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VOLUME 8, ISSUE 1 

 2025 
 

RESEARCH ARTICLE 

 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: 

A chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142  

 

  

 

https://jps.library.utoronto.ca/index.php/cpoj/index
mailto:cpoj@online-publication.com
https://publicationethics.org/about/our-organisation
https://pmc.ncbi.nlm.nih.gov/journals/?term=%22Canadian+Prosthetics+%26+Orthotics+Journal%22
https://doi.org/10.33137/cpoj.v8i1.45142


 

1 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

 

 

RESEARCH ARTICLE 

 

PROSTHETIC TREATMENT OF WOMEN WITH LOWER LIMB ABSENCE DURING 

PREGNANCY & THE POSTPARTUM PERIOD: A CHART REVIEW 

Pousett B.M1,2 *, Cumming D1, Phillips C3,4, Azhari F4, MacKay C3,5,6 

1. Barber Prosthetics Clinic, Vancouver, Canada. 
2. Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada. 
3. West Park Healthcare Centre, University Health Network, Toronto, Canada.  
4. Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada. 
5. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 
6. School of Rehabilitation Therapy, Queen's Health Sciences, Queen's University, Kingston, Canada. 
    
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

Pregnant women with physical disabilities often face a 

variety of challenges to receiving high quality perinatal care 

due to a lack of awareness and education among medical 

professionals.1,2 Limited  information  is  available  for  both  

 

 

 

 

 

women and health care providers (HCPs) about the 

interaction between disability and pregnancy and about the 

needs of women living with disability throughout the 

perinatal period.1-5 This may be detrimental to care, as 

women have reported benefiting substantially from care 

where HCPs anticipated and carefully managed potential 

complications or challenges throughout their pregnancy.3 

However, to facilitate this level of care, effort is needed to 

address the gap in HCPs’ education about disability and 

pregnancy, so that they can offer evidence based care.1,5 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: Little information is available for women with lower limb absence (LLA) and their prosthetists 

regarding expectations for prosthetic treatment during and after pregnancy. A main concern is prosthesis use 

and what adjustments may be required to sustain mobility. 

OBJECTIVES: This study examines the prosthetic treatment of women with LLA to understand what specific 

prosthetic interventions occurred during the perinatal period and to gather information from the prosthetists 

regarding key learnings to be shared with others. 

METHODOLOGY: This study was a retrospective review of clinical records for women with LLA who received 

prosthetic care across Canada. Between January – May 2023, all 19 women who participated in a previous 

study on LLA and pregnancy consented to have their prosthetist contacted. Prosthetists were asked to complete 

a structured survey documenting appointment details, socket and alignment adjustments made during the 

perinatal period and key learnings in providing care to this population. 

FINDINGS: 15 prosthetists were contacted to complete surveys for the 19 participants. Reviews of clinical 

records were completed between April – August 2023 by 7 prosthetists covering 18 pregnancies from 11 women 

with LLA (two bilateral transtibial, two unilateral transtibial, four unilateral transfemoral, and three unilateral 

rotationplasty). Socket adjustments were required in 11/18 pregnancies with common methods including 

circumferential stretching and localized adjustments. Alignment adjustments to existing sockets were only 

required in two pregnancies. Additional sockets were required in six pregnancies when the existing socket could 

no longer be adjusted to achieve comfort, most often during the first six months of pregnancy (the first or second 

trimester). Everyone who had a socket adjustment during pregnancy required additional socket adjustments or 

new sockets in the postpartum period. Prosthetists observed wide variations in physiological changes and 

prosthetic fit during the perinatal period and shared prosthetic management techniques to address residual limb 

volume changes. A data collection framework was also proposed to support the ongoing collection of this data 

to include a wider diversity of women and experiences.  

CONCLUSION: A wide range of prosthetic treatment interventions may occur during pregnancy and the 

postpartum period. While prosthetists and women with LLA can anticipate that socket and alignment changes 

may be necessary, sometimes none are required. By preparing for potential fluctuations in prosthetic fit and 

addressing each individual's needs, prosthetists can help minimize disruptions to mobility throughout pregnancy. 

 

ARTICLE INFO 

Received: April 8, 2025 

Accepted: June 9, 2025 

Published: July 16, 2025 
 

CITATION 

Pousett B.M, Cumming D, 

Phillips C, Azhari F, MacKay C. 

Prosthetic treatment of women 

with lower limb absence during 

pregnancy & the postpartum 

period: A chart review. 

Canadian Prosthetics & 

Orthotics Journal. 2025; 

Volume 8, Issue 1, No. 7. 

Https://doi.org/10.33137/cpoj.

v8i1.45142 

KEYWORDS 

Lower Limb Absence; 

Prosthetics; Perinatal Period; 
Survey; Pregnancy; Prosthetic 

Treatment; Rehabilitation; 
Postpartum Period; Women; 

Amputation; Prosthesis; 

Prosthetist.  
 

 

 

* CORRESPONDING AUTHOR: 

Brittany Mae Pousett, CP(c), MSc. 

Affiliations: 1) Barber Prosthetics Clinic, Vancouver, Canada;  
2) Rehabilitation Sciences, Faculty of Medicine, University of British 
Columbia, Vancouver, Canada. 

