A Good Socket Fit Needs A Creative Mindset And The Guts To Improvise
Most amputees know that the key to an active lifestyle is a well-fitting socket. Most amputees also know that the process to get a well-fitting socket can be long, tedious, and often frustrating. And to make things even more complicated, even if you manage to bring this process to a successful end - read: If you have a socket that feels good, is comfortable to wear all day long while being snug enough to be active and use the leg in all kinds of situations - your residual limb can change and - as a result - your overall situation changes. Either over the course of a day, from one week to the next, or over a longer period of time. This can be a change along a trajectory, a trend in a given direction. Or it can be oscillating. So changes without a clear direction to where the journey is leading to. And while more significant changes need to be addressed together with your prosthetist, there are some options you have to fix things yourself. This can be handy if you feel the need for adjustments over the course of day, for example while on a walk or when away on holidays with no access to a prosthetist.
So here are a few life hacks you might want to try. But before you do so, let me state one thing clearly. The following approaches to deal with an ill-fitting socket have been tried by me. They worked for me. And they might work for you. But if you try them, you do so at your own risk.
For me staying hydrated is a key one and makes a huge difference. I sweat a lot when I am active. Not just in summer, but also when it is rather nippy or when I am just out for a walk of a few kilometers. When walks get longer, the pack on my back gets heavier, and the temperatures rise, I sweat even more. And I mean more as in my clothes will be soaking wet (sorry for the details). And this effects the volume of my residual limb. I tend to lose a good fit quickly. And once the snug fit is gone, the vacuum breaks regularly. And with it the limb falls off easily. So one of the basic strategies for me to work towards a well-fitting socket while I am active is to stay hydrated. And as I don’t like to carry tons of water on longer hikes, I regularly take a small water filter with me and get water out of creeks and lakes when I need it.
Regular Breaks During Which I Take Off My Liner
Taking regular breaks during which I take off the liner is part of a strategy which I initially only used during long and arduous hikes. Knowing that for a long day outdoors - especially in difficult terrain, with a pack in access of 15 kilograms on my back - it is essential to keep the residual limb in good shape. And this means trying to keep sore spots and blisters to a minimum, taping broken skin areas early on, and doing all I can to keep unwanted friction from the socket and the liner to a minimum. So I commit to regular breaks (depending on the terrain, about every 6-7 kilometers or roughly every 75 minutes), even if I am not yet tired, don’t really feel the need for a break at that moment. I sit down, take off the prosthesis, take off the liner, dry the residual limb, and let the skin breath. I check for sore spots and broken skin, treat it if necessary, and basically just give the residual limb a break. After 15 minutes I get back into my liner, get back into the socket, before embarking on the next 6-7 kilometers, or abut 75 minutes. Then I repeat this exercise. And it works surprisingly well for me. I normally have a really good fit of the socket after the break. Even if it felt a bit wobbly just before the break. I admit sticking to this strategy is much easier in summer when the weather is nice and a 15 minute break in the sun is a welcome change. As compared to a winter walk in rainy and muddy conditions when a break means getting all dirty and wet, often combined with cooling off way more than feels good.
Use Additional Seal-In Rings
Another option you have is using a second seal-in ring over your liner (if you use a liner system, that is). That is the reason why I keep some of my old seal-in rings. This gives me the option of using a second one to improve the fit of the prosthesis on long days out in the hills. A second ring does not necessarily improve the fit of the socket, at least not always. But if I notice that the volume of my stump is reducing and the vacuum breaks on a hike, adding a second seal-in ring is one of the options I normally try. Sometimes it works, sometimes it doesn’t. And sometimes it addresses the issue of a bad fit, but gives me problems with my gait or the precision with which I can place my foot on difficult terrain. So it’s a bit of a gamble. But it’s easy to find out.
Fixing The Seal-In Ring With Kinesio Tape To The Liner
A similar option to the one above is to use kinesio tape to fix a seal-in ring to the liner. I often encounter the problem that once my residual limb gets a bit smaller (and once the seal-in ring is bit older and worn out), that the ring starts to roll up, thus breaking the vacuum. In these cases taping the seal-in ring to the liner can work wonders and significantly improve the fit of the socket. Just move the ring into the right place on the liner, add a full round or two of kinesio tape, and get back into the socket. Another easy option that often works very well for me.
Use Cut-Out Patches Made From Old Liners
Last but not least: Slide patches made from old liners into your set-up to add volume to the residual limb. I regularly chop up old liners and cut out silicone patches of various forms and sizes. Normally kidney-shaped ones. When the fit of the socket is worsening, I can easily add the patches in order to increase the volume of the stump and thus create a better fit within the socket. I just roll down the liner to about half-way down, then insert the patches between the skin and the liner on the lateral side, then roll the liner up again. Done. It’s a matter of minutes, can be done on the go, and for me it works in about 85% percent of the cases when I face problems while being outside. Yes, it might give you some minor skin irritation along the edges of the additional patch. But they are gone after a day or two. And for me this is a price well worth paying.
So much for my five life hacks to deal with a loose fitting socket yourself. These are easy DIY ways of tackling the challenges - and frustrations that come with an ill-fitting socket — while you are out and about. Give them a try and see what works for you.
And if you have additional life hacks and tested advice, I would love to hear about them.
Post by Bjoern Eser, the creator of The Active Amputee.
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