Partial Foot Prosthesis

Physical Rehabilitation Programme

Manufacturing guidelines
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MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poestma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
1
Table of contents
Foreword 2
Introduction 4
1.Footprintofsoundside 5
2.Castingandrectifcation 6
3.Sofsocketfabrication 7
4.Forefootbuild-up 11
5.Firstfttingofsofsocket 13
6.Drapingofpolypropylene 15
7.Trimlines 17
8.Fitting 20
9.Straps 21
10.Finishedpartialfootprosthesis 22
Listofmanufacturingmaterials 23
Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
2 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedtheuse
oftechnologythatisappropriatetothespecifccontextsinwhichtheorganizationoperates,
i.e.,countriesafectedbywarandlow-incomeordevelopingcountries.
Tetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountries
concerned.
Tetechnologyadoptedmustthereforebe:
durable,comfortable,easyforpatientstouseandmaintain;
easyfortechnicianstolearn,useandrepair;
standardizedbutcompatiblewiththeclimateindiferentregionsoftheworld;
low-costbutmodernandconsistentwithinternationallyacceptedstandards;
easilyavailable.
Techoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitation
services.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-made
orthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhich
theorganizationworks.TecostofthematerialsusedinICRCprostheticandorthoticdevices
islowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-made
components.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailable
materialssuchaswood,leatherandmetalwereused,andorthopaediccomponentswere
manufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthe
techniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweenthe
projects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprosthetic
sockets.Tefrstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents
suchasvariousalignmentsystemswerefrstdevelopedinColombiaandgraduallyimproved.In
parallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowof
polypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,afercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductionin
ordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
3 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
Objective of the manuals
TeICRCsManufacturingGuidelinesaredesignedtoprovidetheinformationnecessaryfor
productionofhigh-qualityassistivedevices.
Temainaimsoftheseinformativemanualsareasfollows:
TopromoteandenhancestandardizationofICRCpolypropylenetechnology;
Toprovidesupportfortrainingintheuseofthistechnology;
Topromotegoodpractice.
Tisisanotherstepforwardintheeforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRC
AssistanceDivision/HealthUnit
PhysicalRehabilitationProgramme
4
Introduction
Teaimofthisdocumentistodescribeamethodforproducingpartial foot prostheses,working
withtheICRCpolypropylenetechnologyandorthopaediccomponentsusedattheRegionalPhysical
RehabilitationCentreinBattambang,Cambodia.
Tecasting,rectifcationandalignmentmethodsusedcorrespondtointernationalprostheticand
orthotic(P&O)standardsofpracticeandarethereforenotdescribedintheseICRCmanufacturing
guidelines.
Remarks
Teproceduredescribedrelatestooneofthemostcommontypesofpartialfootamputation,
whichisalsoknownasChoppartormid-footamputation.
Iffullendbearingisnotpossible,thePatellar-Tendon-Bearing(PTB)designbrimshouldbeused.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
FOOTpRInT OF sOund sIde 1
6Copythesound-sidefootprintonasheetofpaperandmarkthefootrotation(~10).
Insertfrontalline.
6Fixthepaperagainstawindowandcopythereversesideofthefootprint.
Teprintwillhelpinpositioningthebuild-upofthefootontheprosthesis.
6 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
CasTIng and ReCTIFICaTIOn 2
PatientassessmentandcastingareperformedinaccordancewithP&Ostandards.However,thecast
istakenwhiletheamputeeissittingdown.

Patientswhowillhavetheirfullweightbearingontheprosthesisshouldstandbeforetheplaster
bandageshavehardened.Formoresensitivestumpsthepatientshouldstandonalayerofsoffoam,
andifnecessaryaheelwedgemaybeaddedtocompensateforequinuspositionofthestumporthe
heightoftheshoeheel.
Caremustbetakentoensurethatthecalcaneusisheldinaneutralposition.
RectifcationofthepositivecastimpressionisperformedinaccordancewithP&Ostandards.
6Referencelinescanbeaddedonthemouldsandthefootprint.
7
2
1
3
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
sOFT sOCkeT FabRICaTIOn 3
MeasurementofEVAfoam:
1 Circumference2cmabovetheheadofthefbula.
2 Circumferencemiddleofthecalcaneus.
3 Lengthofplastercast.
Cutatrapezoidfromasheetof6mmEVAfoamaccordingtotheabovemeasurements.
8 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
4Trima10mmstriponbothlateralsidesof
theEVAfoamtozeromillimetres.
4ApplyNeoprenecontactgluetwiceonboth
trimmedsides.
4Oncetheglueisdry,jointhetwosurfaces
toformacone.
9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
4Dusttheplasterpositiveandtheinside
oftheEVAconewithtalcumpowderto
facilitatesliding.
4HeattheEVAconeinanovenforabout
5minutesat120Candthenpullitover
theplasterpositive.
4TokeeptheEVAfoaminthesameshape
astheplasterpositive,secureitwithelastic
bandagesorplaceitundervacuumuntilit
hascooleddown.
10 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
4TrimthedistalsectionoftheEVAcone
withaknifeandsmoothitbygrinding.
4ApplytwolayersofNeoprenecontactglue
tothetrimmedsectionandtothe12mm
EVAfoamsocketcap.
4Heatthecapfor2to3minutesat120Cin
anovenandglueitontothesofsocket.
Cutofandgrindtoremovetheexcess
EVAfoam.
11 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
FOReFOOT buIld-up 4
4Gluelayersof12mmEVAfoam
correspondingtothelengthofthesound
footmeasuredbeforecasting.
4Usethefootprinttakenbeforecastingto
determinethecorrectfootrotation.
Checktheanterior/posteriorandthe
lateral/medialalignmentsagainstthe
measurementcard(e.g.heelheight).
6Pre-shapetheforefootwithaknife.
12 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
6Finishshapingtheforefootonthegrindingmachine.
Makesurethattheplantarsolebetweenheelandtoesisparalleland,ifnecessary,thattheheel
heightiscorrect.Wherepossible,shapethelongitudinalarchsupport.
6Forfnishing,asheetof3mmEVAfoamisdrapedoverthefoot.
FitthesheetofEVAfoamonthefootbycuttingitroundaroundtheankle.
ApplytwolayersofNeoprenecontactglue,thenheatthe3mmEVAfoamintheovenfor
2minutesat120Cbeforedrapingit.Cutandsmooththeedges.Afurthersheetof3mm
EVAfoammaybeadded(glued)tothesole.
Tisoperationcanalsobecarriedoutaferthefrstfttingofthesofsocketontheamputee,
describedbelow.
13 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
FIRsT FITTIng OF sOFT sOCkeT 5
4Beforethepolypropyleneisdraped,
thesofsocketmustbecheckedon
thepatient.
Tesofsocketmustberemoved
fromtheplasterpositivewithout
breakingit.
Ontheposteriorside,puncha
4mmholejustabovethecalcaneus.
TishelpsavoidtearingoftheEVA
foamwhenthesofsocketisbeing
removedfromtheplaster.
Drawalineorusearulertomake
astraightcuttinglineuptothe
proximalendofthesocket.
Removethesofsocketcarefully
andkeeptheplasterpositive.
6Tochecktheft,alignmentandlengthofthesofsocket,fxitwithtape.
14 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
6Checktheheightoftheprosthesisanditsstaticalignment.Makethenecessarymodifcations/
correctionsbygrindingoforaddingEVAfoam.
6Checkalsothelengthandrotationofthefoot,andadjustitasdescribedabove.
Atthispointitisnotrecommendedthatthepatientbeallowedtowalk,asthesocketandforefoot
aretoofexible.However,theamputeemaytakesomestepsinsideparallelbarssothatthe
dynamicalignmentcanbechecked.
15 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
dRapIng OF pOlypROpylene 6
4Putthesofsocketbackontheplaster
positiveandstapleortapethesidesof
theposteriorseamtogether.
4Measurementofpolypropylenesheet:
Lengthfromproximalpartofplaster
positivetotoes+15cm
Circumferenceofproximalpartofsof
socket+2cm
Circumferenceofmid-tibialsection
+2cm