ORCID ID: Https://orcid.org/0000-0002-2272-7847 

E-Mail: brittany@pousett.ca;  Telephone: (604) 321-1115 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 8, Issue 1, Article No. 7. 2025 

 

 

https://doi.org/10.33137/cpoj.v8i1.45142
https://doi.org/10.33137/cpoj.v8i1.45142
https://doi.org/10.33137/cpoj.v8i1.45142
https://orcid.org/0000-0002-2272-7847
mailto:brittany@pousett.ca
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

 A notable example of this information gap pertains to 

pregnant women with lower limb absence (LLA), as there is 

little existing research on their experiences.6,7 Pregnant 

women experience changes to their body composition and 

center of mass throughout their pregnancy which can have 

impacts on their balance and mobility.8-10 These changes 

are typically largest in the second and third trimesters and 

begin to reverse postpartum, but can fluctuate.9,10 Pregnant 

women with LLA experience many of the same physical 

changes throughout the pregnancy and postpartum period, 

and reported fluctuations in limb volume and, balance, in 

addition to increases in pain and fatigue.11,12 However, 

these changes have particular significance for pregnant 

women with LLA as previous studies found 84% of  

individuals with LLA use prostheses as their primary form of 

mobility, for an average of 12.5 hours a day.13 As 

prostheses are fit very intimately to the wearer’s body and 

are sensitive to volume changes, these changes can 

negatively impact prosthetic fit, mobility, physical function, 

balance, and the ability to perform daily tasks.12,14 

Challenges with prosthesis use can require pregnant 

women to use other forms of mobility during the perinatal 

period, such as crutches or wheelchairs.3,11,14 This leaves 

women with LLA with many questions surrounding what to 

expect in regards to their mobility and prosthesis use when 

considering having children.12,15  

Current evidence on prosthetic management during the 

perinatal period is scarce. A systematic review of pregnancy 

experience for women with LLA included several case 

series; however, very few commented on prosthesis use or 

mobility.16 A recent clinical consensus guideline 

acknowledges that, during pregnancy, female patients with 

transfemoral amputations may need socket adjustments to 

accommodate volume gain, trimline modifications to allow 

for comfortable sitting, and alignment adjustments to 

account for center of mass changes.15 The guideline also 

states that new sockets may be necessary but provides no 

concrete evidence. In one case study, a woman with a 

transfemoral amputation visited her prosthetist ten times 

due to physiological changes during a pregnancy,12  while 

for most people with LLA, it is common to visit a prosthetist 

once every six months unless problems arise.17 This case 

study found that, during pregnancy, socket comfort, gait 

speed and functional mobility declined, and that socket 

adjustments could increase comfort and decrease pain. 

However, the specific details of the nature of these 

adjustments were not provided.12 A recent study in Canada 

of mobility outcomes for people with LLA during pregnancy 

reported that among highly active daily prosthesis users, 

64% experienced changes in limb size and prosthesis 

comfort. Additionally, 71% of those who used their 

prosthesis during pregnancy decreased their prosthesis use 

due to limb swelling and over a quarter reported using a 

wheelchair or gait aid during pregnancy for mobility.14 While 

this study14 documents the challenges with limb volume 

change and prosthesis use, there is no information provided 

on the specifics of the prosthetic management.   

The limited evidence has left both health care providers and 

women with LLA without adequate information on prosthetic 

management during the perinatal period.6,7 Therefore, this 

study seeks to explore the prosthetic treatment of women 

with LLA throughout the perinatal period (defined as the 

period from the beginning of pregnancy to one year after 

delivery). We sought to understand which specific prosthetic 

interventions were used by prosthetists (including socket 

and/or alignment adjustments, new sockets, etc.) during the 

perinatal period. We have used the responses to these 

questions to propose a data collection framework for 

prosthetists providing care to pregnant women with LLA. 

This framework identifies key areas where evidence is 

lacking and suggests methods for collecting the necessary 

data. 

METHODOLOGY 

We conducted a retrospective review of clinical records from 

prosthetic clinics across Canada regarding prosthetic 

treatment for women with LLA during the perinatal period. 

The review was conducted from April to August 2023. Ethics 

approval was provided by the Research Ethics Board at the 

University of Toronto. 

Participants 

A previous study examined the physical and psychosocial 

experiences of women with LLA during the perinatal 

period.7,11 To be eligible for the previous study, women had 

to live in Canada, have a LLA, and have been pregnant in 

the last 10 years. All women who participated in that study 

were asked if they consented to have their prosthetist 

contacted to provide a chart review for the dates they were 

pregnant in the previous 10 years. All 19 women who 

previously participated consented and provided the name of 

their prosthetist and the start and end dates (month and 

year) of each pregnancy. The 15 corresponding Canadian 

prosthetists were invited to participate via email (four of the 

prosthetists had seen two participants). Of the 15 invited 

prosthetists, 7 completed chart reviews. Prosthetists 

represented clinics in 3 provinces (Alberta = 4, British 

Columbia = 2, Ontario = 1). They were given the names of 

the patients who consented and the date range of each 

pregnancy and asked to extract data from clinical chart to 

answer questions in a survey format for each pregnancy. 

See Figure 1 for a detailed visual of the recruitment and data 

collection process.  

