User-informed evidence on below-knee prosthetic socket failures, fit, and discomfort: insights from a cross-sectional study in India

PURPOSE: The prosthetic socket is a critical component in lower-limb prostheses, affecting comfort, function, and mobility. Despite its importance, no standardized guidelines exist for testing socket structural strength, and limited data are available on real-world user-reported failures. This study addresses this gap by identifying common below-knee socket failure patterns and documenting user-reported issues, including thermal discomfort, residual limb pain, and poor fit. METHODS: Structured feedback from individuals with below-knee amputation was collected across orthopedic and rehabilitation centers in Goa and Maharashtra, India. The survey covered socket failure patterns, prosthetic fit and strength, heat build-up and skin-related issues, limb pain, and overall socket durability. Descriptive statistics were used for data analysis. RESULTS: Socket failure was reported by 80.72% of participants. The most frequent problems were deformation at the socket-pylon interface (37.35%), cracks in the same region (21.69%), and brim cracks (15.66%), mostly during walking (62.65%). Additionally, 80.72% reported excessive sweating, 51.81% had skin issues, and 84.34% experienced limb pain. Poor socket fit (73.49%) and perceived structural weakness (74.70%) were also common. CONCLUSIONS: The study highlights the urgent need for standardized socket testing protocols that reflect real-world failure modes. These findings also underscore the need to develop more robust and user-friendly socket designs.