Circumferenceoffoot-ankle(below
medialmalleoli,includingcalcaneus)
+5cm
4Beforedrapingthepolypropylene,pulla
nylonstockingoverthesofsocketand
dustitwithtalcumpowder.
16 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
4Cuta5mmsheetofPPcorrespondingtothe
measurementstakenabove.
HeatthePPinanovenforabout20minutes
at180C.
4LaythePPoverthemouldwithout
stretchingit.
Drapeitfrstovertheankletowardsthe
middleanteriorpartoftheprosthesis.Ten
pullitaroundtheforefoot.
4FinishdrapingthePPandstickittogether
alongthemiddleanteriorsideofthe
prosthesis.
TightenthePParoundthesuctionconewith
abicycleinnertube,aropeorastockingand
openthevacuumvalve.
4Withscissorsoraknife,cutoftheexcess
alongtheweldingseamwhilethePPisstill
hot.
4Keepthevacuumonforabout5min.,but
waituntilthePPhascompletelycooled
downbeforeremovingthemouldfromthe
vacuumcone.
17 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
TRIm lInes 7
4Proximaltrimline:
1to2cmbelowthefbulahead.
Lateral/medialtrimlines:
On1/3oftheproximaltibialsection,
2to3cmwiderthanthe2/3distal
tibialtrimline,whichisdrawn
straightupjustbehindthelateral
andmedialmalleoli.
Distal/posteriortrimline:
Alongthecalcaneustuberosity.
6Forefoottrimline:
5mmposteriortothe1stmetatarsaltodistalphalanges,butkeepthePPtipforprotectionofthe
EVAfoam.
18
4Removethesofsocketfromthe
plasticsocket.Bearinmindthatit
mightbedifculttoextractthesof
socketfromthePPshell.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
4Cuttheposterioropeningwithan
oscillatingsaw.
4ToavoiddamagingtheEVAfoam,
donotcuttheforefootopeningwith
anoscillatingsaworknife.Instead,
carefullygrinditof.
19 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
6GrindtheanteriorPPweldingseamdownto5mmandshapethetrimlines
oftheplasticandsofsockets.
6Shapealsothetrimlinesoftheforefootopening.
20 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
FITTIng 8
6Duringfttingandgaittraining,fxtheproximalpartoftheprosthesiswithtape.
Modifcationscanstillbemadetothealignment,especiallytocorrecttheeversionorinversionof
thefoot,andtotheheelheightbyaddingEVAfoamonthesole.
Iftheprosthesisistoolong,compensateforthediferenceinlengtheitherinsidetheshoeoron
thesoleofthesoundleg.
21 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
sTRaps 9
4PositionaVelcrostrap(width:25or40mm)
justbelowthefbulahead.
4Fixthelooponthemedialwallandthe
Velcrostraponthelateralwallwithtubular
rivets.
22 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
FInIshed paRTIal FOOT pROsThesIs 10
23 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Par ti al Foot Prosthesi s
ICRC Code Description
Unit of
measure
Quantity
MDREBANDP12 Plaster bandages 12 cm Each According to stump
dimension
OMIS Plaster of Paris Each According to cast
dimension
OPLAEVAFERA03
OPLAEVAFERA06
OPLAEVAFERA12
OPLAEVAFKIN03
OPLAEVAFKIN06
OPLAEVAFKIN12
OPLAEVAFLIV03
OPLAEVAFLIV06
OPLAEVAFLIV12
EVA foam 3 mm, terra brown
EVA foam 6 mm, terra brown
EVA foam 12 mm, terra brown
EVA foam 3 mm, beige
EVA foam 6 mm, beige
EVA foam 12 mm, beige
EVA foam 3 mm, olive
EVA foam 6 mm, olive
EVA foam 12 mm, olive
Each According to cast
dimension
OHDWGLUENEO4 Glue, Neoprene contact Each According to soft socket
OMIS Tubular nylon stocking 60 mm for PP draping Each 1 length according to
prosthesis
OPLAPOLYCHOC05
OPLAPOLYSKIN05
OPLAPOLYLIV05
Polypropylene 5 mm, terra brown
Polypropylene 5 mm, beige
Polypropylene 5 mm, olive
Each According to cast
dimension
OSBOSTRVP325
OSBOSTRVP440
Velcro strap with loop 25 mm
or
Velcro strap with loop 40 mm
Each 1 length according to
patient size
OHDWRIVET081
OHDWRIVET131
Tubular rivet 8 mm x 9 mm
or
Tubular rivet 13 mm x 12 mm
Each 2
list of manufacturing materials
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poetsma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
Physical Rehabilitation Programme
ankle-Foot orthosis
Manufacturing guidelines
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trans-tibial Prosthesis
Physical Rehabilitation Programme
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Manufacturing guidelines
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poestma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
1
Table of contents
Foreword 2
Introduction 4
1.Rawmaterialsandcomponents 4
2.Measurementsandsofsocketmanufacture 6
3.Trans-tibialcupalignmentandsocketmanufacture 11
4.Buildinguptheprosthesisandbenchalignment 17
5.Polypropylenecosmeticmanufacture 26
5.1Cosmeticwithupperpartofsocketremoved 26
5.2CosmeticwithcompletePPsocket 34
6.EVAcosmeticmanufacture 41
Referencelistofmaterials 46
Standardcutsofpolypropylenesheetsforlower-limbprostheses 48
Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
2 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedthe
useoftechnologythatisappropriatetothespecifccontextsinwhichtheorganizationoperates,
i.e.,countriesafectedbywarandlow-incomeordevelopingcountries.
Tetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountries
concerned.
Tetechnologyadoptedmustthereforebe:
durable,comfortable,easyforpatientstouseandmaintain;
easyfortechnicianstolearn,useandrepair;
standardizedbutcompatiblewiththeclimateindiferentregionsoftheworld;
low-costbutmodernandconsistentwithinternationallyacceptedstandards;
easilyavailable.
Techoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitation
services.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-made
orthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhich
theorganizationworks.TecostofthematerialsusedinICRCprostheticandorthoticdevices
islowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-made
components.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailable
materialssuchaswood,leatherandmetalwereused,andorthopaediccomponentswere
manufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthe
techniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweenthe
projects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprosthetic
sockets.Tefrstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents
suchasvariousalignmentsystemswerefrstdevelopedinColombiaandgraduallyimproved.In
parallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowof
polypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,afercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductionin
ordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
3 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
Objective of the manuals
TeICRCsManufacturingGuidelinesaredesignedtoprovidetheinformationnecessaryfor
productionofhigh-qualityassistivedevices.
Temainaimsoftheseinformativemanualsareasfollows:
TopromoteandenhancestandardizationofICRCpolypropylenetechnology;
Toprovidesupportfortrainingintheuseofthistechnology;
Topromotegoodpractice.
Tisisanotherstepforwardintheeforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRC
AssistanceDivision/HealthUnit
PhysicalRehabilitationProgramme
4
Introduction
Teaimofthisdocumentistodescribeamethodformanufacturingtrans-tibial (TT) prostheses
usingtheICRCspolypropylenetechnologyasappliedinICRCprojectsworldwide.
Tecasting,rectifcationandalignmentmethodsusedcorrespondtointernationalprostheticand
orthotic(P&O)standardsofpracticeandarethereforenotdescribedintheseICRCmanufacturing
guidelines.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
For short and medium stump, aduIt
Te alignment system and foot components are available in adult and child sizes.
Raw maTeRIals and COmpOnenTs 1
4Description:
1 Convexankle
2 Twoconcavecylinders
3 Convexdisc
4 CylindricalTTcup
5 Flatsteelwasherandcountersunkheadbolt
6 SolidAnkleCushionHeel(SACH)foot
7 Hexagonalheadboltandlockwasher
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
For Iong stump
Te alignment system and foot components are available only in adult size.
4PTB(patellar-tendon-bearing)socketsecuredwith
acufsuspension.Tesuspensioncanbeadjusted.
Incaseofmedio-lateralinstabilityofthekneeor
forastronghyperextension,athighcorsetwith
sidebarsissuitable.
Tiscanbemadewithorwithoutasofliner.
Socket design
4Description:
1 Concaveankle
2 Convexdisc
3 CylindricalTTcup
4 Flatsteelwasher
5 SolidAnkleCushionHeel(SACH)foot
6 CountersunkheadM10boltandthelock
washer
6 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
measuRemenTs and sOFT sOCkeT manuFaCTuRe 2
6PTB-SC(supra-condylar)
Shouldbemadewithasofliner.
6PTB-SCSP(supra-condylar,supra-patellar)
Mustbemadewithasofliner.
6Tepatientisassessed,aprescriptionismade,measurementsaretakenandmouldingand
rectifcationareperformedaccordingtobestP&Opractice.
7
soft liner manufacture
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Measuretheplastermould.Notethe:
smallestcircumference;
largestcircumerence;
length.
6Drawatrapezoidonasheetof6mmEVAaccordingtothemeasurementstakenbutadding3cm
tothelengthontheshortsideofthetrapezoid.
CuttheEVAandskivethelateralandthedistalsides(about12mm).
8
6Applyglueonbothskivedsidesandformacone.Keepthetrimmeddistalsideontheoutsideof
theconeandleaveitfreeofglue.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
Applytalcumpowderinsidetheconeandontheplastermodel.
Termoformingisdoneusingthevacuumpump,onaverticalsuctionhose.
HeattheEVAconeintheovenat120C.
9
4Allowthesoflinertocooldownforfew
minutes.
Removetheplasticbag.
Prepareapieceof6mmEVAtocoverthe
bottomedge.
Applygluetothetrimmededgeandthe
covercap.
Heatthecapintheovenandmoulditon
thesocket.
CutoftheextraEVAandgrindtillsmooth.
Addpaddingabovethemedialcondyleand
otherareasifrequired.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6PulltheEVAconeovertheplastermould,keepingthegluedlineontheposteriorside,untilthe
trimmeddistalsidecoincideswiththetipoftheplastermould.
Coverthemouldwithaplasticbag,closeitsecurelybelowthemouldwithanelasticstrapand
switchonthevacuumpump.
10
4Coverthesofsocketwithatubular
cottonstockingandglue.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Prepareasheetof3mmEVAtocover
thecotton.
SkiveonesideoftheEVA,applyglueto
theentiresurfaceoftheEVAincluding
theskivedside,andplaceitintheoven
at120C.
Coverthesofliner,startingfromthe
posteriorside.RemovetheexcessEVA
andgrindtheposteriorsideandthe
distalparttillsmooth.
11
4Lastly,coverthedistalpartwitha
3mmor6mmEVAcapand
grindtillsmooth.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
TRans-TIbIal Cup alIgnmenT and sOCkeT manuFaCTuRe 3
4Grindtheedgeofthesocketcup.
12
alignment of the trans-tibial cup
4Fixthenailatthebottomofthemould,wherethe
cupwillbeattached.
PlacetheTTmouldontheCRalignmentjig;
alignaccordingtotheinstructionsontheuseof
thejig(separatemanual).Performthealignment
inaccordancewiththemeasurementcard.Fixthe
cuptothesocketwithplaster.
4Fromthemiddleofthe
condyle,theplumbline
shouldpassabout1cm
infrontofthecupaxis.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
13
manufacture of the socket (4 mm polypropylene)
measurements
4Whentheplasterhasset,
smoothit.
4Add15cmtothemeasurement
takenatpatellalevel.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Coverthesoflinerwithanylon
orcottonstocking.Removethe
nyloncoveringthecup.
14
4FixaroundpieceofEVA
(12+6mm)withanailinsidethe
openingofthecup.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Add15cmtothemeasurement
takenatthedistalpart.
4Add15cmtothemeasured
lengthofthesocket.
15
4Cutasheetof4mmPPcorresponding
tothesemeasurements.CleanthePP
sheetandtheTefonintheovenwith
thinner.
Put the PP in the oven at 180C .
4Switchonthevacuumpump;
drapethePParoundthesocket.
Weldingseamposition:
forPPcosmetic:lateralormedial
forEVAcosmetic:posterior
CutoftheexcessPPwhileitis
stillhot.
Leavethevacuumonuntilthe
PPcoolsdown.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
16 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6CutthePPaccordingtothetrimlines,removetheplasterwithoutdamagingthesocketlinerand
PPsocket,andgrindtheweldingseamdownto3mm.
6Oncetheplasterisremoved,useascrewdrivertoremovethepieceofEVA.
6Grindthedistalpartandcheckthatthesurfaceisfat.
Formaximumstrength,keepaminimumPPthicknessof2to3mmunderthecup.
17 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
buIldIng up The pROsThesIs and benCh alIgnmenT 4
steps to follow:
Ankle-footbuild-upandalignment;
Socketbuild-up;
Adjustmentoflengthandweldingofconcavecylinderbutt;
Finalbenchalignment.
6Te foot, the convex ankle and the concave cylinder are attached together.
Te window in the concave cylinder must be anterior.