Survey 

The structured survey (Appendix A) was developed 

specifically for this study by authors BMP and FA, one is a 

prosthetist, and one is a woman with LLA who has been 

pregnant. It was piloted with a prosthetist who had 

experience providing care to women with LLA during 

https://doi.org/10.33137/cpoj.v8i1.45142


 

3 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

pregnancy. The survey included a detailed prosthetic 

prescription for each woman as well as how many 

appointments they had during their pregnancy and what 

was done at each appointment (including socket 

adjustments, alignment adjustments, socket replacements, 

new componentry required, etc.). The survey also asked if 

any adjustments occurred in the postpartum period (defined 

as being one year following pregnancy). Prosthetists were 

given the opportunity to share what they learnt about 

working with women during the perinatal period and what 

information they wished was in resource material.  

 

 

 

Figure 1: Participant recruitment and data collection process. 

Data Analysis 

Quantitative data (such as number of appointments, type of 

prosthesis, level of amputation, and nature of the 

adjustment) was analyzed using descriptive statistics. Open 

text boxes were analyzed using conventional content 

analysis, where we reviewed the data, inductively 

developed codes from key concepts, grouped the codes 

together into categories, and summarized the findings for 

each category.18 These text boxes were also used to 

provide context to the data captured by quantitative 

methods. 

RESULTS 

Chart reviews of 18 pregnancies from 11 women with LLA 

were included. This corresponds to 58% of women who 

consented to have their prosthetists contacted. Six women 

had one pregnancy included, three women had two 

pregnancies included, and two women had three 

pregnancies included. Levels of amputation included 

bilateral transtibial amputation/ankle disarticulation (n = 2), 

unilateral transtibial amputation (n = 2), transfemoral 

amputation (n = 4), and rotationplasty (n = 3). The average 

number of appointments during pregnancy was 4.2 (SD: 

3.6), with a range of 0 to 12. Suspension and interface types 

can be found in Table 1. 

Socket Adjustments 

No socket adjustments were needed in 7/18 pregnancies. 

Two women (A*: bilateral ankle disarticulation with one 

pregnancy, J: transfemoral amputation with three 

pregnancies) required no socket adjustments in any 

pregnancy. Two women (K: rotationplasty, G: transtibial 

amputation) had adjustments made in their first pregnancy 

but no adjustments made in their second pregnancy. One 

woman (B: rotationplasty) had no adjustments made in her 

second pregnancy but the chart review for the first 

pregnancy was not completed by the prosthetist.   

Socket adjustments were needed or made in the remaining 

11/18 pregnancies to adjust sockets as described in  

Table 1. Circumferential adjustments were common (n = 5: 

D, F, G, H & K; 3 transfemoral, 1 transtibial, 1 

rotationplasty), especially for those with transfemoral 

sockets (n = 3: D, F, H), and were done via heating and 

stretching the socket, removing existing padding or 

grinding. A transtibial socket (G) was also circumferentially 

adjusted via heating and stretching and one rotationplasty 

prosthesis (K) had the corset made larger. Localized 

adjustments were also common (n = 4: C, E, G & H 

rotationplasty, bilateral transtibial, transtibial, transfemoral), 

typically via grinding to remove material. Areas frequently 

adjusted were fibular head (transtibial), medial hamstring 

(transtibial), anterior distal tibial (transtibial), anterior 

proximal tibia (transtibial), knee condyles (transtibial), 

dorsum of foot (rotationplasty) and medial wall 

(transfemoral). For one woman using a transfemoral waist 

belt for suspension, the strap was made longer.  

In regard to when adjustments were done, localized 

adjustments tended to be early in pregnancy, during the first 

or second trimester, while circumferential adjustments were 

spread out across all trimesters. 

Alignment Adjustments 

Alignment adjustments on existing sockets were only done 

in 2/18 pregnancies – once to lengthen the prosthesis (D: 

transfemoral – 3rd trimester) and once to shift the socket 

medially to widen the base of support (L: transtibial – 3rd 

trimester). The prosthesis that was lengthened was 

shortened again in the postpartum period. One clinician 

measured the changing center of mass of their patient with 

a transfemoral amputation (J) using the LASAR Posture 

(Ottobock) and found it moved 29 mm forward from baseline 

to 37 weeks pregnant.  

At Home Management 

At home management was rarely documented. Socks and 

shrinkers were each provided to one patient (A, B). One 

* Letters refer to subject identifiers listed in Table 1.  

January – May 2023

19 women with lower limb
absence completed an interview.
All 19 women consented to have
their prosthetist contacted to
complete a survey.

April – August 2023

15 prosthetists were invited
to complete a survey
reviewing the clinical records
for the women during and
after their pregnancies.

August 2023

7 of the 15 prosthetists
completed chart reviews.
This included data from 11
women with a total of 18
pregnancies.

4 prosthetists were the primary 

clinician for multiple participants. 

https://doi.org/10.33137/cpoj.v8i1.45142


 

4 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

woman (A) was fit with diagnostic transtibial/ankle 

disarticulation sockets that were too large right after she 

found she was pregnant, in anticipation of limb volume gain. 

The prosthetist reported that this worked well and was able 

to support socket fit management by providing thinner socks 

as the pregnancy progressed.  

New Sockets 

Twelve pregnancies did not require a new socket, and six 

pregnancies did require a new socket (D x 2, E, F, G, L) 

(Table 1). New sockets were required when existing sockets 

could no longer be adjusted to comfortably fit. In one 

situation, a new socket was required but not made due to 

the inability to receive funding approval. When new sockets 

were fit, dynamic alignment was done as is standard clinical 

practice. New sockets were most often made in the first or 

second trimester. One prosthetist commented that a new 

socket was needed but the patient opted to persevere with 

their existing socket (L). 

