Background: Pressure distribution for transtibial amputees (TTA) patients varies at the limb socket interface according to several factors. Although socket technology is getting more advanced, the majority of researchers are still facing problems with relief areas.

Objectives: This study focused on the theoretical and experimental aspects of the design to figure out patients’ sensitivity to pain when wearing sockets. Relief areas were analyzed using data collected from patients’ centers and optimized under different static and dynamic conditions.

Methods: Finite element trials and DOE optimization using Design Expert 8 software and analysis of variance (ANOVA) revealed that holes with relief areas are appropriates for lower extremities patients where scanning electron images (SEM) of the worn areas show direct relations between relieved sockets with holes at fibula head (FH) and patient lifestyle and activity.

Clinical Relevance: A patient that moves rather slowly, as a result of old age or sedentary level of activity would greatly benefit from the FH socket hole implementation, and thus reduces the wear of socket materials after longer period of time and increases the level of comfort of patient skins. the interviews conducted were evident that patients endured pain at the PT and FH. Moreover, further studies were performed on the FH, and results revealed that lateral forces play a major role and is influenced by the lifestyle of the patient.

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