Trans-tibial trim-line height discussion

Trans-tibial trim-line height discussion

Kevin Garrison

5/2/2013

Fellow practitioners,
 
        I personally feel the trans-tibial patient should have a socket design
that takes the strain off the knee joint as much as possible. The sides, medial
and lateral encapsulating the distal femur taking the strain off the joint as
well as the posterior wall offering a counter pressure against the patella
tendon areas anterior pressure. This area must be high enough to offer support
properly and still with adequate relief for the hamstring tendons.
 
What is often overlooked is the fact that younger amputees will go many years
straining their knee joint ambulating on the prosthesis resulting in a very soar
and stiff joint as they age. The geriatrics already have strained knees just
from a life of use, or abuse, and need the support around the joint as much as
possible minimizing continued strain as well.
 
        I have noticed in myself ambulating on a prosthesis now for 44 years
(since I was 17), that if the toe lever arm is too stiff I start getting pain in
my knee joint immediately, whereas in the past nothing bothered me. I always
kept the medial and lateral and anterior and posterior socket on my Symes socket
very low as recommended, not protecting the knee joint from strain at all. I
feel if I had kept the trim-lines higher I might be able to tolerate a stiffer
toe now and benefit from the energy storing?
 
        That's just my philosophy, as I think that lowering the trim-lines may
be a very cool thing to do, especially cosmetically, but risks
are absolutely there in the long term for future problems to develop especially
in the more active patients. Let someone prove me wrong, for now I'm keeping
the trim-lines high.
        
        What do you think?
 Kevin S. Garrison, C.P., L.P. / Author


Garrison's Prosthetic Services, Inc.
17184 N.E. 19 Avenue
North Miami Beach, Florida, 33162
305-949-1888
www.GarrisonsProsthetics.com