Postpartum Period 

After pregnancy, nothing was done in the 7/18 pregnancies  

who had no adjustments made during pregnancy. Two 

women (C, G) required a new socket post-delivery as their 

current socket no longer fit appropriately: one who had 

adjustments made during pregnancy (C: rotationplasty), 

and the other who had both adjustments and 2 new sockets 

made during pregnancy (G: transtibial). One woman (D: 

transfemoral) required adjustment to her alignment after her 

first and second pregnancies and as after pregnancy she 

switched from a larger socket that was fit during pregnancy, 

to a previously worn socket that was smaller. Three women 

(E, H, K) required socket adjustments to reverse 

adjustments made during pregnancy. All women who had 

adjustments during pregnancy also had adjustments after 

pregnancy.  

Learnings & Take Aways 

Prosthetists reported key learnings from providing 

prosthetic care to women with LLA during the perinatal 

period. In the prenatal period, prosthetists reported 

observing a wide range of physiological changes and 
changes to prosthetic fit. Some found that their patients 

managed without any changes to their prostheses but that 

it depended on the individual and level of amputation.  

      Table 1: Summary of prosthetic treatment for each woman included in the chart review. 

ID 
LLA 

Level 

Interface / 
Suspension 

System 

Pregnancies 
(n) 

Appts 
(n)* 

During Pregnancy 
During 

Postpartum 

Notes 
Socket Adjustments 

(Trimester) 

Alignment 
Adjustments 

(Trimester) 

New 
Socket 

(Trimester) 

Adjustment 
Made After 
Pregnancy 

A BTT 
Socks / 
Anatomical/Supra
- condylar 

1 of 1 3 None None No None 

Fit diagnostic socket with 
4 ply socks in T1 (before 

pregnancy known). 
Socks were supplied. 

B RP 
Socks / 
Anatomical/ 
Supra-condylar 

1 of 2 

(only 2nd 
included) 

2 None None No None 

Provided shrinker socks 
to use if needed. Patient 
asked prosthetist for peer 
support connections after 
finding no resources. 

C RP 
Socks /  

Cuff/strap 
1 of 1 1 

1 localized adjustment: 
removed padding on dorsum 
of foot (T3) 

None No 

New socket 
required as 
limb was 
smaller than 
before 
pregnancy 

 

D TF 
Silicone Liner / 
Locking Liner - 
Pin 

2 of 
Unknown 

5 

3 circumferential adjustments: 
stretched socket globally over 
cast.  (once in T2 on first 
socket, twice in T3 on new 
socket) 

None Yes (T2) 
Alignment – 
did not 
specify how 

 

8 

2 circumferential adjustments: 
stretched socket from first 
pregnancy globally over cast 
(T1, T2) 

Lengthened 
prosthesis 
(T3) 

Yes 2 
sockets 
(both T2) 

Shortened 
prosthesis. 
Refit 
previous 
socket 

Switched to socket from 
first pregnancy early in 
T1 before any 
adjustments done 

E BTT 
Gel Liner / 
Suction Sleeve 

1 of 1 10 

4 localized adjustments: 
adjusted fibular head via 
heating (T1), adjusted medial 
hamstring and anterior distal 
tibia by heating and grinding 
(T1), adjuster posterior 
trimline via grinding (T2), 
adjusted proximal anterior 
tibia via grinding & medial 
hamstring via heating (T2) 

None Yes (T1) 

Pressure 
relief – did 
not specify 
where or 
how. 

 

               * Number of Appointment. 

https://doi.org/10.33137/cpoj.v8i1.45142


 

5 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

Others reported the difficulty of managing prosthesis use 

during pregnancy due to changes with weight, limb volume, 

socket pressure, and the location of the center of mass. A 

wide range of specific learnings were reported with 

prosthetists reporting different observations about the 

patient they worked with. These included that “volume 

changes are greatest in the 3rd trimester”, “adjustments are 

needed more often for individuals with transfemoral 

amputations than transtibial amputations”, “patients with 

congenital limb loss have less volume concerns and need 

for adjustments” and “weight gain impacts the thigh not the 

foot for people with rotationplasty amputations”. However, 

these observations are not necessarily supported by the 

aggregated data. For example, we did not see the most 

adjustments or new sockets in the third trimester to match 

the observation that this is when there were the greatest 

volume changes. Also, for people with rotationplasty 

amputations, we saw examples of both the foot and the 

      Table 1 (continued): Summary of prosthetic treatment for each woman included in the chart review. 

ID 
LLA 

Level 

Interface / 
Suspension 

System 

Pregnancies 
(n) 

Appts 
(n)* 

During Pregnancy 
During  

Postpartum 

Notes 
Socket Adjustments 

(Trimester) 

Alignment 
Adjustments 

(Trimester) 

New 
Socket 

(Trimester) 

Adjustment 
Made After 
Pregnancy 

F TF 
Silicone Liner  / 

Seal-In Liner 
1 of 1 3 

1 circumferential adjustment: 
stretched proximal 2/3 of 
socket(T1) 

None 

Yes (T1). 
Refit a 
previous 
check 
socket. 

Unknown. Did 
not follow up 
with that 
clinic. 