18 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
ankle-foot alignment
Anextra4mmplatemustbeattachedtotheconvexankle.Drilltwoholesasshownonthe
illustrationbelowandfxthetwocomponentstogetherwithaPPweldingrod.Tis will prevent
breakage of the foot bolt.
Components
19 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
preparation before fxation
Attachtheconcavecylinder(withtheopeninginfront)tothefootandtheconvexankle.
Teheelheightisadjustedaccordingtothepatientsshoe;theconcavecylindermust be
perpendicular to the ground.
Tefoothasaheelheightof10mm(maximumheelheight:15to20mm).
Te ankle alignment system allows antero-posterior movements (fexion, extension).
Tis alignment system is used to adjust the angulation of the prosthesis according
to heel height.
In any event, the concave cylinder must remain perpendicular to the ground.
20
6Tefootisadjustedin5to8
externalrotations.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Checkthealignmentonceagain
withthepatientsshoeonthefoot.
6Tesocketisattachedtothe
concavecylinderwiththeconvex
discinbetween.
6Teopeningintheconcavecylinder
remainsinfront.Tealignment
systemisinneutralpositionforthe
frstftting.
21 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Adjustthelength
accordingtothe
measurementstakenon
thepatient.
Marktheconcavecylinder
andsawoftheexcess.
Cuttheconcavecylinderat
anangleof90.
4Setthetemperatureofthe
mirrorwelderbetween
185and200C.
6HoldtheconcavecylindersonthemirrorwelderuntilarollofmeltedPPforms.
22 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Carefullybringthecylinderstogetherandapplyslightpressure.
Concave cylinders correctly welded
23 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
Concave cylinders incorrectly welded
socket alignment
Tesocketisconnectedtoaconcavecylinderwithaconvexdiskinbetween.Teconnectionis
securedbyacountersunkheadboltandfatwasherinsidethesocket,withtheT-nutinsidethe
concavecylinder.
Shifingcanoccurinalldirections:anterior,posterior,medial,lateralandcombinedmovements,
witharangeof10mminalldirections
anterior shifting Initial position posterior shifting
24 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Tealignmentsystemalsoallowsfexion,extension,abduction,adductionandrotation.
6BenchalignmentisperformedaccordingtoP&Opracticeandadjustedduringfttingandduring
thegaittrainingperiod.
25 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Beforethecosmeticismade,allthecomponentsmustbeweldedtogether.
26 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
pOlypROpylene COsmeTIC manuFaCTuRe 5
TerearetwowaysofmanufacturingaPPcosmetic.
5.1 Cosmetic with upper part of socket removed
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
27
Minus
4 mm
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddraw
alinewithapermanentmarkeronthe
topoftheconvexankleandonthetape.
4Disassemblethefootanddrawalineall
aroundtheplate4mmfromtheedge.
Grindtheedgecarefully.
28 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Checkagainwiththefoot.
Weldthetwoplatestogether,frstusingthe
weldingirontomakeagrooveandthen
weldingwiththehot-airweldinggun.
Grindagaincarefully.
manufacture of cosmetic shell
6Cutacrosstheprosthesisbelowthelevelofthehamstringtendonsandremovetheupperpart.
4SkivethePPedgecarefully.
29 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Addplastertoshapetheshank.
4Reducethecircumferenceoftheshank
by3cmtoallowforthethicknessofthe
4mmPPsheet.
Smooththeplaster.
Leavetheankleedgefree
ofplasterforthefnalwelding.
4Fixthe4mmPPreinforcementplateat
thepopliteallevelwith2nails.
4Drawanylonorcottonstocking
overtheplaster.
Addtalcumpowder.
Heatthe4mmPPsheetintheoven
at180C.
30 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Glueornail5mmPPunderthe
ankleplatetocompensatefor
retractionofthePPaferopening.
6DrapethePPundervacuum.
6CutoftheexcessPPattheweldingseam.Keepthevacuumonuntiltheplasticcoolsdown.
31 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Grindtheposteriorseamdownto
2to3mm.Inthreeplaces,leavea
wideroverlapofPPforholdingthe
prosthesisduringwelding.
4Opentheseamcarefullywithan
oscillatingsawtoavoidbreakage.
6RemovethePPshellfromtheprosthesisandremovetheplaster.Cleantheprosthesisthoroughly
toensurethatnopiecesofplasterremain.Puttheprosthesisbackintotheshell.
32 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Holdtheprosthesisina
parallelvicewithEVA
orrubberprotection
betweenthevicejaws
andthecosmeticshell.
Closethetwosidesof
theposteriorseamwith
lockgripsand/orother
suitabletools.
Beforewelding,make
V-shapedindentations
alongtheseamwitha
weldingiron.
4Tefnalweldingis
donewithahot-air
weldinggunanda
4mmPPweldingrod.
4Weldtheankletothe
shell.Aferwelding,
carefullyfattenthe
anklesurface.
33 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Polishwitharaspand/ora
sharppieceofglass.
4Attachthe4mmPP
reinforcementtotheshell
withtubularrivets.
Telaststepistofxthefootontheprosthesis.
34 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
5.2 Cosmetic with complete pp socket
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
35
Minus
3 mm
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddraw
alinewithapermanentmarkeronthe
topoftheconvexankleandonthetape.
4Disassemblethefootanddrawalineall
aroundtheplate3mmfromtheedge.
Grindtheedgecarefully.
36 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Checkagainwiththefoot.
Onceagoodfthasbeenachieved,weldthe
twoplatestogether:frstmakeagroovewith
theweldingironandthenweldwiththe
hot-airweldinggun.
Grindagaincarefully.
4Roughenthesurfaceofthesocket.
4Covertheconcavecylinderswithadhesive
tape.
37 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Shapetheshankwithplaster.
4Drawanylonorcottonstocking
overtheprosthesis.
4Glueornail5mmPPunder
theankleplatetocompensate
forshrinkageofthePPafer
thermoforming.
38 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Drapeasheetof3mmPParoundthemouldundervacuum.
4Grindtheposteriorseamdownto
2to3mm.Inthreeplaces,leavea
wideroverlapofPPforholdingthe
prosthesisduringwelding.
4Opentheseamcarefullywithan
oscillatingsawtoavoidbreakage.
4RemovethePPshellfromthe
prosthesisandremovetheplaster.
Cleantheprosthesisthoroughly
toensurethatnopiecesofplaster
remain.
39 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Holdtheprosthesisina
parallelvicewithEVA
orrubberprotection
betweenthevicejaws
andthecosmeticshell.
Closethetwosidesof
theposteriorseamwith
lockgripsand/orother
suitabletools.
Beforewelding,make
V-shapedindentations
alongtheseamwitha
weldingiron.
4Tefnalweldingisdone
withahot-airwelding
gunanda4mmPP
weldingrod.
4Weldtheankletotheshell.
Aferwelding,carefully
fattentheanklesurface.
40 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
6Grindtheseamdownto2to3mm.Polishwitharasporapieceofglass.
6Weldtheproximalpartoftheprosthesis.
Telaststepistofxthefootbackontheprosthesis.Checkthefatnessoftheankle.
41 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
eVa COsmeTIC manuFaCTuRe 6
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddraw
alinewithapermanentmarkeronthe
topoftheconvexankleandonthetape.
42 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Dismantlethefootanddrawalineall
aroundtheplate,3mmfromtheedge.
4Grindtheedgecarefully.
4Roughenthesurfaceofthesocket.
For heavy patients, reinforce the concave
cylinders with a 3 mm PP sheet.
43 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4GluelayersofEVAontheprosthesis.
4Shapetomatchthesoundleg.
LeavetheankleplatefreeofEVAforthe
fnalcosmetic.
Bearinmindthefactthatanadditional
layerof3mmEVAwillcovertheentire
prosthesis,andthatthiswillincrease
thecircumferenceoftheprosthesisby
about1cm.Atthisstage,checkyour
circumferencesbycomparingthemwith
themeasurementsnotedonthepatients
technicalcard,andreducethesizeby
1cmallover.
44 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4Cutasheetof3mmEVAaccordingtothe
circumferencesmeasured,butlongerthanthe
measurements.
Skivethesidethatwillbegluedontopofthe
foot.
SkiveonelongsideoftheEVAsheetandapply
gluetothatpart.
TurntheEVAsheetover,andcoverthis
reversesidewithglue.
4Applygluetotheentireprosthesis(exceptthe
foot).
Heatthe3mmEVAsheetintheovenat
120Cforafewsecondsuntilitbecomesvery
fexible.DonotoverheattheEVAoryoumay
accidentallymakeprintmarksonitduring
manipulation.
Takethe3mmEVAsheetoutoftheovenand
glueitovertheprosthesis,startingbygluing
theskivededgealongtheposteriorsideofthe
prosthesis.
4Tenstartgluingthe3mmEVAsheetonthe
prosthesisbyrevolvingtheprosthesisonit,
applyingconstanttensionontheEVAtoavoid
airbubblesandfolds.
45 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
4TelaststepistoremovetheexcessEVAand
togrindtheseamandtheproximaltrimline
oftheprosthesissmoothly.
46
ICRC Code Description Specifcation Unit of Measure
Trans-tibial module, child
OCPOMODUTTC Countersunk head bolt
Flat washer, steel
Trans-tibial cup
Convex disc
Concave cylinder with M8 T-nut
Convex ankle
M8 x 60 mm
D40 x d10 x H2.5 mm
D70 x H26 mm
dia. 22 mm
1 piece
1 piece
1 piece
1 piece
2 pieces
1 piece
Reference list of materials
Components: Trans-tibial module, child
ICRC Code Description Specifcation Unit of Measure
Trans-tibial module, adult
OCPOMODUTTA Countersunk head bolt
Flat washer, steel
Trans-tibial cup
Convex disc
Concave cylinder with T-nut M8
Convex ankle
M10 x 60 mm
D44 x d15 x H3 mm
D70 x H26 mm
dia. 25 mm
1 piece
1 piece
1 piece
1 piece
2 pieces
1 piece
Components: Trans-tibial module, adult
Weight per unit of measurement: 285 grams Quantity per box: 25 sets Box size: L40 x l30 x H44 cm
Weight per unit of measurement: 490 grams Quantity per box: 25 sets Box size: L40 x l30 x H44 cm
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
47
ICRC Code Description Specifcation Unit of Measure
Trans-tibial module, long stump prosthesis
OCPOMODUTTLA Flat washer, steel
Trans-tibial cup
Convex disc
Concave ankle
D44 x d15 x H3 mm
D70 x H26 mm
1 piece
1 piece
1 piece
1 piece
Components: Trans-tibial module, long stump prosthesis
Weight per unit of measurement: 130 grams Quantity per packet: 1 piece
ICRC Code Description Specifcation
Feet for prosthesis
OCPOFOOT... Foot 22 28 cm, left and right,
olive and terra colours
Heel, 10 mm
When ordering feet from 22 to 28 cm, change the number in the ICRC code and description.
4With all the adult feet a M10 bolt and a M10 lock washer are included.
4Weight per unit: (size 25) 605 grams Quantity per box: 25 pcs. Box L40 x l30 x H44 cm
OCPOFOOT... Foot 14 -21 cm, left and right,
olive and terra colours
Heel, 10 mm
When ordering feet from 14 to 21 cm, change the number in the ICRC code and description.
4With all child feet a M8 bolt and a M10 lock washer are included.
4Weight per unit: (size 19) 340 grams. Quantity per packet: 1 pc.
Components: Feet for prosthesis
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Ti bi al Prosthesi s
48
Designation Used for
Materials
POP bandage 15 cm Cast-taking
POP powder Positive mould
Contact glue Soft socket
Soap (demoulding agent) Positive mould
Talcum powder Thermoforming
Vaseline Cast-taking
Nails Positive mould
Colorant for plaster Positive mould
Cotton/nylon stockinet dia. 8 or 10 cm Cast taking and soft socket
Cotton stockinet or sock Stump sock
Welding rod PP dia. 4 mm Welding components
Polypropylene 4 mm Hard socket
EVA 3 mm Soft socket
EVA 6 mm Soft socket
Polypropylene cosmetic
Polypropylene 3 or 4 mm Cosmetic shell
Welding rod dia. 4 mm Welding cosmetic shell
Plaster powder Cosmetic shape
Adhesive tape
Tubular rivets (2) Posterior reinforcement
EVA cosmetic
EVA 3 mm; 6 mm; 12 mm
Contact glue
pp, eVa and other consumables
I CRC Physi cal Rehabi l i tati on Programme
polypropylene sheet: 2000 mm x 1000 mm
standard cuts of polypropylene sheets for lower-limb prostheses
Trans-tibial socket
4 mm
Trans-tibial cosmetic
3 mm or 4 mm
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poetsma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
Physical Rehabilitation Programme
ankle-Foot orthosis
Manufacturing guidelines
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Physical Rehabilitation Programme
trans-Femoral Prosthesis
0
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2
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Manufacturing guidelines
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poestma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP

