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Achieving Good Suspension

One of the questions that a prosthetist gets asked often is “how does the prosthetic leg stay on?” This is a great question, and often the answer depends on the results and findings from the evaluation process of each patient. There are many suspension methods applicable to the below-knee amputation level and in this post we will cover a few examples of suspension methods. We will briefly discuss the pros and cons, relating to the ease of donning or application and the overall comfort of each method.

Achieving good suspension for a prosthetic user improves the energy transfer, enhances the control of their prosthesis, and decreases any discomfort or abrasions they may experience.

Sleeve Suspension

A prosthetic sleeve is applied to the socket and rolled up over the thigh section to create a link between the prosthetic leg and the residual limb. (Fig.A Sleeve suspension). This method requires the user to roll their prosthetic liner on, add the appropriate amount of prosthetic socks, and then roll the sleeve over. The material build up behind the knee might constrict full knee flexion, but with time will loosen slightly.

Figure A: Sleeve Suspension

Pin Suspension

A pin system suspension method has a gel liner with a pin attached at the end, and a shuttle molded in the prosthetic socket. (Fig. B) The prosthetic user must align the pin into the shuttle and once engaged, the system will lock in and thus provide suspension. The prosthetic user must ensure that when wearing prosthetic socks with a pin system, they need to make sure the fabric does not slide in the shuttle. This sliding movement may cause the pin and shuttle system to get stuck and make it difficult to remove the prosthetic leg.

Figure B: Pin Suspension

Seal-In Liner Suspension

A seal-in liner suspension method has a gasket built in the silicone liner. (Fig. C) The prosthetic user will apply the liner, add prosthetic socks if applicable, spray rubbing alcohol along the seal/gasket, and then slide into the socket. The seal is created once the rubbing alcohol has completely evaporated and air has evacuated the socket. This system requires good hand dexterity and strength for ease of donning. A current user of this system stated that they feel safer with this system, but they also notice more pressure around the seal/gasket when wearing their prosthetic.

Figure C: Seal-in Liner Suspension

Additional Suspension Methods Available

In addition to the suspension methods discussed above, there are also other methods such as the supracondylar suspension and cuff strap suspension. (Fig. D and E respectively). These options may not be cosmetically appealing, but they are simple and inexpensive.

Figure D: Supracondylar Suspension
Figure E: Cuff Strap Suspension

Finding the Right Suspension Method

It is best to consult with your clinician when trying to determine what suspension system method is best for you and your needs as there are other factors that should be considered when choosing the appropriate suspension method. Contact Tillges today to schedule a complimentary consultation with a certified prosthetist at 651-772-2665.



  1. Google Images 2023
  2. Atlas of Amputation and Limb Deficiencies, Vol. 2, 2016  Krajbich, J.; Pinzur, M.; Potter, B.; Stevens, P.

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