Abstract:
A dynamic variable geometry fitting system with fluid-filled bladders and automatically regulating their volumes to provide a continuously secure fit. This system can vary volume continuously to accommodate natural variation in an amputee&#39;s residuum. It makes reliable suction retention of a prosthesis easier for the prosthetist to achieve while reducing the potential for tissue lesions. By maintaining a continuous, secure fit, the amputee&#39;s sense of confidence and willingness to use the prosthesis increases.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]    This application claims priority of Provisional Application No. 60/199,574, entitled Lower-Limb Prosthesis Socket System and Its Production and Use filed on Apr. 25, 2000, and which is incorporated herein by reference. 
     
    
     STATEMENT OF GOVERNMENT INTEREST  
       [0002] This invention was made with U.S. Government support from the National Science Foundation and National Institutes of Health Small Business Innovation Research programs. 
     
    
     
       BACKGROUND OF THE INVENTION  
         [0003]    This invention relates generally to a dynamic variable geometry fitting system for continuously maintaining a secure fit of an external appliance to a body segment, and, more particularly to, a variable geometry system for use with a lower-limb-prostheses.  
           [0004]    Lower-limb amputees typically have difficulty maintaining a comfortable, yet secure attachment of their prosthesis to their residual limb (residuum). The volume of the residuum fluctuates both throughout the day and periodically as a result of normal physiological mechanisms. The amputee can detect very small changes in residuum volume. These volume variations often will decrease stability and cause maldistribution of weight-bearing forces, increase locomotion effort, exacerbate insecurity and even cause detachment of a suction-retention socket.  
           [0005]    The socket is the mechanical connection between a lower-limb prosthesis and the amputee&#39;s anatomy. As such, the quality of socket fit is usually the most critical determinant of the amputee&#39;s satisfaction with his prosthesis. The precise fitting of the socket and the maintenance of a precise fit are extremely important to the amputee&#39;s comfort, skin integrity, sense of ambulatory security and stability, and locomotion effort.  
           [0006]    When an adequate socket fit is finally obtained by the prosthetist, frequently after much trial and error fitting often requiring several check sockets, this fit cannot easily be maintained. Modern fabrication techniques using advanced tools such as CAD/CAM may reduce the iterations required to achieve an initial socket fit. Even using these techniques, initial precise socket fit is frequently lost due to natural volumetric changes of the residuum. Unfortunately, such volumetric change of the residuum is unavoidable. Such change can occur hourly, daily and monthly. For many amputees, the residuum is in a constant state of volumetric flux.  
           [0007]    Modern Medial-Lateral (ML) transfemoral (TF) sockets are very sensitive to residuum volume variations which can cause, late in the day, intolerable pain in the groin. This is because the M-L socket is designed to carry about 40% of the load with soft-tissue hydraulic pressure and about 60% by ischial tuberosity support. When the tissue shrinks, the hydraulic support diminishes rapidly. The volume shrinkage then drops the TF residuum into the socket causing its medial brim to load excessively the tissue over the ischial ramus and adductor longus.  
           [0008]    A volume change of just 0.2% in a 1500 ml transfemoral total-contact socket can alter the amputee&#39;s perception of ambulatory security. Further, a volume change of 1% was sensed as a “sloppy fit” by wearers of transfemoral (TF) total-contact, suction-retention sockets. A volume change of 5-6% can cause detachment of a suction-retention socket.  
           [0009]    Transtibial (TT) amputees typically have a diurnal variation in residuum volume that requires the addition of one to several single-ply stump socks, from morning to evening, in order to maintain a tight fit. For the typical TT residuum (girth=100 mm; L=150 mm) and stump sock thickness (t=2 mm), two of these sock additions can amount to a volume change of about 2.7%. A residuum volume change of such magnitude, without compensation, is intolerable. For this reason, some TT amputees must continue to don greater numbers of socks during the day in order to maintain a satisfactory fit. Large and frequent volumetric changes of the TT residuum make it difficult to achieve and maintain proper socket contact pressures and compression.  
           [0010]    Consequently, TT amputees are often unable to utilize effectively and benefit from the suction-retention socket, which requires a tight, non-leaking fit in order to maintain the suction needed to retain the TT prosthesis. This consequence is very unfortunate because a poorly fitting suction socket is usually intolerable, so such afflicted TT amputees may be forced to abandon use of their prostheses. The efficacy of both TF and TT lower-limb prostheses is often reduced due to uncompensated soft-tissue volume variations, which are unavoidable and occur regularly.  
