Adjustment Checklist

In order to walk well and be comfortable, your prosthesis must be adjusted just right. No amount of rehabilitation will allow you to walk better if your prosthesis is not adjusted correctly. Here is a list of adjustments that can be made to make things better. Each symptom listed assumes all other adjustments are correct. In reality, there are usually several adjustments that are off. Each adjustment that is off affects the other adjustments. This makes the prosthesis very difficult to get adjusted correctly. The best way to work on this is to be incremental in your adjustments. Do one small adjustment at a time, try it out for a while and then make more. Eventually, you will get the prosthesis close to the "perfect adjustment". Before you do any adjustments, get permission from your prosthetist. Also, after making the adjustment, tighten it up, walk a little, stop, and re-tighten. Be very careful! Patience is needed as your work on your prosthesis. Hang in there!!

# Portion of prosthesis
Symptoms

Adjustment needed

1 socket
Socket feels loose or there is a "forward lean" that cannot be corrected no matter how much the socket slants backwards or the socket "rotates"

socket is too loose. This could be due to residual limb shrinkage or due to one dimension in the socket being wrong.   Add socks if you have a silicone sleeve socket, or otherwise, go back to the prosthetist for some changes to the socket or a new socket

2 socket
Socket feels like it is just barely hanging on.    The foot tends to "dangle" and rotates (generally inward)

Socket is too tight. This could be due to muscle expansion. You need to reduce the number of socks, or the socket needs to be made bigger, or one dimension of the socket is off. A likely cause will be the area of the socket on the inner side near the pelvic bone. If the socket is too tight, the inner side of the pelvic bone might land on the edge of the socket.

3 socket
Prosthesis "rotates" when you have it on (silicone sleeve type only).

Socket shape may not be correct. You may not be captured around the tuberosity correctly. The edges around the socket around the tuberosity may need to be flared out. The front of the socket may not be as tight as the rest of the socket

4 socket
Prosthesis is on wrong.    If it is too far left, there is a whipping action and when looking down the foot is turned out less than desired. If it is too far right, there is no leverage in walking, when looking down the foot is out too far right

The socket should tend to be on the correct way if you put the leg on every day starting with the leg in the same orientation. If it seems to be difficult to get the socket on the same every day, that is a clue that the socket has a fit problem.   Also, note, that a silicone sleeve socket will allow the amputee to reorient in the socket without taking it off (a big plus)

5 socket alignment
You feel a "push" at the end of your step. You feel like your pelvis is being forced down and you lose leverage in the final portion of your step

Socket may need to be tilted backwards more. You need around 15 degrees of tilt in the socket to keep the back of the socket from jamming up against your tuberosity on the final part of the step. This adjustment usually can be made at a little ball at the bottom of the socket

6 socket alignment
You have no leverage in your step. You feel like you are not getting over your leg before you have to take another step. You feel like you are pulling out of your socket.

The socket may be tilted too far back. You can change that by doing the opposite adjustment of step 5

7 socket alignment
Socket tilts too far left or right. You feel like you are "mounted" improperly. You feel off balance and you have a difficult time keeping your gate smooth

The side-to-side tilt of the socket should be such that your tuberosity and the outside of your residual limb hit the socket at the same time when you put it on. This will give you stability and balance. Usually you just have to experiment with this adjustment a while to get it correct.   The adjustment is in the same place as in steps 5 and 6

8 socket alignment
symptoms vary

The amputee generally needs the socket to be attached in front of the knee by a little bit. With the socket sloping backwards, the center of gravity will be farther back, thus the need to move the connection with the knee forward.

9 knee
Leg "wipps" inwardly, there is a lack of balance as the amputee walks

Knee is rotated inwards too much. Move the knee out (usually done with a simple connection below the socket)

10 knee
Foot is outward, lack of leverage. Toe pressure seems to be gone

Knee is rotated outwards too much. See adjustment in 9

11 knee
Leg doesn't allow normal gate

Depending on the knee, there are two or three different adjustments at the knee that affect, extension and flexion of the knee. Once they are set up properly, the leg will "be there" for the amputee when he/she takes a step and there won't be noticeable bumps and delays

12 foot
similar to 9

Foot is inward compared to the knee. Foot should be in line with knee to a little bit outward from knee

13 foot
similar to 10

Foot is too outward compared to the knee. Foot should be in line with knee to a little bit outward from knee

14 foot
Amputee has hard time getting over foot

Foot is angled down too much. This creates too much toe pressure too early in the step. This adjustment is usually made at the foot or above the foot (depending on the foot type and various other connections to the foot). This adjustment is affected by shoe heel height. So beware that if you change shoes, you have to add or subtract inserts in the heels.

15 foot
Amputee has no toe pressure, there is a tendency to "drop down" as the amputee goes over the foot

Need more toe pressure, the foot needs to be angled down. For adjustment see 14

16 height
Pelvis on amputated side is too high or low compared to other side.