 

G TT 
Gel Liner  / 

Locking Liner – 
Pin 

2 of 3 

(2nd & 3rd 
included) 

9 

2 localized adjustments: 
adjusted knee condyles via 
grinding (T1, T1). 1 
circumferential adjustment– 
stretched 2nd new socket 
distally (T3). 

None 
Yes (2 
sockets) 
(T1 & T2) 

New socket 
New sockets made after 
localized adjustments. 

3 None None No None  

H TF 
Skin /               

Skin fit Suction 
3 of 3 

12 

5 localized adjustments: 
adjusted medial trimline by 
grinding (T1), adjusted medial 
trimline by grinding and 
heating (T1), added padding to 
lateral socket (T2), added 
padding to anterior socket 
(T2), removed padding from 
lateral socket (T3) 

None No 

Added 
padding to all 
4 walls of 
socket. 

New socket was fit 
before pregnancy was 
known, adjustments may 
have been part of 
routine fitting. 

6 
1 localized adjustment: 
removed padding from medial, 
lateral and anterior socket (T2) 

None No 

Replaced 
padding that 
was removed 
during 
pregnancy 

Prosthetist would have 
liked to increase socket 
volume in last month of 
pregnancy but didn’t 
want to make changes 
that could not be easily 
reversed. 

7 

1 localized adjustment: 
adjusted distal lateral femur by 
grinding (T1). 1 circumferential 
adjustment– ground proximal 
socket as much as possible 
before risking socket failure.  
(T2) 

None No 

Added 
additional 
padding as 
volume 
decreased. 

 

J TF 

Socks  / 
Anatomical/ 

Supracondylar & 
Cuff/Strap 

3 of 3 

2 None None No 
None 

 

Lengthened waist belt 
(T2) 

1 None None No None  

1 None None No None  

K RP 
Neoprene Sock / 

Cuff/Strap 
2 of 2 

1 
1 circumferential adjustment: 
lengthened thigh corset (T2) 

None No 
Shortened 
thigh corset 

 

0 None None No None  

L TT 
Gel Liner /   

Locking Liner - Pin 
1 of 1 2 

Needed 

(not made due to funding) 

Shift socket 
medially to 
widen base 
of support 
(T3) 

Yes(T3) 

(not made 
due to 
funding) 

None 
Patient opted to 
persevere with poorly 
fitting socket 

 

      Level of Amputation: BTT = Bilateral Transtibial or Ankle Disarticulation, RP = Rotationplasty, TF = Transfemoral, TT = Transtibial. 
      Trimester: T1 = first trimester, T2 = second trimester, T3 = third trimester. 
      Localized: Adjustment done in a specific area.  
      Circumferential: adjustment done over entire circumference of the socket.   

       * Number of Appointment. 
 

https://doi.org/10.33137/cpoj.v8i1.45142


 

6 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

thigh section needed to be adjusted. One prosthetist 

reported that “setting up a schedule to meet regularly [over 

the pregnancy] was a good way to keep small problems 

small”.  

In the postpartum period, prosthetists reported a wide range 

of learnings; some found that volume changes reversed 

quickly, while some found it took approximately three 

months to get back to a pre-pregnancy socket fit. 

Managing Volume Change 

Prosthetists reported their key learnings surrounding finding 

success with several different volume management 

techniques, including: 

• Using interfaces that can be easily modified to allow 

maximum adjustment (e.g., flexible inner liners, Pe-Lite 

liners) 

• Heating and stretching sockets 

• Holding on to previous sockets so that one has multiple 

sockets of different sizes to help accommodate volume 

changes during and after pregnancy 

Five prosthetists commented that making “future-proof” 

sockets that allow for volume adjustment is helpful. Ways of 

doing this include making sockets larger, making sockets 

with liners that can be removed, making sockets with 

padding that can be removed, etc. 

Helpful Resources 

One prosthetist reiterated that there are no resources 

available for pregnant women with LLA but that peer support 

and advice from other women with LLA who have been 

pregnant can be helpful. The remaining prosthetists did not 

comment on any helpful resources.  

DISCUSSION 

This study presents the experiences of prosthetists 

providing care to women with LLA during and after 

pregnancy, and the wide range of prosthetic treatment 

interventions that occur. The review of clinical records 

includes women with a wide range of levels of amputations, 

including both ankle disarticulation and rotationplasty 

amputations, which are infrequently included in research. 

Some women did not require any prosthetic appointments 

or adjustments during pregnancy, while others visited their 

prosthetist frequently. These findings spanned all levels of 

amputation, and no level-specific recommendations can be 

made due to the small number of participants and the wide 

range of experiences. However, for those who did not 

require any adjustments over their pregnancy, many, 

though not all, of these were women in their second or third 

pregnancies and had sockets that had previously been 

adjusted. Prosthetists should be diligent—particularly in first 

pregnancies—to anticipate and address any prosthesis 

issues that arise, while also being aware that women may 

require no adjustments in pregnancy. As always, it is 

important to treat each patient and their unique situation 

individually.   

Prosthetists demonstrated a large toolkit of possible 

prosthetic treatment interventions when working with 

women whose pregnancy-related changes did require such 

interventions. These most often included global socket 

adjustments, localized socket adjustments, and new 

sockets. While limb volume change is reported to peak later 

in pregnancy,9,10 adjustments did not follow the same trend. 

