Case Report: Glidewear Patch on a bilateral below the knee amputee with ulcers on her knees from shear forces Charles Kuffel CPO, FAAOP Kevin L Hines CPO Patient Demographics: Name: Mrs. X Age/sex: 54 yrs/female Primary diagnosis: Bilateral below knee amputee from complications from type 2 diabetes and neuropathy of her lower extremities. Case Overview: The referenced patient is a bilateral transtibial amputee. She presents with type II diabetes with complications resulting in her first transtibial amputation on the left side approximately 7 years ago. She had been a full time prosthetic user since shortly after that first amputation with a K3 functional level. This past year, patient had her right leg amputated below the knee after multiple complications of a wound. Patient was fit with bilateral transtibial prosthetic sockets with gel locking liners. Patient has returned to normal activities of daily living after fitting and break in period in her new bilateral transtibial prosthetics. She continues to function as a full time wearer at a K3 functional level. Patients only issue since being fit was consistent skin break down over her patella’s bilaterally from shear forces between patients skin and the gel locking liners. Treatment Protocol: Following patient’s initial fitting in her bilateral sockets, patient was refit into cushioning liners and suction sockets with multi‐surfaced flexible inner sockets to increase suspension and reduce rotational and shear forces between patient’s skin and the prosthetic gel liners. Patient continued to have skin break down over both of her patellas from skin traction during sitting. Normal prosthetic techniques such as lubricated gels, socks or sheaths beneath the interface liners were used to try and address the areas of concern. Although lubricated gels, socks and sheaths were helpful when used beneath the liner, they did not provide adequate relief from shear to keep patient from having skin break down. The use of the socks and sheaths also caused distal migration of the liner and loss of suspension. A patch of a shear reducing material was placed between patient’s patella and the cushioning gel liners. The material was used to spot reduce the shear forces over patients patella’s that are causing her to have skin break down. Interface liners are fabricated in a linear fashion but undergo multiple plane disfiguration during dynamic prosthetic use. This pushing and pulling between the skin, liner and socket can created areas of shear leading to skin disruption. The use of the patches has allowed patient to spot reduce shear over her patellas. Patient healed her open areas and has maintained healed status since being fit with the patches. Ongoing Management: Mrs. X continues to function as a K3 ambulator working full time and often spending 12‐14 hours a day using her bilateral transtibial prosthetic limbs. She uses shear reducing fabric over har patellas and underneath her gel liners. The use of these patches has allowed patient to function at her highest possible level without the incidence of reoccurring skin disruption.