ISPO AMS 2023 - Invited Paper


Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications


Presenters:  Michael Baldock & Nicolaas Pickard, PhD Students, CDT in Prosthetics & Orthotics, University of Salford, UK



Introduction and Objectives

Socket fit significantly impacts patient comfort and prosthesis satisfaction. Traditional sockets are monocoque structures which cannot easily be adjusted after fabrication. This review focusses on adjustable sockets, which have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure.

Materials and Methods

A systematic review of six academic literature databases; two patent databases; and one news database, was conducted to identify academic publications, patented designs and news articles relating to adjustable sockets. Screening was conducted by two authors, with a third used to settle disagreements.


50 academic articles, 63 patents and 36 news articles were identified after screening, spanning 35 different designs reported in the literature, and 16 commercially available devices. It was notable that 73% of all publications occurred in the past 10 years alone. Two characteristics were used to classify the designs: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length) and surface form (conformable, rigid multi-DOF, and rigid single DOF). Key differences were seen between the designs reported in the academic literature, and commercially available designs. For example, 40% of academic papers reported on designs which used inflatable bladders for adjustment, but only 1 (out of 16) of the commercial designs used this approach. Many adjustable sockets lack safety features to limit over or under tightening. Clinical studies of these devices are generally small in size and only 17.6% of them assessed a commercially available socket.


Overall, the principles of adjustability and surface form varied widely, particularly between commercially available designs and designs reported in the academic literature. Justification for location and range of adjustment was not common. Improved communication and collaboration between industry and academia would be of value in progressing the field.


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