Part 1 of 5 in Your First Year with a Prosthesis, a series with Bethany Nelson, PT — a physical therapist based in the Atlanta, Georgia area with more than 25 years of experience in amputee rehabilitation.
Donning, socket fit, and sock ply — the foundational skills of the first weeks.
Receiving a prosthesis is a major milestone, but it is only the beginning of the recovery process. The weeks and months that follow involve learning new routines, adjusting to physical changes, and gradually building confidence in a device that will eventually become part of everyday life.
When someone receives their prosthesis for the first time, they usually have only one initial training session with their prosthetist. During that appointment they learn the basics — how to put on the liner, how to attach the prosthesis, and how prosthetic socks work. After that, many people begin outpatient physical therapy.
By the time patients arrive at therapy, they often feel overwhelmed. They are learning to use a completely new device while also adjusting to the changes in their body and daily routine. Therapy focuses on building the foundational skills needed to use the prosthesis safely and comfortably in everyday life.
Learning to put on and remove the prosthesis
One of the earliest skills patients work on in therapy is donning and doffing, which means putting on and taking off the prosthesis. Although it may sound simple, it is a skill that requires repetition and practice. The liner must be positioned correctly, the prosthesis must be attached properly, and the user needs to become comfortable handling the residual limb.
With practice, this process becomes easier and more routine. Over time, many patients reach the point where putting on their prosthesis becomes just another part of their morning routine. Practicing donning and doffing also helps the residual limb gradually become less sensitive, which can improve comfort when wearing the prosthesis.
Understanding socket fit and sock ply
One of the most important parts of prosthetic comfort is the fit of the socket. The first socket is usually created while the residual limb is still swollen from surgery. As the limb heals and the person begins wearing a compression shrinker, the swelling decreases and the limb gradually becomes smaller.
However, the socket itself does not change size. As the limb shrinks, the space inside the socket increases. This can cause the prosthesis to move within the socket — a movement often called pistoning — which may create friction and lead to skin irritation. To compensate for this change in limb size, prosthetic socks are layered inside the socket. These socks fill the space and help maintain a secure fit.
Over time, the number of sock layers increases. When the sock count reaches around ten ply, the prosthetist will usually modify the socket or create a new one. This brings the sock count back down to around three ply. This process may repeat several times until the limb stabilises and the patient receives what is known as the definitive socket.
Learning how to manage sock ply is one of the most important practical skills for prosthetic users because it directly affects comfort and skin health.