Height of prosthesis from knee to foot or from socket to knee is wrong.   Your Prosthetist will have to fix this.

17 sleeve
Amputee feels loose in socket, the sleeve "rolls up" and there is chafing of the residual limb at the top of the socket

Sleeve needs to be trimmed so that there is not very much left above the socket line (do this gradually so as not to make a mistake). The end result may be a sleeve that is not uniform at the top.

#	Portion of prosthesis	Symptoms	Adjustment needed
1	socket	Socket feels loose or there is a "forward lean" that cannot be corrected no matter how much the socket slants backwards or the socket "rotates"	socket is too loose. This could be due to residual limb shrinkage or due to one dimension in the socket being wrong. Add socks if you have a silicone sleeve socket, or otherwise, go back to the prosthetist for some changes to the socket or a new socket
2	socket	Socket feels like it is just barely hanging on. The foot tends to "dangle" and rotates (generally inward)	Socket is too tight. This could be due to muscle expansion. You need to reduce the number of socks, or the socket needs to be made bigger, or one dimension of the socket is off. A likely cause will be the area of the socket on the inner side near the pelvic bone. If the socket is too tight, the inner side of the pelvic bone might land on the edge of the socket.
3	socket	Prosthesis "rotates" when you have it on (silicone sleeve type only).	Socket shape may not be correct. You may not be captured around the tuberosity correctly. The edges around the socket around the tuberosity may need to be flared out. The front of the socket may not be as tight as the rest of the socket
4	socket	Prosthesis is on wrong. If it is too far left, there is a whipping action and when looking down the foot is turned out less than desired. If it is too far right, there is no leverage in walking, when looking down the foot is out too far right	The socket should tend to be on the correct way if you put the leg on every day starting with the leg in the same orientation. If it seems to be difficult to get the socket on the same every day, that is a clue that the socket has a fit problem. Also, note, that a silicone sleeve socket will allow the amputee to reorient in the socket without taking it off (a big plus)
5	socket alignment	You feel a "push" at the end of your step. You feel like your pelvis is being forced down and you lose leverage in the final portion of your step	Socket may need to be tilted backwards more. You need around 15 degrees of tilt in the socket to keep the back of the socket from jamming up against your tuberosity on the final part of the step. This adjustment usually can be made at a little ball at the bottom of the socket
6	socket alignment	You have no leverage in your step. You feel like you are not getting over your leg before you have to take another step. You feel like you are pulling out of your socket.	The socket may be tilted too far back. You can change that by doing the opposite adjustment of step 5
7	socket alignment	Socket tilts too far left or right. You feel like you are "mounted" improperly. You feel off balance and you have a difficult time keeping your gate smooth	The side-to-side tilt of the socket should be such that your tuberosity and the outside of your residual limb hit the socket at the same time when you put it on. This will give you stability and balance. Usually you just have to experiment with this adjustment a while to get it correct. The adjustment is in the same place as in steps 5 and 6
8	socket alignment	symptoms vary	The amputee generally needs the socket to be attached in front of the knee by a little bit. With the socket sloping backwards, the center of gravity will be farther back, thus the need to move the connection with the knee forward.
9	knee	Leg "wipps" inwardly, there is a lack of balance as the amputee walks	Knee is rotated inwards too much. Move the knee out (usually done with a simple connection below the socket)
10	knee	Foot is outward, lack of leverage. Toe pressure seems to be gone	Knee is rotated outwards too much. See adjustment in 9
11	knee	Leg doesn't allow normal gate	Depending on the knee, there are two or three different adjustments at the knee that affect, extension and flexion of the knee. Once they are set up properly, the leg will "be there" for the amputee when he/she takes a step and there won't be noticeable bumps and delays
12	foot	similar to 9	Foot is inward compared to the knee. Foot should be in line with knee to a little bit outward from knee
13	foot	similar to 10	Foot is too outward compared to the knee. Foot should be in line with knee to a little bit outward from knee
14	foot	Amputee has hard time getting over foot	Foot is angled down too much. This creates too much toe pressure too early in the step. This adjustment is usually made at the foot or above the foot (depending on the foot type and various other connections to the foot). This adjustment is affected by shoe heel height. So beware that if you change shoes, you have to add or subtract inserts in the heels.
15	foot	Amputee has no toe pressure, there is a tendency to "drop down" as the amputee goes over the foot	Need more toe pressure, the foot needs to be angled down. For adjustment see 14
16	height	Pelvis on amputated side is too high or low compared to other side.	Height of prosthesis from knee to foot or from socket to knee is wrong. Your Prosthetist will have to fix this.
17	sleeve	Amputee feels loose in socket, the sleeve "rolls up" and there is chafing of the residual limb at the top of the socket	Sleeve needs to be trimmed so that there is not very much left above the socket line (do this gradually so as not to make a mistake). The end result may be a sleeve that is not uniform at the top.