Localized adjustments tended to be made earlier in 

pregnancy (in the first and second trimesters) and 

circumferential adjustments were made approximately 

evenly throughout all trimesters. All women who required a 

socket adjustment during pregnancy had adjustments after 

pregnancy as well, demonstrating that it is important to 

reassess prosthetic fit and function in the year after 

pregnancy.  

While not frequently documented within the clinical charts, 

one prosthetist reported in the open-ended questions that 

they provided supplies for at-home management. In the 

previous phase of this research, women with LLA frequently 

discussed how their prosthetists provided them with 

education and supplies for at-home management that 

helped them throughout their pregnancies.11 This 

discrepancy highlights the importance of the at-home 

management strategies for women with LLA and 

emphasizes that prosthetists need to ensure they provide 

education on appropriate at-home management strategies 

in the future.  

We know that the center of mass changes throughout 

pregnancy, which may impact prosthesis function.12,15 

Alignment is sensitive to the location of the center of mass; 

however, no one in our study reported making an alignment 

adjustment in the anterior-posterior plane, and only one 

prosthetist reported making an adjustment in the medial-

lateral plane. It is unclear if this is because the center of 

mass moves so slowly that the body makes other 

adaptations and therefore prosthesis function is not 

impacted in a way requiring alignment or componentry 

adjustments. This is something that needs to be more 

closely noted in the future.  

New sockets were required for those with residual limb 

volume and shape changes beyond what could be 

accommodated for in an existing socket. In this study, most 

of the sockets required were made in the first or second 

trimester, even though the weight gain and limb volume 

change tend to be the largest later in pregnancy, in the 

second and third trimester. While our data cannot explain 

this discrepancy, it appears the prosthetists included in this 

chart review were proactive about keeping sockets fitting 

comfortably early on in pregnancy and mentioned several 

strategies that allowed them to accommodate for volume 

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increases over pregnancy. Our previous research has found 

barriers to accessing prosthetic care, including scheduling 

constraints, funding availability and the time it takes for a 

socket to be made may limit women from accessing 

prosthetic care.11 Women who need adjustments later in 

pregnancy but choose not to seek prosthetic care were not 

captured in this chart review study, except for the one 

woman whose prosthetist noted that a socket was required 

but not supplied (L) and one prosthetist who commented 

that they would have liked to further increase the socket 

volume in the last month of pregnancy but didn’t want to 

make a non-reversable change (H). Future research should 

look specifically into when new sockets are required in 

pregnancy, regardless of if treatment is sought. 

Overall, prosthetists demonstrated strategies similar to 

those mentioned by women with LLA, notably that planning 

ahead is key to successfully managing prosthesis fit 

throughout pregnancy.7 These planning-ahead techniques 

included having conversations early, making adjustable 

interfaces, using thermoplastic check sockets that can more 

easily be stretched or adjusted, keeping old sockets for 

women of childbearing age in case they are needed, making 

sockets too big early in pregnancy, and using techniques to 

future-proof sockets. 

Data Collection Framework 

The information gathered in this study sets the foundation 

for a larger data collection framework (Appendix B). While 

the current study provides more information than previous 

studies on experiences of pregnant women with LLA 

regarding their prosthetic treatment,12,14,16 additional data is 

needed to provide a comprehensive overview, which would 

include the diversity of women and their specific prostheses. 

The framework should include details on socket 

adjustments, new sockets, alignment adjustments and at-

home management. When documenting new sockets 

specifically, it should be noted when the new socket is 

identified as being needed, regardless of if it is supplied. 

Women and prosthetists may choose to tolerate a poorly 

fitting socket or switch to using other forms of mobility 

instead of investing the time and money required to make a 

new socket.  

Overall, the format of the current survey seemed to have 

been satisfactory for the purposes of this study and the data 

was effective for describing their experience and informing 

future care. 47% of the 15 prosthetists who were invited to 

participate completed the survey. It is important to note that 

of 15 invited prosthetists, it was discovered that one 

prosthetist had passed away and two prosthetists had 

retired from their clinical practice. From the current review, 

data on socket adjustments and the provision of new 

sockets seemed straightforward to collect, while information 

on alignment and at-home management was less specific. 

In the future, attention should also be given to documenting 

alignment adjustments and to education on at-home 

management techniques. We may also need to explore 

different ways of asking these questions.  

Data collection needs to continue to include information on 

patient demographics (e.g., cause of amputation, level of 

amputation, BMI, ethnicity, activity level, etc.) and 

pregnancy details (e.g., number of pregnancies, time in the 

pregnancy that adjustment is made, weight gain, etc.). In 

the current study, prosthetists hypothesized that the third 

trimester was the trimester most likely to require 

adjustments to accommodate for changes, and that women 

with congenital LLA have less limb volume and shape 

change issues; however, we do not have enough data to 

provide evidence for or against these speculations. In 

addition, it could be helpful to collect more details regarding 

the postpartum period, including details on how the socket 

fits in the 3–12 months after birth. In the current study, 

prosthetists commented that it takes approximately three 

months to get back to pre-pregnancy limb volume, despite 

women commenting it took up to 18 months,11 

demonstrating the discrepancies between these two points 

of view. The proposed framework builds off of the existing 

chart-review survey and adds components which should be 

reported by both the patient and the prosthetist. Information 

from prosthetists should rely on objective adjustment data, 

while women with LLA can provide any additional contextual 

information. In the future, this data collection framework 

could be expanded to collect information on the experiential 

aspects of pregnancy from women with LLA as well.  