Table of contents
Foreword 2
Introduction 4
1.Rawmaterialsandcomponents 4
2.Measurementsandsocketmanufacture 5
2.1Trans-femoralcupalignmentandsocketmanufacture 6
2.2Total-contactprosthesis 11
3.Buildinguptheprosthesisandbenchalignment 15
4.Polypropylenecosmeticmanufacture 28
5.EVAcosmeticmanufacture 38
Referencelistofmaterials 41
Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedtheuse
oftechnologythatisappropriatetothespecifccontextsinwhichtheorganizationoperates,
i.e.,countriesafectedbywarandlow-incomeordevelopingcountries.
Tetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountries
concerned.
Tetechnologyadoptedmustthereforebe:
durable,comfortable,easyforpatientstouseandmaintain;
easyfortechnicianstolearn,useandrepair;
standardizedbutcompatiblewiththeclimateindiferentregionsoftheworld;
low-costbutmodernandconsistentwithinternationallyacceptedstandards;
easilyavailable.
Techoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitation
services.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-made
orthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhich
theorganizationworks.TecostofthematerialsusedinICRCprostheticandorthoticdevices
islowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-made
components.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailable
materialssuchaswood,leatherandmetalwereused,andorthopaediccomponentswere
manufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthe
techniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweenthe
projects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprosthetic
sockets.Tefrstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents
suchasvariousalignmentsystemswerefrstdevelopedinColombiaandgraduallyimproved.In
parallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowof
polypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,afercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductionin
ordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Objective of the manuals
TeICRCsManufacturingGuidelinesaredesignedtoprovidetheinformationnecessaryfor
productionofhigh-qualityassistivedevices.
Temainaimsoftheseinformativemanualsareasfollows:
TopromoteandenhancestandardizationofICRCpolypropylenetechnology;
Toprovidesupportfortrainingintheuseofthistechnology;
Topromotegoodpractice.
Tisisanotherstepforwardintheeforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRC
AssistanceDivision/HealthUnit
PhysicalRehabilitationProgramme

