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Clin Biomech (Bristol, Avon). 2012 Jan;27(1):34-9. doi: 10.1016/j.clinbiomech.2011.07.004. Epub 2011 Jul 26.

Transtibial prosthetic socket pistoning: static evaluation of Seal-In(®) X5 and Dermo(®) Liner using motion analysis system.

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Department of Biomedical Engineering, University of Malaya, Malaysia.



The method of attachment of prosthesis to the residual limb (suspension) and socket fitting is a critical issue in the process of providing an amputee with prosthesis. Different suspension methods try to minimize the pistoning movement inside the socket. The Seal-In(®) X5 and Dermo(®) Liner by Ossur are new suspension liners that intend to reduce pistoning between the socket and liner. Since the effects of these new liners on suspension are unclear, the objective of this study was to compare the pistoning effect of Seal-In(®) X5 and Dermo(®) Liner by using Vicon Motion System.


Six transtibial amputees, using both the Iceross Seal-In(®) X5 and the Iceross Dermo(®) Liner, participated in the study. The vertical displacement (pistoning) was measured between the liner and socket in single limb support on the prosthetic limb (full-weight bearing), double limb support (semi-weight bearing), and non-weight bearing on the prosthetic limb, and also under three static vertical loading conditions (30 N, 60 N, and 90 N).


The results demonstrated that the pistoning within the socket when Seal-In(®) X5 was used, decreased by 71% in comparison to the Iceross Dermo(®) Liner. In addition, a significant difference between the two liners under different static conditions was found (p<0.05).


Participants needed to put in extra effort for donning and doffing the prosthesis with Seal-In(®) X5; however, this type of liner provided less pistoning. The new approach that uses the motion analysis system in this study might be an alternative for measuring the pistoning effect in the prosthetic socket.

[Indexed for MEDLINE]

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