ALIGNMENT AND PRESSURE DISTRIBUTION

DEFINITION; refers to the rela ve posi oning of the various parts of the prosthesis with respect to each
other, par cularly the socket and foot in the case of below knee prosthesis.

Alignment influences magnitude and distribu on of the forces applied to the stump by the socket.

The rela ve lower pressures are applied to sensi ve areas.

This angular changes of the socket brings about the ssues on opposite respect of the stump being
compressed as the angular change begins to take place. The counterforces developed by compression of
the ssues establish equilibrium and arrest the incipient mo on

Stump length related to pressure

The length of a stump has a marked bearing on the magnitude of the pressures that are applied
whenever the socket tends to change its angular rela onship with respect to stump.
Fig. above;-

Delineates the resultant of NON-COLINEAR FORCES applied to the prosthesis by the stump from above
and by the floor from below.

These opposing forces cons tutes a force couple that tends to rotate a prosthesis in a counter clock wise
direc on, as indicated by the curved arrows.

At a given instant that rota on is taking place at the axis designated by ‘O’ in the diagram.
The moment of force generated by the forces represented by AB and CD is indicated by the formula;-

M1 = (AB × d1) + (CD × d2) in which M1 = the moment of force due to AB & CD

AB = the applied by the body to the prosthesis from above.

CD = the counterforce applied by the floor to the prosthesis

d1 = the perpendicular distance from O to the line of ac on of force AB,

d2 = the perpendicular distance from O to the line of ac on of form CD.

The fig below represents the counter forces applied to the PROXIMOMEDIAL & DISTOLATERAL ASPECT
OF THE SOCKET as the ssues in the corresponding areas are compressed because of the incipient
mo on is arrested when the resis ng clockwise moment developed by the forces represented by LL &
MM are equal to the counterclockwise moment due to LL & MM is represented by the formular.;-
M2 = ( LL × dL) + (mm × dm)

M2 = the resul ng clockwise moment

LL = counterforce on the distolateral socket wall that is developed as ssues are compressed.

MM = counterforce on proximomedial socket wall as ssues are compressed.

O = the instantaneous center of rota on of the socket as it tends to change its angular rela onship.

dl = perpendicular distance from O to the line of ac on of LL.

at any given instant, if no change in angular rela onship is taking place between socket and stump it
indicates that the resultants AB & CD are collinear or that there is equilibrium between the moments
developed by the forces represented by AB, CD, LL andmm.

In the la er case, the rela onship between these forces and moments is shown by the formula ;-

(AB × d1) + (CD × d2) – (LL × dL) – ( MM × dm) = 0

The fig. below similar to the one above except that the stump is shorter.

With the shorter stump the distance from the axis of rota on “O” to the line of ac on of the force LL is
reduced, i.e. dL in fig below in fig, below is less than dL in fig. above .

If a condi on of equilibrium is to exist in the fig. below the combined value of the force LL & MM must
increase propor onately to compensate for te decrease in length of the moment arms.
For this reason whenever the socket tends to change its angular rela onship with respect to the stump,
a shorter stump is subject to greater pressure than a longer one under the same circumstances.

Mediolateral alignment

In aligning prosthesis, the prosthe st may displace the foot forward the mid-line

Producing a narrow base, or he may displace the foot laterally which will result in a rela vely wider
walking base.
The term INSET is used to refer to rela ve displacement of the foot towards the midline.

The term OUTSET refers to displacement of the foot away from the mid-line. These displacements are
rela vely small in magnitude, but they have a significant effect on the pressure applied to the stump as
well as the gait pa ern.

The fig. below shows a prosthesis aligned with a narrow base. The medial displacement of the foot is
exaggerated in the illustra on.
In actual prac ce of cause the displacement would not be as great as that shown in the diagram but the
marked displacement has been shown so that the effect on pressure distribu on will be more apparent
medial displacement of the foot tends to make the socket change its rela onship to the stump in the
direc on shown by the curved arrow with resul ng increased compression of ssues on the distolateral
and proxmomedial aspect of the stump.

