Replacement prosthetic socket

Replacement prosthetic socket

Wil

1/29/2013

Hello Colleagues and Guests,

I suppose this is the venue for wrestling with this question. What is
your general criterion for making the decision to replace a trans-tibial
prosthetic socket, rather than trying to accommodate a negative volume
change. I know this could get very philosophical and turn into a long
discussion with an assortment of valid opinions. That said, I'd like to
know approximately how many ply of prosthetic socks you believe an
individual should add before making a determination to make a smaller
prosthetic socket? We'll assume that the patient wears a typical 6mm
prosthetic liner. We all know that volume changes typically occur more
in some areas than others. Even so, clients tend to add socks uniformly
and many don't use varying lengths of socks for volume management
changes along with other spot remedies. So to start the discussion out,
I personally believe 5-8 ply is a reasonable number to add if comfort
remains. I also believe 18 ply is too much. In my mind, the driving
question is how much discomfort does the patient have and where?

We recently had a Medicare denial when the client presented at the
physician's office wearing 15-18 ply of socks. When that many socks are
involved and the client is uncomfortable, we usually don't hesitate to
replace the socket and accommodate the new topography, unless the client
wants us to do otherwise. Any thoughts about what documentation you need
and what effort needs to be recorded before replacement begins?
Realizing that there are exceptions to every rule and case by case
judgement is often required, what is your general thinking? Or, do you
base your decision primarily upon a set number of pounds in weight loss?
I don't, but I think there may be a valid correlation.

Thanks again for your replies. I'll post anonymous responses in a few days.

Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123