Introduction to Residual Limb Health

Biomechanically, the residuum-socket interface behaves as an extra joint in the lower limb1–3. There is potential for relative movement in three directions and relative rotation about three axes1,2. With excessive movement, a loose joint can lead to wear (e.g. chafing and rubbing) and a loss of control. To further complicate matters, the residuum size and shape can vary and the loads applied to it are drastically different to what nature intended.

Another consideration must be the cause of the amputation in the first place. The biggest causes of amputation in the developed world are vascular health problems, such as diabetes4. Over 23 million Americans (7% of the population)5 have been diagnosed with the condition, costing $237 billion in direct medical costs in 20176 – an increase of 35% since 20127. In the UK, it costs £1.5 million an hour8 (or 10% of the total NHS budget) to treat the 3.8 million diagnosed with the condition9.

A common side effect of dysvascular conditions is poor circulation that results in the formation of ulcers and wounds. When excessive pressure and shear loads act on the soft tissue, it is susceptible to damage and can’t heal as quickly because poor circulation does not allow enough blood transport of nutrients to, and waste product removal from, the affected area10,11. A large proportion of these healthcare costs relates to the treatment of these ulcers and wounds12. Another side effect is nerve damage, resulting in reduced sensation that can lead to delays in detection of tissue damage, allowing time for wounds to become infected13. Diabetic foot ulcers are a leading cause of amputation12 and residual limb pressure ulcers are a leading cause of reamputation14–16. Following a dysvascular amputation, there is a 21% chance that a second, more proximal amputation will be required within a year14–16. The rate of contralateral amputation is higher for amputees with diabetes than those without14.

Three areas must be considered in order to make the socket connection as sympathetic and compatible as possible.

References

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