When PTB prosthesis is aligned with a rela vely narrow walking base. It is essen al that the socket be
shaped and fi ed properly so that the greater part of the mediolateral forces will be distributed over the
lateral distal half or distal third of the stump and on the medial flare of the bia and the area in contact
with the supero-medial of the socket.

Fig. below shows the exaggerated lateral displacement of the of the foot to illustrate the effect on
pressure distribu on.
From the two illustra ons it can be seen that as the foot is displaced, medially from an ini al lateral
posi on, pressure on the disto-lateral and proximomedial aspect of the stump is increased. With
rela ve decrease of pressure on the proximolateral and disto-medial aspects of the stump.

This is a good procedure to follow, since the proximolateral area is the pressure sensi ve (fibular head)
while the proximomedial area (medial flare) is pressure tolerant.

If prosthesis is aligned, with a base substan ally wider than the normal walking base
Mediolateral alignment

In aligning the prosthesis, the prosthe st may displace the foot towards the mid-line, producing a
narrow base or he may displace the foot laterally which will result in a rela vely wider walking base.

The term ‘inset’ is used to refer to rela ve displacement of the foot towards the midline, the
term “outset” refers to displacement of the foot away from the midline
These displacements are rela vely small in magnitude but they may have a significant effect on
the pressure applied to the stump as well as the gait pa ern.
The figure above again, shows a prosthesis aligned with a narrow base. The medial
displacement of the foot is exaggerated as shown in the illustra on. Actually, the displacement
would not be as great as that shown in the diagram but the marked displacement has shown
that the effect on pressure distribu on will be more apparent.
Medial displacement of the foot tents to make the socket change its rela onship to the stump in
the direc on shown by the curved arrow, resul ng increased compression of ssues on the
disto-lateral and proximo-medial aspects of the stump. When a PTB prosthesis is aligned with
rela vely narrow walking base, it is essen al that the socket be shaped and fi ed properly so
that the greater part of the mediolateral forces will be distributed on the lateral distal half or
distal third of the stump, and on the medial flare of the bia and the area in contact with the
superimedial aspect of the socked.
The figure below shows exergerated lateral displacement of the foot to illustrate the effect of
pressure distribu on. With this alignment, the socket tends to rotate so that the rela ve greater
pressure is applied to the proximo-lateral and disto-medial of the stump.
From the two illustra ons it can be seen that as the foot is displaced medially from an ini al
lateral posi on, pressure on the distolateral and proximomedial aspect of the stump is;-
increased with rela ve decrease of pressure on the proximo-lateral and distomedial aspects of
the stump.

This is a good procedure to follow since the proximolateral area is pressure sensi ve (fibula
haed) . while the proximal area (medial flare is pressure tolerant

If the prosthesis is aligned with a base substan ally wider than the normal walking base, it is
quite likely that the amputee will have to result lateral bending of the trunk as he walks. He
does this to reduce his tendency to fall to the supported side

Gravity and iner a interact during stance phase the figure above S indicates the support point
on the foot which is a theore cal point which forces ac ng on the support area are assumed to
be concentrated.
When during stance phase the CG is medial to the supported point. gravity will tend will tend to
cause the body to fall towards the unsupported side. Soon a er heel strike, as the toes of the
opposite foot leaves the ground, the tendency of the body to fall to the unsupported side is
opposed by the iner a effect that is generated by the side to side movement of the body in
walking.
As viewed from above, the COG follows a sinusoidal path, in following this path, the COG
changes with respect to the line of progression. At toe-off the center of gravity is moving
towards the supported side.
A basic principle of physics states that;- a body in mo on tends to remain in mo on with
uniform speed in a straight line, unless a force acts upon it to cause a change of direc on of
speed. The iner a effects by the horizontal arrow designated as in the figure above. From this
diagram it can be seen that the direc on of the horizontal component of the iner al effect is
such that it opposes the tendency in the body to fall towards the suppor ng side during stance
face.