Transtibial alignment debate

Transtibial alignment debate

Matthew Mikosz

3/25/2004

I have an on going debate with my technicians on this topic and hopefully some of you could share your knowledge on the issue. When I dynamically align a prosthesis, I try to use a slide unit in case I have to do an angular change, I can maintain my weight line by compensating with a linear shift. Once I am happy with the alignment I send the prosthesis to another office for finishing. When the prostheses are being transferred in the the jig my technicians are not keeping the pylon vertical when transferring the alignment. For example, If I have a transtibial with excessive valgus at the knee, my technician will attach a 4 prong pyramid on the distal end of the socket and then angle the pylon tube to connect to the foot adapter. Whereas I would set the pylon in the transfer jig vertical, do my first lamination and then attach a 5R1 wood block to the bottom and then do a second lamination. Now when I walk my patient with the finished prosthesis the pylon tube is vertical at midstance, whereas when they are set up by my tech the pylon is not vertical at midstance. I am seeing this most often with single lamination shuttle locks. My technicians tell me that the relationship between the socket and the foot are the same in both circumstances but I feel as though a vertical pylon at midstance is a more satisfactory alignment. If anyone has any input or comments they would be greatly appreciated.

Matthew J. Mikosz, CP
Practice Manager