Introduction
Teaimofthisdocumentistodescribeamethodformanufacturingtrans-femoral (TF) prostheses
usingtheICRCspolypropylenetechnologyasappliedatthePhysicalRehabilitationCentrein
AddisAbaba.
Tecasting,rectifcationandalignmentmethodsusedcorrespondtointernationalprostheticand
orthotic(P&O)standardsofpracticeandarethereforenotdescribedintheseICRCmanufacturing
guidelines.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Trans-femoralkitsareavailableinadultandchildsizes.
6Contentsofthekit:
SolidAnkleCushionHeel(SACH)foot
Hexagonal-headboltandlockwasher
Convexankle
Concavecylinderandpin
5 Setofwashers,nutandbolt
6 Convexdisc
7 Conicalcup
8 Trans-femoralcup
9 Kneeshell
Raw maTeRIals and COmpOnenTs 1
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
assessment, measurements and casting
measuRemenTs and sOCkeT manuFaCTuRe 2
4Tepatientisassessed,aprescriptionis
madeandmeasurementsaretakenin
accordancewithbestP&Opractice.
4Anegativecastistakeninaccordance
withusualP&Opractice.
6
2.1 Trans-femoral cup alignment and socket manufacture
4Temouldisflledtoproduce
thepositive,whichisrectifed
accordingtothemeasurements
taken.
4Chamfertheedgeofthe
trans-femoralcup.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
7 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
alignment of the trans-femoral cup
4Coverthemouldwithnylon.
Fixthenailatthebottomofthe
mould,wherethecupwillbeattached.
PlacetheTFmouldontheCR
alignmentjig;alignaccordingto
theinstructionsontheuseofthe
jig(separatemanual).Makethe
alignmentinaccordancewiththe
measurementcard.Fixthecuptothe
socketwithplasterofParis(POP).
4AddapieceofEVAatthedistalpartof
thecup.
TiswillpreventthePPfrombeing
drawninduringsuction.
Itwillalsofacilitateopening.
8
4Cutasheetof5mmPPaccordingto
themeasurements(add5cmtothe
circumferenceand10-15cmtothe
length).
LeavethePPintheovenataround
180forabout20minutes.
DrapethePPonthemouldand
openthevacuumsuction.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4CutoftheexcessPP.
LeavethevacuumonuntilthePP
coolsdown.
4Waitatleast6hoursbeforeopening.
Drawthetrimlineontheproximal
partofthesocket.
UsetheoscillatingsawtocutthePP.
Removetheplaster.
9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Grindthedistalpartofthecupdownto
theEVApad.
UseascrewdrivertoremovetheEVA.
4Grindthedistalpartuntilitisfat.
DonotremoveallthePP.
4Checkthatthesurfaceisfat.
4Grindthedistalpartuntilitisfat.
0 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Grindthesocketalongthetrimlines
withtherouter.
4Useasharppieceofglasstosmooththe
edgeofthesocket.
4Usingaconicaldrill,maketheholefor
thecottonstockingorforthesuction
valve.

