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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 year

Type of study


Prosthesis-induced risk factor

Study Population

Qualitative results

Mak et al. 2001 [40]

Literature review

Overview over current knowledge about biomechanics in TTAa s

Socket design


- 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 review

Overview over experimental and computational studies on tissue deformation and pressure ulcers

Socket design


- 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 review

Critical appraisal of state-of-the-art in FEb analysis in TTAs

Socket design


- Influence of socket design and material properties on loading conditions

- Clinical translation of FE models necessary

Bader et al. 2019 [26]

Literature review

Review of Medical Device Related Pressure Ulcers (MDRPUs) and technologies for their detection

Socket design


- 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 Study

Assessment of differences between hydraulic and ESR feet on internal loading conditions when walking over complex terrain

Prosthetic 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 displacement

Prosthetic liner


- 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