Below Knee Prosthesis

How to Use a Below-Knee Prosthesis

A below-knee prosthesis, also called a BK or transtibial (TT) prosthesis, is designed to support mobility after a below-knee amputation. Properly putting on and removing your prosthesis helps maintain a secure fit, protect your residual limb, and reduce the risk of skin irritation.
Follow the instructional video on this page along with the PDF wear and care instructions provided by Comprehensive Prosthetics and Orthotics. Your prosthesis may use a pin-lock system or a knee suspension sleeve, so follow the instructions provided for your specific device. Always follow any additional or individualized directions from your prosthetist or medical provider.

How to Put On a Below-Knee Prosthesis

Turn your prosthetic liner completely inside out so the gel side faces outward.
Place the end of the liner against the end of your residual limb, making sure there are no air pockets between your skin and the liner.
If your liner has a pin, make sure the pin is centered and points straight away from the end of your limb rather than sitting at an angle.
Roll the liner upward over your residual limb until the gel side rests against your skin and the fabric side faces outward. Do not pull the liner up, as this can create wrinkles that may cause pressure or discomfort.
If you use prosthetic socks, place the appropriate number and thickness of socks over the liner. Prosthetic socks should be worn over the liner, not directly against your skin.
Slide your residual limb into the prosthetic socket. Some minor resistance is expected as your limb settles into the snug-fitting socket.
For a pin-lock prosthesis:Align the pin with the locking mechanism at the bottom of the socket. Continue sliding into the socket until you hear the locking mechanism click and the pin is securely engaged.
For a suspension-sleeve prosthesis:After your limb is fully seated in the socket, roll the knee suspension sleeve upward onto your leg. At least two inches of the gel side of the sleeve should make contact with the skin of your thigh.

How to Remove a Below-Knee Prosthesis

Sit in a stable, secure position before removing your prosthesis.
For a suspension-sleeve prosthesis:Roll the suspension sleeve downward from your thigh to release the suspension around your leg.
For a pin-lock prosthesis:Use the release mechanism on your prosthetic socket as instructed by your prosthetist to disengage the locking pin.
Carefully withdraw your residual limb from the prosthetic socket.
Remove any prosthetic socks being worn over your liner.
Beginning at the top, roll the prosthetic liner downward and off your residual limb rather than pulling it off.
Inspect your residual limb for redness, irritation, sores, or other changes before cleaning your liner and prosthesis.

Because locking and suspension systems can vary, do not force the prosthesis off if it does not release normally. Contact Comprehensive Prosthetics and Orthotics or your prosthetist for assistance.

Maintaining the Proper Prosthetic Fit

The size of your residual limb may change throughout the day as swelling increases or decreases. Prosthetic socks can help accommodate these changes by taking up additional space within the socket. Socks are available in different thicknesses, or “ply,” and more than one sock may be needed to maintain a comfortable fit.
Consider adjusting your prosthetic socks if the socket begins to feel loose, rotates on your leg, feels too tall or short, or creates new areas of pressure. If you have a pin-lock liner, make sure no sock material covers the end of the pin because this can interfere with the locking system. If you regularly need more than 6-ply of prosthetic socks, contact your prosthetist so the fit of your socket can be evaluated.

Cleaning and Caring for Your Below-Knee Prosthesis

Your liner should be cleaned after every wear. Turn it completely inside out with the gel side facing outward and wash it using warm water, soap, and your hand or a soft washcloth. Avoid abrasive cleaning tools that could damage the gel. Once a week, wipe the liner with rubbing alcohol and rinse it thoroughly with warm water.
Prosthetic socks can be hand washed with warm water and mild soap or washed using a delicate washing-machine cycle. Allow them to air dry completely before wearing them again. The inside and outside of the socket can also be hand washed with warm water and mild soap and occasionally wiped inside with rubbing alcohol. Always make sure your liner, socks, and socket are completely dry before use.

Check Your Skin and Prosthesis Daily

Check your residual limb every day for redness, irritation, or other skin changes. A mirror can help you inspect areas that are difficult to see. If you find irritation, check the corresponding area of your liner for rips, tears, or deterioration of the gel material.
Contact Comprehensive Prosthetics and Orthotics if you notice persistent skin irritation, liner deterioration, problems engaging or releasing your prosthesis, or significant changes in socket fit. Your prosthetist can evaluate the device and determine whether adjustments, replacement components, or additional care are needed.

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