6Positionthesuctionvalvemedio-laterallyanddistallytotheplastermould.
Usethesuctionvalveringtoshapetheplaster.Reducethediameterofthe
plastertoallowforthethicknessofPPused(4or5mm).Smoothitnicely
andbreaktheedge.(see2.1,page6).
2.2 Total-contact prosthesis
Terearetwowaysofmanufacturingatotal-contacttrans-femoralsocket:
1.BythesameprocedureasforaconventionalTF;
2.ByweldingtheconicalcupdirectlyunderthePPsocket.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Coverthemouldwithanylon
stocking.
Fixthecupwithplasterinthe
usualway.

3 mm
12 mm
6 mm
3 mm
Duringthefrstftting,glueapieceofEVAinsidethecupinordertoavoidairleakage.
Gluea12mmanda6mmpieceofEVAinsidethecup.Finally,usea3mmpiecetocoverthecup
andthesidesofthecup.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6Materialneededforfnishing.
6Gluethe12mmand6mmEVAdiscsinsidethecup.
6Lastly,gluethe3mmEVAallaroundthecup.

4Drillaholeaccordingtothediameter
ofthesuctionvalve.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Smooththeedgewithasharppiece
ofglass.
4Testthesuctionvalveandcheckby
addingwaterinsidethesocket.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Iftheconicalcupisused,itmustbe
adjustedtothesocketinaccordancewith
thealignment.
Usetheweldingirontomakeagroove
betweenthesocketandtheconicalcup.
4Usethehot-airweldingguntoweldthe
cuptothesocket.
Tishastobedoneverycarefullyto
avoidbreakageduringthefrstftting.
5
6Componentsfor 6 mm ankle disc only.
ankle-foot alignment
Anextra4mmplatemustbeattachedtotheconvexankle.(For 6 mm ankle disc only.)
DrilltwoholesasshownontheillustrationbelowandfxthetwocomponentstogetherwithaPP
weldingrod.(For 6 mm ankle disc only.)
Tis will prevent breakage of the foot bolt.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
The building-up and bench alignment process steps to follow
Ankle-footalignment
Socketalignment
Adjustmentoflength
Weldingofcylinders
Alignmentoffnishedprosthesis

6Preparationbeforefxationfor 6 mm ankle disc only.
BuIldIng up The pROsThesIs and BenCh alIgnmenT 3
6
6Formaximumstrengthofthe
assembly,theopeningoftheconcave
cylindermustbeinfront,andthe
reinforcementbarattheback.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6Fixationprocedure.
6Finalresultfor 6 mm ankle disc only.
7
Teanklealignmentsystemallowsdorsalandplantarfexion,medio-lateralmovementssothatthe
prosthesiscanbeadjustedtotheheelheightoftheshoe.
Tealignmentcanbeadjustedforaheelheightofbetween0mmand20mm,butaheelheightof
10mmisrecommended.
Teheelheightisadjustedaccordingtothepatientsshoe;theconcavecylindermust be
perpendicular to the ground.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Tefootisadjustedin
externalrotationsof5.
4Checkthealignmentonce
againwiththepatients
shoeonthefoot.
8
4Transferthismeasurementfromthefootupto
themechanicalknee-jointaxis.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
knee-ankle-foot alignment
6Samemeasurement.
4Temeasurementtakenonthepatientmustbe
fromthemedialtibialplateauplus1.5to2cm
totheground.
9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Drawalinewithamarkeraccordingto
themeasurementtaken.
Makeanothermark9cmfromthefrst.
Tiscorrespondstothebottomofthe
concavecylinderminus1cm.
4Usethepipecuttertomakethecut.
Smooththeedges.
4Payspecialattentiontotherotationof
theknee-jointwiththefoot.
Heatthedistalpartofthepipewiththe
hot-airweldinggun.
Usearubbermallettoinsertthe
knee-jointintotheconcavecylinderas
farasthemark.
0 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
socket and bench alignment
length adjustment for normal stump length
Tesocketisconnectedtotheconicalcup(aferlengthadjustment)withaconvexdiscinbetween.
Teconicalcupisweldeddirectlyontopofthekneejoint.Teconvexdiscallowsabduction,
adduction,fexion,extensionandshifinginalldirections.
6Checkthealignmentandadjusttheconicalcupaccordingtothemeasurementstaken.
Cup opening in front
CORReCT
Cup opening at back
InCORReCT
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6Teforcepatternsonheelstrikeareasshownintheseillustrations.
Breakagescanhappeneasily.
6Makesuretheconicalcupremainshorizontalinbothplanesbeforeweldingit.
Checkalsokneealignmentandfootrotation.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Tetemperatureofthemirrorshould
bebetween185and200C.
4Holdthecylinderonthemirrorwelder
fornomorethan5minutesuntilaroll
ofmeltedPPisformed.
Weldaccordingtothemarksandapply
slightpressure.
welding the cylinders
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
length adjustment for a short stump
1.Tesocketisconnectedtotheconicalcupwithaconvexdiscinbetween.
2.Tesecondconicalcupisconnectedtotheknee-jointwithanotherconvexdiscinbetween.
3.Oncetheheighthasbeenadjusted,theconicalcupscanbeweldedtogether.
Staticordynamicalignmentcanbedoneeitherabovetheknee-jointorbelowthesocket.
length adjustment for a long stump: pay attention to minimum dimensions (see below)
A 22mmforconvex/concaveplates
B 40mmminimumdistancebetweenconnectionsurfaceandaxisoftheknee

A=22mm(minimum)
B=40mm
Dimensionstobedetermined:
A deviceforadjusting
alignment
B distancebetweenupper
partoftheknee-jointand
kneeaxis
A B
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6
med. laT. anT. posT. anT. posT.
anT. posT. anT. posT. med. laT.
Final prosthesis alignment
6ModularPPtechnologyallowsslidingandtiltingduringalignment.

I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
neutral position Flexion extension
6Backwardoranteriorshifingispossible.Shifingcanalsooccurmediallyorlaterally.

7 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Belt manufacture
Duringthefrstfttingwiththepatient,themeasurementforthebeltistakenfromthegreat
trochanter,aroundthewaistandabovetheoppositeiliaccrestasfarasScarpastriangle.
Tebeltcanbeeitheraleatheroracottonstrap,fxedwitha16mmbuckle.
Add15cmtothemeasurementtakenonthepatienttoallowforadjustmentduringftting.

8 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
pOlypROpylene COsmeTIC manuFaCTuRe 4
6Allcomponentshavetobeweldedtogether.

6Drilla5mmholeintheconcavecylinderand
thepipe.

6Fixtheexpansionpin.

9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4RemovetheexcessPPforfnishingat
theankleplate.
4Drawalinefollowingtheshapeof
thefoot.
4Disassemblethefoot.
0
Minus
mm
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6Checkyourmarkandgrinditcarefuly.Checkoncemoreagainstthefoot.

