Bulbous TT, post fitting notes.

Bulbous TT, post fitting notes.

Lane Ferrin

12/17/2018

Thanks for the many responses. I will repost them after this is all
sorted out.

Two bits of info that were requested; limb length is 18cm from MTP
I am working on a new socket.

The current test socket fits well with either a 6mm gel cushion liner
and 2 plies or an Otto Bock 6y85/75 and 10 plies, until she bears full
weight. Then she feels high pressure, causing pain, on the distal end
of the tibia. I put a hole in the distal anterior socket and the tibia
is not touching the inside of the socket. With the liner off I can
elicit the same pain by pulling upward on the soft tissue, hammocking
the skin over the end of the bone.

This means to me that I need to balance the forces in the socket to
neutralize proximal movement of the soft tissue relative to the tibia,
under load.
In an attempt to do this, I put 4 Otto Bock Spots, sizes 2, 3 and 4 in
the Otto Bock liner, positioned posterior to the distal tibia and
donned the socket. Under full load she felt minor pressure, no pain,
on the end of the tibia. Suspension was good and there were other
areas of the socket that were too tight but they will be easily
rectified.

I have not been happy with custom locking liners in general. Otto Bock
custom silicone liners are not available with the same outer cloth that
is so good at eliminating vertical stretch. Willow Wood liners are not
always available in the shapes needed because they are not fully
custom, being made from standard sizes so the taper is pre-set.

Any suggestions as to an effective custom liner are very welcome.

One comment from my original post I need to respond to. Someone said
that if you use a locking liner with a pin you will always have
pistoning. My response is that pistoning in a locking liner socket
indicates a poorly designed socket. Its easier to stop pistoning with
a locking liner than with sleeve suction but many times the long term
consequences of distal traction outway the benefit of ease of donning
etc.



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Lane Ferrin
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