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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