While this study provides suggestions for the questions and 

format of a data collection framework, it does not identify a 

sustainable location. Perhaps this research could inform 

limb loss registries, which could expand to have a section 

dedicated to pregnancy and limb loss.19 

Limitations 

While this study fills a gap regarding information for 

prosthetists caring for pregnant women, it was done in a 

Canadian context with a small subset of prosthetists. Given 

the variety of experiences of women with LLA during the 

perinatal period, a larger dataset is needed over a wider 

geographic area with more diversity of women and their 

prosthetic prescriptions. In addition, there may be other 

factors that influence prosthetic treatment such how well the 

socket was fitting prior to pregnancy or how often a 

particular patient typically requires adjustments to maintain 

a comfortable socket fit. We cannot make any claims 

regarding the correlation between level of amputation and 

prosthetic treatment due to the lack of other demographic 

factors (e.g. age, prosthetic componentry, activity level, 

prosthetic use, etc.). These demographic factors were not 

included in the scope of the current study but are included 

in the data collection framework so that future studies can 

make more robust conclusions and recommendations.  

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Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

Pousett et al., 2025 

In addition, this study was a survey of clinical records with a 

few additional questions added to gather the ideas of the 

prosthetists. The time between seeing the patient and 

completing the review could have been up to 10 years, 

which may impact recall if prosthetists tried to supplement 

data written in the chart. In the future, it would be ideal to 

complete the review in the 12-18 months after pregnancy.  

CONCLUSION 

This study provides valuable information regarding the 

prosthetic treatment of women with LLA during the perinatal 

period. It highlights the diverse experiences of prosthetists 

providing care to these women and the wide range of 

prosthetic interventions that were found appropriate. It also 

provides suggestions for future data collection to gather 

additional information to address this critical gap in 

knowledge. Given the findings from this study, we can begin 

to better educate women with LLA and their prosthetists 

regarding what to expect during and after pregnancy and 

the range of experiences they may encounter. This can also 

provide information to prosthetists to ensure they have the 

tools and knowledge to provide their patients with as smooth 

a journey as possible. By providing information on the range 

of experiences and prosthetic management techniques, we 

can give women with LLA and their prosthetists the 

information they need plan ahead for a variety of scenarios, 

leading to decreased anxiety about uncertainty regarding 

how to manage limb volume change and prosthesis fit 

during the perinatal period. 

ACKNOWLEDGEMENTS 

Funding was provided through a grant from The War Amps. We 

would like to thank the prosthetists who took the time to complete 

the chart review and the women who consented to letting us contact 

their prosthetists. 

DECLARATION OF CONFLICTING INTERESTS 

The authors have no conflicts of interest. 
 

AUTHORS’ CONTRIBUTION 

• Brittany Mae Pousett: Conceptualization, Funding Acquisition, 

Project Administration, Study Design, Data Analysis, Manuscript 

Writing.  

• Donna Cumming: Project Administration, Study Design, 

Manuscript Editing. 

• Clara Phillips: Conceptualization, Data Analysis, Manuscript 

Editing. 

• Fae Azhari: Conceptualization, Study Design, Manuscript 

Editing. 

• Crystal MacKay: Conceptualization, Study Design, Manuscript 

Editing, Supervision. 

SOURCES OF SUPPORT 

Funding was provided through a grant from The War Amps. 

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14.Bateman EA, Viana R, Sales D, Payne MWC. Pregnancy after 

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15.O’Brien E, Stevens PM, Miro R, Highsmith MJ. Transfemoral 

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16.Bateman EA, Frengopoulos C, Viana R, Payne MWC. 

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17.Hanger Clinic. Patient care manual: above-knee amputation 

[Internet]. Austin (TX): Hanger Clinic; [cited 2024 June 13]. 

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18.Hsieh HF, Shannon SE. Three approaches to qualitative content 

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19.Limb Loss and Preservation Registry [internet]. McLean, VA: 

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APPENDIX  

Appendix A 

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Appendix B 

 

Section 1A: Patient Details: General  

To be completed by the prosthetist or patient, depending on if this information is documented in the clinical records. 

Birth month and year: 

Race or racial background: (check all that apply) 

• Black (African, African Canadian, Afro-Caribbean descent) 

• East Asian (Chinese, Japanese, Korean, Taiwanese descent) 

• Indigenous (First Nations, Inuk/Inuit, Métis descent) 

• Latin American (Hispanic or Latin American descent) 

• Middle Eastern (e.g., Afghan, Egyptian, Iranian, Kurdish, Lebanese, Turkish) 

• South Asian (e.g., Bangladeshi, Indian, Indo-Caribbean, Pakistani, Sri Lankan) 

• Southeast Asian (Cambodian, Filipino, Indonesian, Thai, Vietnamese, or other Southeast Asian descent) 

• White (European descent) 

• Other 

• Do not know 

• Prefer not to answer  

Side of Amputation: (check all that apply) 

• Right 

• Left 

For each side with an amputation: 

Level of Amputation: 

• Symes / Ankle Disarticulation 

• Transtibial 

• Knee Disarticulation 

• Transfemoral 

• Hip Disarticulation 

• Rotationplasty  

• Hemipelvectomy 

• Other:  

Cause of amputation: 

• Vascular/diabetes 

• Trauma 

• Infection 

• Cancer 

• Congenital 

• Other: ________ 

Section 1B: Patient Details at time of Pregnancy 

To be completed by the prosthetist: 

For each side with an amputation, what was the prosthetic prescription at the time of pregnancy?  

