There are a variety of benefits that users with a prosthesis with Direct Socket TF socket will find throughout their day. Donning the prosthetic leg is quick and simple, no time wasting to find the correct position of the socket. This allows more flexibility as the user just focuses on their preferred knee/foot position. The prosthetic leg may feel lighter compared to when used with previous sockets.

A simple pleasure such as sitting down without any discomfort or pressure at the back of their residuum, allows even weightbearing between the buttocks when sitting relaxed. The improved balance and stability whilst sat down can allow more freedom for the user to do activities in this position with their limb still donned comfortably. When the user prepares to stand up, they are ready to load both legs evenly, helping to reduce extra pressure from overloading their sound side repeatedly whenever they stand up or sit down.

When it comes to walking with their prosthesis, the user may feel less restriction from the socket edges, in addition to being able to lean forwards easily whilst sitting down/standing without the socket brim getting in the way of their hip/stomach and causing discomfort which may prevent them from completing these activities regularly.

In sitting, to compensate for the usual discomfort of a socket’s hard edges digging in at the front and back, users will offload the prosthetic side to reduce pressure, this leads to one side of the trunk tightening up whilst the other side lengthens, or they slouch backwards and sit in a posterior tilt, allowing the important postural muscles to disengage. Over prolonged periods of time, both solutions to discomfort, can cause muscle imbalances and lead to weakness, as well as changing a user’s perception of their midline awareness, which is seen as compensations in gait such as dropping a shoulder/flexing the trunk.

With a direct socket, there are no hard edges causing discomfort, which allows for even weightbearing between the buttocks. This allows the pelvis to be in a level position which can have a beneficial impact on a user’s posture over time. By allowing the users pelvis to remain level in sitting, we can reinforce this position sub-consciously to have better carry over from what is worked on with the therapists during gait re-education and exercises.

In traditional sockets, users feel they need to rest onto the back of the socket whilst walking, and subsequently don’t activate the same muscles as you would without a prosthesis. When walking with a direct socket, there is more freedom for movement, as key movements around the pelvis are less restricted, and encourage the user to activate more muscles to allow a smooth, more symmetrical gait. For example, opening up more movement of the pelvis going forwards, naturally encouraged the trunk to rotate and the opposite arm to swing to promote balance.

The manufacturing process is a more relaxed experience for users. They can lie down, and be supported with pillows, feel relaxed and maintain energy. Likely to get a truer fit of user’s anatomy in this relaxed state, when not tensing fatiguing muscles trying to remain upright on one leg for the process. It means that users are not left alone for long periods of time whilst the CPO is in the workshop, as the joint sessions with the Physiotherapist ensures that time and resources can be utilised effectively. For example, exercises/assessments or information can be done/provided by the Physiotherapist whilst waiting for the socket to return for user to begin gait training with physio. The whole process allows for working with the user, and not just the product. More cohesive approach, involves the user much more, buying into the process, happier outcome.

Once the socket has been finished and returned to the user, it is quick and simple to don the limb. No need to worry about precisely where the back of the socket sits, just focus on the knee/foot position as user prefers. This might reduce the time spent on learning how to don the limb.

In the days and weeks following fitting of the socket, users often need adjustments to trimlines of the socket as their volume fluctuates (possibly with increased activity). Often this leads to time wasted during physiotherapy sessions waiting for the CPO’s to attend and fix the issue. With the direct socket, there is no adjusting needed after the first fitting of the socket. This allows users to progress with their physiotherapy training straight away without interruptions from the socket.

Whilst learning to walk with a “traditional” socket, there is always discomfort to begin with, lots of small adjustments are often needed particularly as the user becomes more active and their residuum reduces in volume/changes shape. With the Direct socket, there is no need to get used to feeling of pressure under the sitting bones in the buttocks, or discomfort from a hard brim sticking into the groin area, with its flexible outer brim the DSTF removes this sensation. Of course there will be an adaption time to the overall pressure and a need for working with the muscles which where for a long time inactive.

First feeling/experience of the user is the “freedom” of movement. There is much more leg mobility, sitting in the chair and reaching out for a drink, overall sitting comfort and picking an object from the floor are the first described experiences. It also might be perceived as unsecure/ unstable since the muscles where for a long time not used or since the trochanter wall is free could be perceived as.

Once fitted with a DSTF, physiotherapy training focuses on educating and training the user how to control using the muscles in their residual limb. New users of the DSTF will feel as if the socket is less stable because of the lower brim and lack of high sides, and that they are not “sitting” on the socket which support “the lazy” walker. This is experienced by the user as different, maybe difficult in the beginning. It takes more muscles and stability control of the residual limb. Normally, we don’t think about how we walk, this “lack of support” is different for the user, like when they first started learning to walk with a prosthesis following their amputation. The key thing is about engaging the muscles and not relying on external supports.

We don’t train users to walk any differently whilst using a “traditional socket method” when they first become an amputee. The difference is that the DSTF socket allows the user more freedom to utilise the muscles they should be using to walk with. It takes time and practice to feel confident with this freedom, as well as to learn and trust what their body can do without this support. Therefore is a period of adjustment necessary to transition between a traditional socket and a DSTF? This time depends on the user capabilities.

Here are some exercises to utilise muscles in the residual limb to get used to wearing a DSTF:

1. Standing balance; left right shift
2. Sitting down and standing up whilst loading the prosthesis.
3. Bouncing exercise; more freedom anterior.
4. Step forward and step backwards (with/without exercise step).
5. Pelvic tilts in sitting/ standing.
6. Split stance, prosthetic limb behind, practicing pelvic rotation forwards, reaching the point where the knee starts to flex.
7. During your physiotherapy training your physiotherapist may focus on gait re-education. This will likely involve create a longer stance phase and assessing  and emphasizing the movements of pelvic rotation/ trunk rotation. They may use resisted gait to help you to feel the right movement. The therapist will resist your shoulders or your pelvis to encourage you to move into these positions. This can be using hands/resistance bands and can be reproduced at home with assistance.