allows them to live a functional and full life. At PrimeCare Orthotics & Prosthetics, we excel in the art and science of personalized socket manufacturing, creating bespoke devices tailored to your needs. In this article, we’ll provide a comprehensive understanding of how they work.
What Is a Prosthetic Socket?
A socket is an interface between a residual limb (stump) and a prosthetic device. This custom-made sleeve fits snugly around the end of the residual limb. It creates a suction seal that allows the prosthesis to distribute an amputee's weight and facilitates their movement, making it fluid and comfortable.
Sockets are custom-made to fit the individual amputee's residual limb and may have various features to provide support, stability, and comfort.
Some of the most common features of prosthetic sockets include:
- A suction seal: This helps to create a secure fit between the socket and the residual limb.
- A liner: This is a soft, cushioned layer that distributes pressure and reduces friction.
- A suspension system: This keeps the prosthesis in place and prevents too much socket rotation and slippage.
- Adjustment features: These features allow the prosthetist to make fine-tuning adjustments to the socket fit.
What Are Prosthetic Sockets Made Of?
Today’s prosthetic sockets are made of modern plastic and silicone materials as they offer a good mixture of comfort and functionality for the patient. It’s also common to see materials such as aluminum, stainless steel, carbon, and titanium in prosthetic connective componentry. The use of these materials is relatively new as more research and technology help to modernize and improve the prosthetic socket design. Some of the first lower-limb sockets were made from wood and leather.
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How Do Prosthetic Sockets Work?
During the fitting process, you’ll work directly with a prosthetist to create a check (test) socket. This is a clear socket that helps the prosthetist understand if any areas cause too much pressure or redness. If you try your check socket and you are having issues with its comfortability or wearability, it can easily be modified to better suit the shape of your limb. The prosthetic socket shouldn’t just fit properly, but also have adequate load transmission to ensure stability and control for the patient.
Most Common Prosthetic Socket Type
While there are different options when it comes to prosthetic socket types, most use the PTB SC (Patellar Tendon Bearing Supracondylar) socket for lower-limb amputations. With this type of design, the weight bearing takes place at the patellar tendon which is located underneath the patella. This is often used across the world as the most basic design for fitting medium and long stumps. One upside to this type of socket is that the design doesn’t result in blood circulation problems or atrophy.
Other types of prosthetic sockets used in prosthetic design:
- Total Surface-Bearing (TSB) sockets with gel interfaces offer pressure distribution across the entire limb surface, benefiting those with scar tissue or chronic skin issues.
- Hydrostatic weight-bearing sockets, a variation of TSB, promote tissue elongation and reduce skin breakdown risks.
- Ischial Containment (I.C.) sockets are common in above-knee designs, encapsulating the ischium within the socket for enhanced comfort and stability.
- Marlo Anatomical Sockets provide increased hip motion range and discreetness under clothing for female above-knee amputees.
- For upper-limb sockets, both body-powered and externally powered systems are utilized, with socket design critical for maintaining control and suspension throughout the range of motion.
The Importance of a Good Amputee Socket Fitting
The correct amputee socket fitting is essential for the comfort and function of prosthetic legs and arms. Adjusting the fit of a prosthesis to the correct level of comfort is vital for the following:
- Comfort: The right socket reduces pressure and friction on the residual limb, preventing pain and discomfort, which is essential for those with sensitive skin or prone to developing pressure sores.
- Functionality: A snug socket allows amputees to use their prostheses effectively and comfortably, making walking, running, and participating in activities easier.
- Confidence: A well-fitted socket ensures amputees feel confident and independent, improving their quality of life.
If you are an amputee, it is essential to work with a qualified prosthetist to ensure that you have a well-fitted, weight-bearing socket. They will rectify any prosthesis fit issues to achieve the best possible results from your prosthetic device.
The Prosthesis Fitting Process — What to Expect
We're often asked, "When is a prosthesis fitted after amputation?"