4Stickadhesivetapeonthefootandmake
amarkwithapermanentmarkeronthe
topoftheconvexankleandonthetape.
4Removethefootanddrawalineall
aroundtheplate4mmfromtheedge.
Grindtheedgecarefully.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Checkagainwiththefoot.
Onceagoodfthasbeenachieved,weld
thetwoplatestogether:frstmakea
groovewiththeweldingironandthen
weldwiththehot-airweldinggun.
Grindagaintoobtainasmoothfnish.
6Forheavyandactivepatients,astripof3mmPPcanbedrapedaroundtheconicalcupand
alignmentsystemforextrastrength.Useanelasticbandagetotightenitwell.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4WhenthePPhascooleddown,grind
theedgesandweld.
4Protecttheknee-jointwithadhesive
tape.
Grindthesocketwithsandpaperto
roughenit.
FillthesocketwithPOPinordertofx
thepipe.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Shapethesocketwithplaster
accordingtothemeasurement.
4Smooththeplasterandcoverit
withastocking.
4Drape4mmPParoundthe
socketinthesamewayasforthe
frstsocket.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6OncethePPhascooleddown,removetheproximalpart.
Usetheoscillatingsawtoopentheseam.
Removetheplasterandcleanupthesocket.
Trimtheshellproximallyanddistallyinlinewiththesocketandtheknee-joint.
Replacetheshellonthesocket.
Weldtheseam.
Weldtheproximaledge.
Weldtheshelltotheknee-joint.
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Whentheweldingiscompleted,
removetheexcessPP.
Grindtheseambetweenthe
shellandtheknee-joint.
Teseammustbeground
almostfushwiththesocket.
Grindtheproximaledgeofthe
socket.
Tesethreepartsmustthenbe
polished.
4Protectthepipeandtheknee-joint
withtape.
4ShapetheshankwithPOPand
drapeasheetof4mmPPoverit.
6 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Opentheshellandremovethe
plaster.
4Inserttheprosthesisintothe
cosmeticshell.
Determineandgrindthe
proximaltrimlineformaximum
fexionoftheknee-joint.
4Weldtheseamandtheankle
connection.
7 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Grindandsmooththewelding.
6InsertanEVAwashercuttothesameshapeastheshankabout10cmbelowthe
knee-jointtokeepthecosmeticshankinplace.Tiswillalsopreventcreaking.
4Fixtheknee-jointbackontotheshank.
Fixthebelt.
8 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
eVa COsmeTIC manuFaCTuRe 5
6RoughentheEVAbeforeapplyingittothePPsocket.GluelayersofEVAonthesocketandshapeit.
Afnallayerof3mmEVAwillcovertheentireprosthesis,increasingthecircumferenceby1cm.
4Cutasheetof12mmEVA
correspondingtothecircumference
ofthewoodenorplastermodel
shank.SkivebothsidesoftheEVA
andglue.
9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4PlacethesheetofEVAintheoven
atabout120untilitbecomessof,
thenbendittoobtainaconical
shape.Addtalcumpowderinside
theconeandputitbackintheoven.
4PulltheEVAconeoverthemodel
shankandtightenitwithanelastic
bandage,oruseavacuumsystem.
4Cuttheposteriorproximaledgeto
allowfexionoftheknee-joint.
0 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
4Tip:forfnishingpurposes,windatape
aroundtheproximalaspectofthefoot
topreventdamagetothefootcosmetic
duringgrindingoftheEVA.
4Shapetheshankaccordingtothe
measurementstakenonthesoundleg.
Tenglueitdistallyontopofthefoot.
InsertanEVAwashercuttotheshape
oftheshankabout10cmbelowthe
knee-jointtokeepthecosmeticshank
inplace.
Fixtheshanktothesocket.Fixthebelt.

I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Reference list of materials
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
6 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
7 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Trans-Femoral Prosthesi s
Designation Used for
Materials
POP bandage 15 cm Cast-taking
POP powder Positive mould
Contact glue Soft socket
Soap (demoulding agent) Positive mould
Talcum powder Thermoforming
Vaseline Cast-taking
Nails Positive mould
Colorant for plaster Positive mould
Cotton/nylon stockinet dia. 8 or 10 cm Cast-taking
Cotton stockinet or sock Stump sock
PP welding rod dia. 4 mm Welding components
Polypropylene 5 mm Hard socket
Polypropylene cosmetic
Polypropylene 4 mm Cosmetic shell
PP welding rod dia. 4 mm Welding components
POP powder Cosmetic shape
Adhesive tape
EVA cosmetic
EVA 3 mm; 6 mm; 12 mm
Contact glue
pp, eVa and other consumables
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poetsma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
Physical Rehabilitation Programme
ankle-Foot orthosis
Manufacturing guidelines
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alignment Jig For
lower-limb Prosthetics
Physical Rehabilitation Programme
Manufacturing guidelines
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MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poestma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
1
Table of contents
Foreword 2
Introduction 4
1.Useofthealignmentjig 5
1.1Descriptionofthejig 5
1.2Possiblemovementsforpositioningthepositiveinspace 6
2.Installationofthejig 8
3.Choiceandlocationofcentringaccessories 9
4.Someexamplesofuse 11
4.1Trans-tibialsockets 11
4.2Trans-femoralsockets 13
Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
2 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedtheuse
oftechnologythatisappropriatetothespecifccontextsinwhichtheorganizationoperates,
i.e.,countriesafectedbywarandlow-incomeordevelopingcountries.
Tetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountries
concerned.
Tetechnologyadoptedmustthereforebe:
durable,comfortable,easyforpatientstouseandmaintain;
easyfortechnicianstolearn,useandrepair;
standardizedbutcompatiblewiththeclimateindiferentregionsoftheworld;
low-costbutmodernandconsistentwithinternationallyacceptedstandards;
easilyavailable.
Techoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitation
services.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-made
orthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhich
theorganizationworks.TecostofthematerialsusedinICRCprostheticandorthoticdevices
islowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-made
components.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailable
materialssuchaswood,leatherandmetalwereused,andorthopaediccomponentswere
manufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthe
techniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweenthe
projects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprosthetic
sockets.Tefrstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents
suchasvariousalignmentsystemswerefrstdevelopedinColombiaandgraduallyimproved.In
parallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowof
polypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,afercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductionin
ordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
3 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
Objective of the manuals
TeICRCsManufacturingGuidelinesaredesignedtoprovidetheinformationnecessaryfor
productionofhigh-qualityassistivedevices.
Temainaimsoftheseinformativemanualsareasfollows:
TopromoteandenhancestandardizationofICRCpolypropylenetechnology;
Toprovidesupportfortrainingintheuseofthistechnology;
Topromotegoodpractice.
Tisisanotherstepforwardintheeforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRC
AssistanceDivision/HealthUnit
PhysicalRehabilitationProgramme
4
Introduction
Everymanufacturingtechniquehasitsownspecifcrequirements.Tetechniquebasedontheuse
ofpolypropylenewhichhasbeendevelopedbytheICRCsphysicalrehabilitationprogrammeisalso
subjecttothisrule;itmustcombinequality,easeofuseandlowcost.
Tecomponentsfortrans-tibial(TT)andtrans-femoral(TF)prosthesesproducedbyCR
EquipementsSA(CRE)allowforcertainangularandtranslationadjustments,butthesepossibilities
arelimited:
20mmintranslationorsliding(2x10mmeachsidefromtheneutralpoint)
20degreesintilting(2x10oneachsideofthemedianaxis).
Itisadvisabletoretaintheseadjustmentpossibilitiesfordynamicalignment,andtotakeinto
accountthefactthatstaticalignmentfollowstheweight-bearingreferencelinestoachieveaneutral
position.
Inmostofthetechniquesusedforsocketmanufacturewithpolypropylene,theconnection
component,calledthecup,isincludedinthesocketduringthethermoformingphase.Itisthelink
thatholdstheotherpartsoftheprosthesistogether.Usingthistechniquemeansthatthealignment
mustbeadjustedBEFOREthesocketthermoformingprocess.
Anothertechniqueallowstheproductionoffull-contactsockets.Faultypositioningofthe
connectingcomponent(thesocketcup)duringweldingmakesalignmentdifcultorimpossibleto
achieve.
Particularattentionmustthereforebepaidtowhethertheconnectingcuporsocketcupisplacedon
thepositivebeforeoraferthethermoformingphase.
AspecialtoolhasbeendesignedandmanufacturedbytheICRCandCREtohelpprostheticand
orthotic(P&O)technicianscompletethesealignmentphaseseasilyandwiththerequiredprecision.
Tistoolisthealignmentjig.
Objective of this document
Tepurposeofthisdocumentistodemonstratetherelevanceandusefulnessofthealignmentjigfor
obtaininghigh-qualityresults.
TealignmentprinciplesappliedarebasedoninternationalP&Ostandards.
Remark
TisdocumentisnotatechnicalmanualonthemanufactureofTTandTFprostheses.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
5 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
1.1 Description of the jig
Tealignmentjigisastainlesssteelframeabout2metreshighand0.8metreswide.Itissturdyand
stable.
Use OF The alIgnmenT jIg 1
Positioning phase Fixation phase
6Tepurposeofthejigistofacilitatethe
positioninginspaceofthepositiveplaster,
andtoholdtheconnectioncup(orsocket
cup)frmlyandpreciselyduringtheoperation
tofxittotherectifedpositivewithplaster
(orbywelding).
Obviously,thisfxationphaseisindependent
ofthetypeofsocketused:theillustration
showsTTprostheseswithandwithoutsof
socket.
6
4Inthecentreofthejigtherearetwo
componentswhichallowthepositioning
inspaceandimmobilizationofthe
plasterpositiveinrelationtothe
positionoftheconnectioncup.
Atthetop:theballandsocketjoint.Tis
allows:
suspensionandimmobilizationofthe
positive;
rotationaroundthepipeaxis;
forward,backwardandlateral
movements.
Below:thetray.Tisimmobilizesthe
connectingpart(cuporsocketcup).
Teheightofthetrayisadjustable.Itis
fxedonaverticalaxis,whichrepresents
thelegpartofthefutureprosthesis.
Tohelpthetechnicianvisualize
thecomponentpartsofthefuture
prosthesis,aprostheticfootisfxedto
thelowerendofthisaxis.
Tealignmentprinciplesare
independentofheight.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
1.2 Possible movements for positioning the positive in space
4Longitudinalmovements.
4Lateralmovements.
4Ballandsocketrotation.
7 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
4Lockingoflongitudinal
movements.
4Gradientofthepipe.Te
pipecandescribeacone
ofabout30atthesummit
(about15aroundthe
verticalline).
4Teballandsocketallows
correctpositioningofthe
positiveevenwhenthepipe
iswronglyplaced.
4Ballandsocketdetailsand
blockingscrew.
Lockingofrotationand
gradientofthepipecarrier.
Lockingoflateral
movements.
Tighteningofthepipe.
8
Twoprecautionsmustbetakenbeforestartingtousethejig:
Checkwithaspiritlevelthatthecentralbeamsupportingtheverticalaxis(whichinturn
supportsthetray)isperfectlyhorizontal,andmakeanynecessaryadjustmentsbymeansofthe
adjustablefeet.
Installplumblinesbeyondtherangeofmovementsofthepipecarrier.
Byestablishingfrontalandsagittalplanes,theseplumblinesallowexactapplicationoftheprinciples
ofalignment.
InsTallaTIOn OF The jIg 2
4Frontalandsagittalplanes
areestablishedwithplumb
lines(4x)beyondthe
movementsofthepipe
carrier.
4Checkwithaspiritlevel
thatthecentralbeamis
perfectlyhorizontal;adjust
bymeansofadjustablefeet.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
9 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
(A)The tray
ChOICe anD lOCaTIOn OF CenTRIng aCCessORIes 3
4Tetrayhas3holesM8.
Teholesituated2cmfrom
thecentreisusedforadultTF
alignment
Tecentralholeisusedforadult
andchildTT.
Teholesituated1cmfromthe
centreisusedforchildTF.
WhenusedforadultTF,
thepositivesagittalplanis
perpendiculartothecentral
beam,andwhenusedforchildTF,
themainlineofthisbeamisthe
sameasthepositivesagittalplane.
Positive front for adult size
P
o
s
i
t
i
v
e

