PROSTHETIC CPM FINAL SCRIPT 2026
COMPLETE CLINICAL PRACTICE
QUESTIONS AND ANSWERS PACKAGE
◉ What is the bench alignment for a TF prosthesis
Answer: Sagittal= 5 degrees of socket flexion plus contracture, 5-15
mm (1/4"-1/2") TKA anterior to knee center
Coronal= foot(center of heel) 30-50mm outset from ischium, socket
adducted 6-8 degrees, 2-4" base of support
Transverse= Knee externally rotated 3-5 degrees, foot externally
rotated 5-7 degrees, medial wall in line of progression
◉ What are some questions to always ask during the trouble
shooting section
Answer: Gained lost weight?
Activity level changed?
Limb volume change?
Changed shoes?
Donning liner/prosthesis correctly
Did the problem start at delivery or a time period after
Wearing socks
Is the patient a child/have they grown
,Are there any gait deviation
Are they washing the liner
Are they wearing a shrinker
Do they feel like they are falling medially or laterally
Do they feel like the are walking up or down hill
◉ What is the cause and solution to a patient with
discoloration/blistering on distal limb with appropriate socket fit
Answer: Limb is being milked due to inappropriate liner donning
Solution: educate patient on how to properly don liner
◉ What is the cause and solution to an upper limb patient with the
TD opening with elbow flexion
Answer: Too much force/not enough excursion in system
Solution: Move EFA (Elbow Flexion attachment) distal, move
Proximal Baseplate Retainer(PBPR) Lateral, Anterior, Proximally,
Add forearm lift assist, check housing clearance, add rubber band
◉ What is the cause and solution to an upper limb patient with a TD
that will not open all the way
Answer: Too much excursion with in the system
,Solution: Move EFA proximal, Move PBPR Distal, Medial Posterior,
remove rubber band, check housing clearance, add z strap, tighten
CAS, add dual NW ring
◉ What is the cause and solution to a patient with transtibial
pain/redness on bottom, distal Patel, and fibular head
Answer: Bottoming out- solution add sock, pad pretibial and
popliteal area
◉ What is the cause and solution to a knee disarticulation with pain
on very bottom/condyles
Answer: Using too many socks/ not reaching the bottom
◉ What is the cause of anterior proximal redness with a BK and
solution
Answer: Socket is too extended , flex socket
Shoes were changed to lower heel height
◉ What is the cause of anterior distal redness
Answer: Socket too flexed- extend socket
Socket to anterior to foot- use offset plate to reverse
Shoe heel to height
AP too large- pad popliteal
, ◉ What is the cause of tibial tubercle/proximal fibular head redness
Answer: Too many socks- reduce sock ply
◉ What is the cause of verrucous hyperplasia
Answer: Lack of distal contact, reduce sock ply and use clay ball to
ensure distal contact
◉ What is the cause of distal lateral and proximal medial pressure
Answer: Socket to abducted, adduct socket
◉ What is the cause of distal medial and proximal lateral pressure
Answer: Socket too adducted
◉ What is the cause of redness on distal end, fibular head, distal end
of fibula
Answer: Loss of volume making socket too large, add socks or pad
socket
◉ What is the cause of proximal lateral and distal medial redness?
Answer: Socket too adducted, medially leaning pylon, outset foot.
Patient walking on inside of foot
COMPLETE CLINICAL PRACTICE
QUESTIONS AND ANSWERS PACKAGE
◉ What is the bench alignment for a TF prosthesis
Answer: Sagittal= 5 degrees of socket flexion plus contracture, 5-15
mm (1/4"-1/2") TKA anterior to knee center
Coronal= foot(center of heel) 30-50mm outset from ischium, socket
adducted 6-8 degrees, 2-4" base of support
Transverse= Knee externally rotated 3-5 degrees, foot externally
rotated 5-7 degrees, medial wall in line of progression
◉ What are some questions to always ask during the trouble
shooting section
Answer: Gained lost weight?
Activity level changed?
Limb volume change?
Changed shoes?
Donning liner/prosthesis correctly
Did the problem start at delivery or a time period after
Wearing socks
Is the patient a child/have they grown
,Are there any gait deviation
Are they washing the liner
Are they wearing a shrinker
Do they feel like they are falling medially or laterally
Do they feel like the are walking up or down hill
◉ What is the cause and solution to a patient with
discoloration/blistering on distal limb with appropriate socket fit
Answer: Limb is being milked due to inappropriate liner donning
Solution: educate patient on how to properly don liner
◉ What is the cause and solution to an upper limb patient with the
TD opening with elbow flexion
Answer: Too much force/not enough excursion in system
Solution: Move EFA (Elbow Flexion attachment) distal, move
Proximal Baseplate Retainer(PBPR) Lateral, Anterior, Proximally,
Add forearm lift assist, check housing clearance, add rubber band
◉ What is the cause and solution to an upper limb patient with a TD
that will not open all the way
Answer: Too much excursion with in the system
,Solution: Move EFA proximal, Move PBPR Distal, Medial Posterior,
remove rubber band, check housing clearance, add z strap, tighten
CAS, add dual NW ring
◉ What is the cause and solution to a patient with transtibial
pain/redness on bottom, distal Patel, and fibular head
Answer: Bottoming out- solution add sock, pad pretibial and
popliteal area
◉ What is the cause and solution to a knee disarticulation with pain
on very bottom/condyles
Answer: Using too many socks/ not reaching the bottom
◉ What is the cause of anterior proximal redness with a BK and
solution
Answer: Socket is too extended , flex socket
Shoes were changed to lower heel height
◉ What is the cause of anterior distal redness
Answer: Socket too flexed- extend socket
Socket to anterior to foot- use offset plate to reverse
Shoe heel to height
AP too large- pad popliteal
, ◉ What is the cause of tibial tubercle/proximal fibular head redness
Answer: Too many socks- reduce sock ply
◉ What is the cause of verrucous hyperplasia
Answer: Lack of distal contact, reduce sock ply and use clay ball to
ensure distal contact
◉ What is the cause of distal lateral and proximal medial pressure
Answer: Socket to abducted, adduct socket
◉ What is the cause of distal medial and proximal lateral pressure
Answer: Socket too adducted
◉ What is the cause of redness on distal end, fibular head, distal end
of fibula
Answer: Loss of volume making socket too large, add socks or pad
socket
◉ What is the cause of proximal lateral and distal medial redness?
Answer: Socket too adducted, medially leaning pylon, outset foot.
Patient walking on inside of foot