Regardless of whether it's an above-the-knee or below-knee amputation prosthesis fitting, the process for a new amputee only begins after the swelling in the residual limb has subsided, and the suture line has healed, which usually takes four to six weeks after surgery.
General things you can expect during the fitting process:
- Your physician will prescribe a prosthesis once the limb has healed. They and your insurance company (or other payers) will determine the timing of the fitting.
- As a prosthetic user, your prosthetist will discuss your rehabilitation goals and expectations for everyday life, so they can customize your device to fit your lifestyle and daily needs.
The fitting process can take several weeks or even months, as your prosthetist will need to adjust the socket and other components as your residual limb changes shape and size. Be patient and work closely with your prosthetist to ensure you have a well-fitting prosthesis that meets your needs.
— Fitting the Temporary Socket
The next step in the fitting process is creating a temporary socket. New amputees receive a temporary prosthesis for a few months as their residual limb continues to reduce in size and mature.
However, those who have worn a prosthesis before have a much shorter fitting process – a few days to a few weeks.
Below are some of the things you can expect during this stage of the prosthetic socket fitting process:
- Your prosthetist will create test sockets to see how your residual limb responds to them.
- Other components are added as you start to stand and walk or use your arm and hand. The temporary prosthesis does not usually have a cosmetic covering, as adjustments will need to be made continually as the residual limb decreases in size.
- Physical therapy is an integral part of your recovery and rehabilitation process. Your physical therapist will design a rehabilitation plan that suits your lifestyle goals. Some people may also need to have occupational therapy.
Remember that the temporary prosthesis may not be perfect, but it will allow you to start using your prosthesis and regain your independence.
As your residual limb changes shape and size, your prosthetist will adjust the prosthetic design. At PrimeCare, we monitor your progress with an app that provides important data for the final fitting.
Eventually, you will have a permanent prosthesis that meets your needs.
— Fitting the Final (Definitive) Prosthesis
The final stage of the fitting process is the definitive prosthesis. This is the permanent prosthesis you will use in the long term.
Your prosthetist determines the timing of casting for the definitive prosthesis. For new amputees, it is usually done several months after surgery to allow the residual limb to heal and stabilize in size and shape. However, experienced prosthetic users may undergo casting more quickly as they are accustomed to the process and adjustments.
Here are some of the things you can expect during this stage of the fitting process:
- Your prosthetist will create a final custom socket and attach all other prosthesis components to it.
- There will be options for a cosmetic covering.
- The creation and fitting of the definitive prosthesis will require several visits and can take a few weeks to complete.
The terms "final" or "definitive" prosthesis are not necessarily absolute, meaning no prosthetic leg or arm will last forever. A prosthesis can last anywhere from two to five years, depending on daily usage and activity level.
In some cases, the prosthesis may need repairs. At other times, only single components may require replacement rather than creating an entirely new prosthesis.
Tips for Fitting a Prosthesis Socket
It's normal for your residual limb volume to fluctuate during rehabilitation. To prevent pain and discomfort and improve the fit of your prosthesis, you should:
— Get the Right Liner
If your socket is too loose, switch to a thicker liner to create a snug fit and reduce the amount of movement within the socket. You may also need to reduce the number of plies (layers of fabric) in your prosthetic sock.
If your socket is too tight, switch to a thinner liner to reduce the pressure on your residual limb. You may also need to add a thin sock to take up extra volume within the socket.
Some specific recommendations:
- If you have an above-the-knee prosthetic, switch to a 9mm liner, and reduce the number of plies in your prosthetic sock by 10-15. This usually helps knee amputees manage any rotation they may have been experiencing in their prosthetic leg.
- If you have a below-the-knee prosthetic, switching to a 9mm liner can make it easier to bend your knee, as the liner still features a 3mm thickness in the back, which avoids knee flexion restrictions.
It is important to note that these are just general recommendations. The best way to determine which liner thickness is right for you is to consult your prosthetist. They will be able to assess your needs and make a recommendation based on your situation.
— Consider a Gel Sheath
Consider using a gel sheath or sock if your prosthetic socket feels loose. You can wear this thin, flexible
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