Below knee amputee: Pin VS. Sleeve Suspension 

Glad to hear the pin system has been working well for you!

Wonderful! Hope it has been helpful. Let me know if there are any specific questions or topics you are interested in!

Alright, thank you so much.

It's great to hear you were able to get acclimated to it so quickly! Any wight change of even 5-7lbs can definitely make a difference in the way the socket fits and feels so great to hear you are accommodating the change in volume with socks. If you are up to wearing 2, 6-ply socks (so 12 ply total) they should be able to add some padding to the socket to help snug it up. 8-12ply is really the max you want to be wearing. Insurances, including Medicaid, will pay for a new socket and new supplies (2 lines, 2 sleeves, and socks) at the 6 month mark. But you can get a new socket started and the approval process started so it is ready to deliver right at the 6 months. When it comes to the type of socket what do you mean by "socket system". Were you referring to the pin system since it sounds like you already have sleeve suspension? Limb length, in itself, wouldn't be the main determining factor, although it is a factor. I have had people with both long and short residual limbs be successful with both pin and sleeve suspension. Each style has pros and cons and a lot comes down to patient preference and what they want to use the prosthesis for. It sounds like you are very active and want to do a lot of different things. One option could be a sealing pin system, so you use the pin system most of the time, but for more high intense activities you can add the sleeve for more security. Will you be moving soon? I do mobile prosthetics and am based out of Morganton, NC. Winston Salem would be a reasonable distance for me to travel. Best way to reach out would be through the website: sunshineprosthetics.com and request a consult. Or there is also the Sunshine Prosthetics - Morganton google page. Would be happy to answer any further questions more indepth.

@@TheLegLady thank you so much for your detailed reply. It is much appreciated and I do live in Morganton right now. I will see if I can get a consult with you guys before I leave. I think the main reason my prosthetist said no pin system maybe is because of what’s left of my tibia bone is sticking out substantially and that is what causes me the most pain. I did get padding inside my top piece of the prosthetic last visit but for sure need to get a new top piece soon although it had only been about 3 months.

I have used both successfully for people with diabetes. Typically diabetes isn't a main determining factor when it comes to pin or sleeve suspension. The main factors are going to be the ones mentioned the video. In addition though, when it comes to diabetes and using a prosthesis, you do want to make sure the socket is fitting well regardless of the suspension type. You also want to be mindful of sugar levels and A1C. You also want to be routinely checking the skin of the residual limb (and the intact limb), along with keeping the liner and your residual limb clean. This is true for anybody, but most of the complications I see are correlated with either a poor fitting socket or skin irritations.

I have not personally worked with the Ohio Willowood system a lot, although I do have a lady I am currently working with who has used that system and prefers it to other systems. When doing her new socket we kept with that system and from my stand point it's easy to work with and fabrication/set-up is straightforward. We did change her liner and sleeve though from Ohio Willowood to Alps. I have found the Alps liners and sleeves to hold up better.

Shorter limbs can be trickier to fit with a pin. Hope the suspension sleeve has been working out for you. The socket I had in this video is a PETG 3-D printed socket from Protosthetics. I use them for check sockets. I would not use this specific socket as a definitive. It is durable enough for someone to walk a couple steps in it, but I am fiberglassing the end where it connects to the rest of the componetry if the patient is walking without a walker or cane and especially if I am leaving the socket with them to trial for a couple days.

Thanks for answering! Previous, i used only cloth stockings over the limb, a rubber foam socket, and then the fiberglass socket. Used to have a lot of pain, and common blisters. When changed to a silicone suspension sleeve, no more blisters for me. So im incredible happy with it now. Im from Argentina, and we have a lot of problems to get right tool for the job... so a lot of tinkering is always needed... Thats why im exploring alternatives, like some 3d printed socket (diy alternative to keep me walking if fiberglass is unavailable).

@@julianignacioaydarpaz3851 Happy to hear you found a solution and no longer getting blisters! I know there are a few places doing 3-D printed definitive sockets and even custom inner liners. Not sure the exact materials they are using or how easy it would be to assess though.

Thanks! Do you have a below knee amputation? Sometimes the stiffness of a shoe or the heel stiffness of the foot can cause the prosthesis to want to rotate. More often than not though, it has more to do with the socket shape and fit. When sitting and standing some times it may have to do with some hip weakness, not having the foot in an ideal position, or not putting weight through and using the prosthesis to help you stand. (For above knee amputees, depending on the chair, and the way the socket is designed that can cause some rotation when sitting and standing). A sleeve suspension won’t make too much of a difference there unless there’s some weakness or laxity at the knee (but a lot of that can also be addressed with a well-fitting, well-designed socket).

​@@TheLegLadywow thank you very much for a detailed response, very helpful. I am AK amputee. I have noticed the pin does unscrew itself so every after few hours I have to check & screw it back. What if one was to superglue it to the linee, will that cause any problems?

Sorry, I have another question. Is it necessary for the foot to point downwards? Although this does make the leg more stable, but it kind of messes with the height. Since the tip of the foot is pointed down, the length of the leg has to be shorten a little to allow the foot to swing otherwise it won't have enough clearing space. Can the leg be made more stable without pointing the foot down? Thank you in advance..

@@bahatimabala3430 superglue would only be a problem if you need to remove the pin for any reason (one example would be if you need to switch the pin to a different liner). I am typically using blue LockTite to keep pins in place.

@@bahatimabala3430 Most likely there would be a way to make the leg more stable without the foot pointing down, especially since it was causing you to trip. Without seeing it, it's hard to tell you any thing definitively. If you felt like you were falling backwards and all your weight was on the heel, and that was why the foot was moved to point downwards, you could try to place a small wedge under the heel of the prosthetic foot instead. If the foot was pointed down to try and make the knee more stable: 1. most knees have an adjustment to increase stability 2. stability of the knee is going to be mostly impacted by where your weight line falls and the angle/position of the socket relative to the knee. So if you're looking at the side of you socket and divide it in half and drop a straight line from that point - typically the line should fall through the axis of the knee (where it bends) and through the posterior 1/3 of the foot. If that line is to far forward the knee will be too stable and will be hard to bend. If the line is too far back, the knee will be more unstable and will bend easily.