Impact of physical growth and development on paediatric lower-limb prosthetic provision: prosthetist perspectives and clinical casefile analysis from Cambodia

Abstract

Introduction: Growth affects prosthetic provision in children, leading to socket fit issues and prosthetic length discrepancy. Despite increasing numbers of paediatric amputations, no studies have systematically analysed clinical casefiles or interviewed prosthetists to identify growth-related challenges and mitigation strategies, particularly in low-resource environments where polypropylene (PP) technology is used. This study addresses this gap by interviewing prosthetists and analysing clinical casefiles. Methods: This study combined qualitative interviews with Cambodian prosthetists and analysis of 62 clinical casefiles. Casefile analysis documented growth-related issues, adjustment methods, and time between interventions. Thematic analysis was applied to interviews. Results: Five themes were identified, highlighting that: sockets and their use can account for growth through careful oversizing and using liners/socks; handcrafted adjustments that rely on thermoplastic technology can also accommodate for growth; lack of adjustment increases waste and clinical attendance; poor socket fit causes pain and residual limb problems; and growth issues result in universal problems of socket fit issues and prosthetic length discrepancy. Discussion: This study is the first to interview paediatric prosthetists to assess growth related challenges, identify mitigation strategies and combine these qualitative findings with hard clinical evidence. PP prosthetic systems offer cost-effectiveness and increased adjustability compared to modular components and carbon fibre sockets. However, this adjustability is still limited, leading to waste of resources and increased clinical time. Finally, longer-than-recommended replacement timelines are concerning, and more research is necessary to understand these longer delays. Addressing these limitations is crucial, particularly in low-resource environments, to improve accessibility and prevent secondary impairments