During our lecture on external prosthetics, I learned 30% of amputees fail to achieve ambulation (walk without assistance), which left me unsettled and shocked. Especially as over summer, I watched many amazing events at the Paris Paralympics. Whilst it may be fair to say I don’t expect every person to become an athlete, being able to walk again was not something I anticipated almost a staggering 1/3 of patients are unable to achieve after amputation.

But WHY?

Upon further research, I discovered one of the biggest causes is the uncomfortable, long recovery needed (see video) – pushing through discomfort, pain, fatigue – rooted mostly at the stump-socket (or human-prosthesis) interface. This is the ‘unseen’ side, behind the gold medals I saw growing up on television.

The stump-socket interface has left scientists truly stumped and is one of the biggest challenges in field of prosthetics today.

I interviewed a former colleague, an amputee, who shared how they don’t use prosthetics for this very reason, as they feel the pain and damage, additional to initial recovery, is not worth it. This was a valuable alternative perspective and showed me the importance of considering not just the hard work that needed from those creating and fitting the prosthetics, but the patients too.

Current efforts to tackle this challenge

However, this is an area being worked on continuously by a wide range of people. Researching into the sheer variety of upcoming, innovative ‘solutions’, has given me a sense of hope that the lives of amputees can be improved and ambulation figures can be drastically increased.

I discovered the 2 key elements to tackling this – the stump and socket – with methods targeting one or both. Below is a mind map of the techniques I feel are most significant currently, why and how I think they could be made better to encourage amputees to give prosthetics a go, and improve their experience.

‘The challenge to the prosthetist lays in designing a socket that balances suspension, support, stability, and corresponding contact pressures, all while accommodating the individual’s unique anatomy and locations on the limb to which interfacial pressures are being distributed’

Advances in the measurement of prosthetic socket interface mechanics.
Young PR et al.

My concluding thoughts…

Through considering different view and elements of this challenge, I find myself constantly coming back to the fact 1/3 fail to achieve ambulation, despite new innovating techniques and developing aids. I have also found this problem is much more sinister, with some studies linking a failure of ambulation to morality. Medical conditions and other factors can also limit an amputees return to walking. However I feel improving prosthetics, by coming up with a range of solutions for different patients (as clearly one size doesn’t fit all) – more amputees could be given a fair chance at taking steps back to normality.

And yours…

Now I’ve shared my opinion, it’s time to share yours!

References:

• https://pmc.ncbi.nlm.nih.gov/articles/PMC10257952/#:~:text=Above%2Dknee%20amputations%20(AKA),in%20five%20years%20%5B13%5D – Amputation and Morality.
• https://www.nhs.uk/conditions/amputation – NHS amputation information.
• https://pmc.ncbi.nlm.nih.gov/articles/PMC11272479/ – PTB and TSB sockets.
• https://www.physio-pedia.com/Emotional_and_Psychological_Reactions_to_Amputation – Common issues amputees face.
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8189153/ – Psychological consequences.