f
r
o
n
t

f
o
r

c
h
i
l
d
-
s
i
z
e

B
K
()Production by means of the cup (use of the centring cylinder)
Positive front
Positive rear
6AdultandchildTTalignment. 6AdultTFalignment.
10
Positive front
Positive rear
6TFchild-sizealignment. 6Teconnectingcuponthetray.
(C)Production by means of the socket cup
Tesocketcupmakesitpossibletomanufacturefull-contactsockets(withcontactontheentire
surfaceofthestump,includingtheextremity).
Teprinciplesarethesame;onlytheaccessoryisdiferent.
6Teaccessoryforcentringthesocket
cupispositionedforTTinthe
centralhole.
6Tesocketcupispositionedfor
adultTF.
5Centralbeammainline.
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
11 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
sOme examPles OF Use 4
sockets without terminal contact
Teconnectioncupisassembledwiththepositivebeforethesocketthermoformingoperation
(methodmostfrequentlyused).
4.1 77 sockets
(A) alignment of a short TT positive (right)
6Posteriorview:Tepictureistakenofthepositivewithoutsofsockettomaketheshapesand
marksofthepositivemoreclearlyvisible.Tepresenceorabsenceofasofsockethasnoefecton
thealignmentprinciples.
View before joining View after joining
12
6Lateralview:
View before joining View after joining
() alignment of a long TT positive (left)
lateral view before joining Posterior view before joining
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
13 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
4.2 7F sockets
(A) Parameters to be observed between the CRe knee and the alignment jig
a=22mm(minimum)
b=40mm
Dimensionstobedetermined:
a deviceforadjusting
alignment
b distancebetweenupperpart
ofthekneeandkneeaxis
a b
6Tereisa2cmgapbetweenthe
socketfxationscrewandtheknee
axistotakethefexumintoaccount.
6Tekneeaxisisonthesame
verticallineasthepipe(thepart
belowtheknee).
Tesamepositioningfeaturesarefoundonthealignmentjig.
14
() long stumps
6Itispossibletoadjustthedistancefromischiumtokneewhentheconnectioncupisbeingfxed
bycalculatingheightainadvanceaccordingtothedetailsgivenabove.
Posterior view before joining side view after joining
a
I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
15 I CRC Physi cal Rehabi l i tati on Programme Manuf actur i ng Gui del i nes Al i gnment Ji g f or Lower -Li mb Prostheti cs
(C) short stumps
FuII-contact sockets
Teconnectingelement(thesocketcupinthiscase)isassembledwiththesocketaferthe
thermoformingoperation.
Warning:Specialcaremustbetakenwhenthesocketcupisusedastheconnectingcomponent
withthecontactsocket,forthesafetyofthepatient.Indeed,inordertostrengthenthewelding
betweensocketandcupaferthermoforming,thesocketmustbecarefullyadjustedasshowninthe
illustrationabove.
Ten,toensurethepatientssafety:
theweldingshouldbeperformedwithparticularcare;
thepatientshouldnotbelefaloneduringthefttingandrehabilitationphases;
polypropylenemustbeusedforfnishingsoastoformanexoskeletonthatguaranteesthe
solidityoftheprosthesis.
16
Tesocketcupiseasytouse:
Alignthesocketaccordingtothepossibilitiesoferedbythejig.
Installinthetraythecentringdevicedesignedforsocketcups.
Cutthesocketcupatthedesiredlengthandgiveittheappropriateshape.
Weldthesocketcuptothesocketlightlywithaweldingiron.
Removetheassemblythusobtained.
Endwithcarefulwelding.
(A) TT socket
short TT socket (side view) long TT socket (posterior view)
short TF socket (posterior view)
long TF socket (side view)
() TF socket
I CRC Physi cal Rehabi l i tati on Programme
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean Franois Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poetsma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
ICRC, September 2006
All photographs: ICRC/PRP
Physical Rehabilitation Programme
ankle-Foot orthosis
Manufacturing guidelines
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