Question
If we are adding socks to a patient and encounter a loose socket, at what point should we refer back to the prosthetist?
Answer
Usually an 8-ply fit is an indicator to us that we either want to pad the socket some more or we want to make a replacement socket for the patient. One of the nice things about interchangeable components is that we can just change the socket and reuse the foot, the knee, or the other components.
Generally speaking, 8-ply is a good benchmark. That could be a 5 plus a 3, or it could be a single 8 ply sock. I have had patients who were asymptomatic in a 12-ply sock, and then I have had patients who are getting all bruised up in a 5-ply sock. I will tell you a little trick. If the patient is having a localized problem, and they are wearing a decent number of socks, until they can get to the prosthetist, you can cut a small hole right over the localized problem. Let's say they have a fibular head problem or a distal tibial problem. It is Monday, you want to do therapy with them, but they say they cannot finish therapy due to discomfort. They don't have an appointment with the prosthetist until Thursday, so take the thickest sock that they have on and cut a dime or quarter-size hole right over the localized area. Then put it back on the patient, and line it up right where it was. You will find that that is almost like a prosthetic relief.
