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  • Writer's pictureGainesville Prosthetics

Residual Limb Volume Management

Managing the volume of your residual limb is a key part of wearing your prosthesis effectively, comfortably, and consistently, as well as preparing you to receive a prosthesis if you are early in the process. While managing volume could be considered most important in the immediate post-operative period, limb volume fluctuates throughout the day for many individuals even after years of using their prosthesis. It is best practice to begin managing limb volume early in the surgical recovery process both to speed up the process of receiving a prosthesis and so that good habits are established and can be maintained for as long as you use your prosthesis.

Limb volume varies depending on the individual; some may experience constantly fluctuating volume, some may experience far more loss in volume than gain, and some may experience little variation at all. The immediate post-surgical period is both the best time to establish limb volume management habits and to gather some idea on how your limb specifically changes in volume. Below is a table detailing common reasons for limb volume loss or gain.

Note that these fluctuations occur most often while you are using your prosthesis; in the weeks or months following your surgery when you are not using a prosthesis, you are much more likely to experience volume gain than loss. It is for this reason that shrinkers and ACE bandages are so important in the immediate post-surgical period.

Immediately following your surgery and throughout the healing process, your limb will inevitably swell; this is a normal response from the body due to the trauma of surgery, but must be addressed in order to promote healing and the eventual use of prostheses. Excessive swelling increases tension on your wound and limb, slowing the healing process and keeping your limb in an abnormal shape, both of which delay the start of your prosthetic journey. The keys to reducing swelling are activity, elevation, and compression. Shrinkers and ACE bandages provide this essential compression.

Limb volume can be managed through a number of ways, including shrinkers, ACE bandages, and socks, with socks being worn with a prosthesis and the former two worn without. Shrinkers are breathable compression garments most often made of cotton or wool; they are worn directly on your limb and can be the easier and more consistent option as they can be worn for long periods without necessarily needing to be adjusted, such as while sleeping. For more information on shrinkers, please refer to our in-depth educational post specifically dedicated to them.

In contrast, ACE bandages are elastic bandages wrapped around the limb. They typically need to be adjusted or reapplied every couple of hours, but can provide more localized compression or a more specific fit for the uniqueness of your limb if that is your preference. Because of this, when applied "optimally," some individuals consider ACE bandages more effective for compression than shrinkers. The decision is entirely yours based on your preference and there is no wrong answer; either or both can be used to effectively manage limb volume. Below are graphics providing step-by-step instructions on applying an ACE bandage for both transtibial and transfemoral individuals.

Transtibial ACE Bandage Instructions

Transfemoral ACE Bandage Instructions

ACE bandages may be used one at a time or two at a time for stronger or more targeted compression. Ensure you use medical tape or velcro to secure the bandage rather than metal clips or pins, which can puncture the skin. Many ACE bandages come with velcro already attached. Avoid adhesive gauze, especially when your wound is not fully healed.

When wrapping the bandage, apply the most pressure to the bottom of your limb and less pressure as you go up your limb if you are a transfemoral patient. If you are a transtibial patient, apply the most pressure to the bottom of your limb and less pressure on the thigh. Ensure the bandage is not wrapped too tightly on the knee; you should be able to freely and comfortably bend and straighten your knee, and should try to keep your knee straight as often as possible. Try to have at least two layers across the entirety of the bandage, but especially on the lower portion of your limb. Avoid wrinkles or kinks as well as horizontal turns of the bandage, which can restrict blood flow more than is necessary. Remember, the purpose of compression is to reduce blood flow, not to restrict it.

While awake, remove and rewrap the bandage every 3 to 4 hours or earlier as needed to avoid skin irritation and ensure proper compression. The bandage should never cause pain; if it does, remove the bandage and try rewrapping the bandage more loosely. If the bandage hurts no matter how you apply it or is causing skin issues, cease use immediately and contact your physician.

Another important tool to manage residual limb volume once you have received your prosthesis is prosthetic socks. Prosthetic socks are typically cotton garments that are worn while wearing your prosthesis, most commonly over your liner and directly connecting with the inside of the socket. Socks come in different plys, or levels of thickness, can be stacked, and are added and removed as needed to manage limb volume fluctuations throughout the day. The table above provides common reasons for volume changes and notes how you should add or remove socks in response. For more detailed information on prosthetic socks, please refer to our educational post dedicated to them.

When to add a prosthetic sock

When to remove a prosthetic sock

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