Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028 1 OPEN ACCESS AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 ABSTRACT (ORAL PRESENTATION) EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB Kamiar Ghoseiri*1, Mohammad Yusuf Rastkhadiv2, Mostafa Allami3 1Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. 2Department of Occupational Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. 3Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran. * Email: k.ghoseiri@umsha.ac.ir DOI: https://doi.org/10.33137/cpoj.v1i2.32028 PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit. METHODS Nineteen veterans with unilateral transtibial amputation participated in this cross sectional study. In supine position, the pain threshold and tolerance were evaluated at 12 locations on the residual limb with indentation method. Pain values at different locations were compared to each other. Correlations of pain values with demographic characteristics were explored. RESULTS Pain threshold and tolerance differed at all locations; however their difference was significant in mid-patellar tendon, medial tibial flare, and distal end of the tibia. The lowest and highest pain threshold and tolerance was distal end of the residual limb and mid-patellar tendon, respectively (Figure 1). There were no significant correlations between pain and demographic characteristics of participants except for the daily hours of prosthesis use. CONCLUSION Although the mid-patellar tendon and distal end of the residual limb were the best and worst load tolerant regions in transtibial amputees, due to the small difference between pain threshold and tolerance limits (range of 11-21 N/cm2), a small pain may be transformed to an intolerable pain, skin irritation and scar. Therefore, transtibial prosthetic sockets should be designed based on load tolerability of the residual limb. Figure 1: The results of pain threshold and tolerance at different locations on transtibial residual limb SIGNIFICANCE • Residual limb pain may be sourced from a misfit prosthetics socket. • In transtibial residual limb, the lowest and highest pain threshold and tolerance was related to the distal end of the residual limb and mid-patellar tendon, respectively. • Due to the small difference between pain threshold and tolerance limits, a small pain may be transformed to an intolerable pain. • Transtibial socket design should be based on pain tolerability of the residual limb. mailto:k.ghoseiri@umsha.ac.ir mailto:k.ghoseiri@umsha.ac.ir https://doi.org/10.33137/cpoj.v1i2.32028 https://doi.org/10.33137/cpoj.v1i2.32028 Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028 2 OPEN ACCESS AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 ABSTRACT (ORAL PRESENTATION) REFERENCES 1. Dou P, et al. Pressure distribution at the stump/socket interface in transtibial amputees during walking on stairs, slope and non-flat road. Clin Biomech (Bristol, Avon); 21, 1067-73, 2006. DOI:10.1016/j.clinbiomech.2006.06.004 2. Zhang M & Lee WC. Quantifying the regional load-bearing ability of trans-tibial stumps. Prosthet Orthot Int; 30, 25-34, 2006. DOI:10.1080/03093640500468074 3. Fischer AA. Pressure tolerance over muscles and bones in normal subjects. Arch Phys Med Rehabil; 67, 406-9, 1986. 4. Lee WC, et al. Regional differences in pain threshold and tolerance of the transtibial residual limb: including the effects of age and interface material. Arch Phys Med Rehabil; 86, 641- 9, 2005. DOI:10.1016/j.apmr.2004.08.005 DISCLOSURE The authors report no declarations of interest. However, the financial support of the research was done by the Janbazan Medical and Engineering Research Center (JMERC). ACKNOWLEDGMENTS The authors would like to thank the Veterans and Martyrs Affairs Foundation (VMAF) for their cooperation with the study. https://doi.org/10.1016/j.clinbiomech.2006.06.004 https://doi.org/10.1016/j.clinbiomech.2006.06.004 https://doi.org/10.1080/03093640500468074 https://doi.org/10.1080/03093640500468074 https://doi.org/10.1016/j.apmr.2004.08.005 https://doi.org/10.1016/j.apmr.2004.08.005