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Table 4 Studies on prosthesis-induced risk factors for DTI

From: Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review

Author and yearType of studyObjectiveProsthesis-induced risk factorStudy PopulationQualitative results
Mak et al. 2001 [40]Literature reviewOverview over current knowledge about biomechanics in TTAa sSocket designNA- Influence of socket shape on pressure distribution
- Need to quantify residuum-socket interactions
- Need to address controversies in socket design
Mak et al. 2010 [9]Literature reviewOverview over experimental and computational studies on tissue deformation and pressure ulcersSocket designNA- Influence of socket interface on transmission of pressure and shear to residual limb
- Pressure profile affected by variations in socket and fitting techniques
- Even load distribution as way to reduce DTI risk
Dickinson et al. 2017 [41]Systematic reviewCritical appraisal of state-of-the-art in FEb analysis in TTAsSocket designNA- Influence of socket design and material properties on loading conditions
- Clinical translation of FE models necessary
Bader et al. 2019 [26]Literature reviewReview of Medical Device Related Pressure Ulcers (MDRPUs) and technologies for their detectionSocket designNA- Deviations between stiffness of device material and skin/subdermal tissue as major issue
- Inadequate guidance for use of devices
- Individualisation as key concept
Portnoy et al. 2012 [32]Experimental StudyAssessment of differences between hydraulic and ESR feet on internal loading conditions when walking over complex terrainProsthetic feet- 9 unilateral TTAs
- Traumatic cause
- All male
- Mean age 42.7 yrs.
- Mean weight 78.2 kg
- Significant decrease in internal stress and loading rates with hydraulic vs ESR feet when walking on paved floor or ascending stairs
- Tendency towards internal stress reduction when using split-toed ESR compared to single-toe version
Lenz 2017 [38]In Silico Study (PhD thesis)Investigation of pressure ulcer formation due to deformation, based on gel liner displacementProsthetic linerNA- Increased interface shear with addition of socks over liner
- Cushioning effect of gel liner
- Increase in shear stress at bone-muscle interface with no-slip condition
- Increase in shear and von Mises but decrease in compression at bone-muscle interface with decreasing liner thickness
- Decreased muscle compressive stress with increased liner stiffness
  1. a Transtibial amputee; b Finite Element