Dale’s conclusion is that with the advent of liners, I no longer need to load the patellar tendon. In fact, if I relieve the patellar tendon it is able to fully fire. Once I relieve the tendon, the quadriceps are allowed to gain strength and more normal extension is achieved at midstance. With these concepts, I, along with others, have hypothesized that this may be the missing link to a normal gait pattern rather than a “normal amputee gait pattern”.
Armed with my new-found knowledge, I went back at my office and tried it on my first, brave patient volunteer. The patient was in a socket with a very tight AP─so tight, that it actually caused a bulge in the popliteal area. He said he mostly just sat around because it was too painful to walk any distance. I casted him with the two-part high tension cast that the RCR mandates and had him weight bear through the cast. As he was putting weight through the cast, a smile crossed his face; this was the first time he was truly comfortable. I knew at that point not to do too much to the cast because I could mess up the fit. I followed the modifying instructions and enhanced my cast accordingly. The process did not take a great amount of time, and it gave me the confidence that I had a great fitting socket. The patient returned, and I was able to quickly align the prosthesis and allow the patient to leave on the copolymer check socket. I followed up with the patient in one week, and he had increased his activity level and kept telling me he was so amazed to not have pain. After this experience with the RCR, I knew that all my transtibial patients deserved to experience the comfort and freedom it offers.