Fabrication of a Prosthetic Socket for a Transtibial Amputee: The Sculptor's Contribution

Introduction

The amputation of a limb is an irreversible intervention in the natural physiological makeup of a human being. Physical loss of a body part is caused by underlying disease, comorbidities, and concurrent injuries as well as the psychological instability of the victim. Cardiovascular complications and diabetes cause limb loss, increasing obesity, an ageing population and trauma (Dal Canto et al., 2019). Amputation makes ambulation extremely difficult for amputees (Finch, 2011). Much of amputee's ambulation is associated with transtibial prostheses of the upper and lower extremities (Sewell, Noroozi, Vinney & Andrews, 2000). The prosthesis is categorised into upper and lower prostheses (Bates, Fergason & Pierrie, 2020). The upper-extremity prostheses are used at varying levels of amputation: forequarter, shoulder disarticulation, trans-humeral prosthesis, elbow disarticulation, trans-radial prosthesis, wrist disarticulation, full hand, finger, partial finger and hand, whereas the lower-extremity prostheses provide replacements at varying levels of amputation (Bates et al., 2020; Chadwell et al., 2020). These include hip disarticulation, trans-femoral prosthesis, knee disarticulation, transtibial prosthesis, Syme's amputation, foot, partial foot, and toe (Bates et al., 2020; Chadwell et al., 2020; Krebs, Edelstein & Thornby, 1991).

Grosz (2003) posits that there are two main subcategories of lower extremity prosthetic devices, namely trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency) and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency). Lower limb amputations are considerable among 805,426,000 people with locomotor disability (Oosterhoff, Geertzen & Dijkstra, 2022; Spoden, Nimptsch & Mansky, 2019). Most members of this group are young, active-earning males (Finch, 2011). Ambulation with prostheses is considered a basic need and a significant means of survival (Lee, Winson, Zhang & Ming, 2005). Even though passive prostheses replace missing body parts to a high degree and improve patients' independence and mobility, those in the lower-income bracket in developing countries, especially Ghana, still have strong feelings about their inability to procure prostheses for their livelihoods. Hence, in Ghana, especially those with transtibial cases (legs missing below the knee), amputees are selective as to what they consider appropriate to assist them in ambulation (Pollock, 2015). Amputees experience activities of limitation and participation restrictions. Typical activity limitations and participation restrictions for lower extremity amputees relate to self-care activities and mobility (Gallagher et al., 2011). These affect the person's ability to return to and maintain work, maintain social relationships, participate in leisure activities and be active members of the community (Brigham and Women’s Hospital (BWH), 2011). Environmental factors such as barriers in the community related to physical/structural environments and personal factors such as age, gender, level of education, and ability to adjust restrict participation in normal social roles for lower extremity amputation (Hawkins et al., 2016; BWH, 2011).