The Prevalence of Dermatological Problems for Transtibial Amputees Using a Roll-on Liner

In Brief Össur Kristinsson first developed the Icelandic roll-on silicone socket (ICEROSS) in the mid 1980s. This type of socket interface was quickly popularized in the prosthetic community and has become the standard of treatment for transtibial amputees. Multiple manufacturers of roll-on liners, of various materials, now exist. These companies claim that liners offer superior comfort, suspension, and relief of dermatological problems compared with previous prosthetic options. A review of relevant literature reveals studies that are limited by the lack of diagnoses made by dermatologists (Cluitman et al., Prosthet Orthot Int. 1994;18:78–83; Lake and Supan, J Prosth Orthot. 1997;9:97–106; and Hachisuka et al., Arch PhysMed Rehabil. 2001;82:1286–1289) and a failure to identify the frequency of these problems (Levy, Prosthet Orthot Int. 1980;4:37–44 and Dudek, et al. Arch Phys Med Rehabil. 2005;86:659–663). The purpose of this cross-sectional study is to determine the prevalence of dermatological problems in transtibial amputee subjects who use a roll-on liner with their prosthesis. A questionnaire determined demographic information, skin type, hygiene and prosthetic habits, comorbidities, and reported skin problems. All participants were offered a free examination by the dermatologist to verify medical history and document current skin problems. A χ2, trend, and rank-sum test were used. Results indicated that 90.9% of subjects reported a history of skin problems, whereas 78% presented with a problem during the exam with the dermatologist. Specific correlations between habits and reported skin problems are also reported in this article. However, a direct correlation between amputee habits and skin problems is not clear. Because of high gasoline prices in rural Iowa, few participated in the skin exam. In this study, a greater number of transtibial amputees using roll-on liners had dermatological problems than previously reported. This cross-sectional study used a questionnaire and skin examination by a dermatologist to examine types of skin problems reported and possible causes. The study found that a greater number of transtibial amputees who utilize a roll-on liner have dermatological problems than was previously suspected or reported, raising a challenge to manufacturers, practitioners, and researchers to further evaluate liner problems and make appropriate changes.