Prosthetic interface:  

• None (skin) 

• Socks 

• Pelite/foam Liner 

• Gel Liner 

• Silicone Liner 

• Urethane Liner 

• Neoprene Sock 

• Other: ________ 

 

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Suspension mechanism: 

• Skin Fit Suction 

• Anatomical/Supracondylar 

• Cuff/Strap 

• Tension Sleeve  

• Suction Sleeve  

• Locking Liner – Pin 

• Locking Liner - Lanyard 

• Seal-In Liner 

• Elevated Vacuum 

• Other: ___________ 

Socket Design: 

• Window (obturator) 

• Total surface bearing (Transtibial) 

• Patella tendon bearing (Transtibial) 

• Specific weight bearing (Transtibial) 

• Hydrostatic (Transtibial) 

• Thigh lacer 

• Quadrilateral (Transfemoral) 

• Narrow ML (Transfemoral) 

• Ischial Containment (Transfemoral) 

• Sub-ischial (Transfemoral) 

• MAAS (Transfemoral) 

• Other:____________ 

Foot: 

Knee or side joints: (if applicable): 

Hip joint (if applicable):  

 

To be completed by the patient: 

What was your activity level at the time of pregnancy? 

• Low 

• Moderate 

• High 

• Extremely high  

Did you wear your prosthesis as your primary means of mobility for your entire pregnancy?  

• Yes 

• No 

If no, when did you stop using it and what form of mobility did you use instead?  

What was your pre-pregnancy weight? 

Section 2: Pregnancy Details 

To be completed by the patient: 

How many times have you been pregnant? 

What was the anticipated due date? (This will be used to calculate in which trimester adjustments were done.) 

What was the baby’s birth date? (This question in combination with the question above can calculate the dates of pregnancy).  

How much weight did you gain during each pregnancy? 

Survey Section 3: Appointments 

To be completed by the prosthetist: 

How many appointments did this patient have during their pregnancy? (Calculated as the 9 months before the due date to the birth date).  

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Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

 

Pousett et al., 2025 

For each appointment: 

What was the date of the appointment? 

What was the goal of this appointment? 

Were any socket adjustments made? (If yes, answer the questions below) 

A. What was the goal of the socket adjustment? 

B. Was pressure added or removed? 

C. What was the method of adjustment 

• Padding 

• Heating 

• Grinding 

• Other: ________ 

D. Which location(s) was the adjustment made in? 

• Anterior distal tibia 

• Medial tibial flare 

• Posterior tibial area 

• Fibula 

• Knee condyles 

• Medial thigh 

• Lateral thigh 

• Anterior thigh (scarpas) 

• Posterior thigh 

• Other: _______ 

E. Please describe the adjustment in as much detail as possible: 

Were any alignment adjustments made? (If yes, answer the questions below) 

A. What was the goal of the alignment adjustment? 

B. Which of the following was done? 

• Socket flexion  

• Socket extension 

• Socket abduction 

• Socket adduction 

• Socket medial shift 

• Socket lateral shift 

• Socket posterior shift 

• Socket anterior shift 

• Knee internally rotated 

• Knee externally rotated 

• Foot inverted 

• Foot everted 

• Foot toed in  

• Foot toed out 

• Prosthesis lengthened 

• Prosthesis shortened 

• Other: _________ 

C. Please describe the alignment adjustment in as much detail as possible: 

Was a new socket indicated? (If yes, answer the questions below) 

A. Please describe why it was determined that a new socket was required. 

B. Will the new socket be made? If no, please describe why it will not be made (i.e., funding, time requirements, etc.) 

C. If the socket is not fitting properly, will the patient use alternative means of mobility? If so, what mobility devices will they 

use?  

Were any consumables or components required at this appointment relevant to the pregnancy? (If yes, answer the questions 

below) 

A. Pease describe the consumables and components required at this appointment relevant to the pregnancy. 

Was any education provided on at-home management strategies (e.g., wearing shrinker socks when not wearing the prosthesis, 

switching to thinner socks or liners, etc.)? If so, please describe.  

Section 3: Post-Natal Questions 

To be completed by the prosthetist: 

A
P

P
E

N
D

IX
 B

 

https://doi.org/10.33137/cpoj.v8i1.45142


 

20 

Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A 
chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

ISSN: 2561-987X PREGNANCY AND POSTPARTUM PROSTHETIC CARE IN WOMEN WITH LOWER LIMB ABSENCE 

 

Pousett et al., 2025 

Please describe all the adjustments made in the year after pregnancy that revered adjustments made during the pregnancy, accommodated 

volume changes or involved the provision of a new socket.  

Section 4: General Questions 

To be completed by the prosthetist: 

Did you (the prosthetist) learn anything while treating this patient during pregnancy that you think may be helpful for other people treating 

pregnant individuals with lower extremity prostheses to know? If yes, please describe. 

Is there anything else from treating this patient during this pregnancy that you would like to share with us?   

 

 

 

 

 

 

 

 

 

 

 

 

 

A
P

P
E

N
D

IX
 B

 

https://doi.org/10.33137/cpoj.v8i1.45142