           [0011]    Further, suction pressure during the swing phase and positive pressure during the stance phase, of the walking cycle, with a suction socket, has been shown to be beneficial to the TT amputee&#39;s residuum skin and tissue health. Severe lesions, cysts and abrasion have actually been cured by use of a suction socket by TT amputees. This is especially true with a dysfunctional vascular system in the residuum, and such vascular dysfunction is the leading cause of TT amputations.  
           [0012]    A further difficulty with all of these present day socket-fitting means is that when the residuum swells, the intra-socket pressure will become intolerable when the residuum swells, and could even result in ischemia (i.e., pinching of the capillaries stops blood flow to tissue), if the socks are not removed in a timely fashion.  
           [0013]    Today, prosthetists most often manage residuum volume shrinkage by adding socks, making new sockets or by internal padding of existing sockets. These approaches are entirely inadequate to accommodate natural diurnal volume changes and the weekly and monthly volume variations of the ill, the diabetic, the kidney dialysis patient and the menstruating woman. Furthermore, the accommodation of residuum atrophy of new amputees, accomplished by manufacturing multiple sockets, is very expensive, even using modern CAD/CAM fabrication.  
           [0014]    Many different types of variable-volume sockets have been proposed and tried, but none of these apparatuses address adequately the fundamental problem of automatically adjusting for volumetric change of the residuum.  
           [0015]    It is the object of this invention to provide a dynamic variable geometry fitting system for use in, for example, lower-limb prostheses that continuously maintains a secure fit of an external appliance to a body segment.  
           [0016]    It is a further object of this invention to provide a variable geometry system for use in lower limb prostheses, which automatically accommodates to the amputee&#39;s normal variation in residuum volume while maintaining a secure fit.  
           [0017]    It is still a further object of this invention to provide a low-compliance attachment between the amputee&#39;s residuum and the prosthesis and which reduces the portent of tissue damage and/or discomfort as well as reducing incidences of instability and insecurity due to poor fit.  
           [0018]    It is even another object of this invention to provide a system that improves for the prosthetist the reliability of fitting suction-type sockets and reduces the extent of trial-and-error fitting.  
           [0019]    It is still another object of this invention to provide a continuously adjustable prosthesis attachment to the anatomy, which accommodates natural, physiological volume changes of the amputee&#39;s residuum.  
           [0020]    It is yet another object of this invention to provide a means for employing and automatically regulating fluid fill in bladders within a prosthesis socket.  
           [0021]    It is a further object of this invention to resolve stump-volume sensitivity.  
           [0022]    It is still a further object of this invention to provide a means for increasing appliance volume for easy donning and doffing of the appliance.  
           [0023]    It is another object of this invention to provide a dynamic variable geometry fitting system for maintaining secure fit of external appliances, such as shoes, boots, braces, wraps, garments to various body segments of humans and other animals.  
           [0024]    It is a further object of this invention to provide a device for improving comfort of an external appliance applied to the body of humans and other animals by allowing dynamically adjustable pressure regulation.  
         SUMMARY OF THE INVENTION  
         [0025]    The objects set forth above as well as further and other objects and advantages of the present invention are achieved by the embodiments of the invention described hereinbelow. Briefly stated, the present invention provides a means for achieving dynamically variable geometry adjustable fit of an external appliance to a body segment of a human or other animal. For example, one embodiment of the present invention gives prosthetists a dynamic fitting system the use of which will provide lower-limb amputees with prostheses that maintain automatically a secure and comfortable fit throughout normal residuum volume fluctuation. The system employs the advantages of using incompressible fluid fill in the bladders rather than compressible gas fill. One or more of the bladders serves as a pump, energized by walking, for example, which is regulated by a control system. Once donned, the entire system requires neither manual intervention nor an outside power source to function. This embodiment of the present invention adjusts the socket volume automatically in order to maintain a proper fit on a transfemoral (TF) or transtibial (TT) residuum or other body-fitting appliances. However, the dynamic variable geometry fitting system is adaptable to other body appliances such as ski boot, boots (including sports boots), shoes, sneakers, prosthetic appliance, orthopedic appliance, brace, or body part wrap, and virtually anything that is designed to be worn on a body part.  
           [0026]    For a better understanding of the present invention, together with other and further objects thereof, reference is made to the accompanying drawings and detailed description and its scope will be pointed out in the appended claims.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0027]    [0027]FIG. 1 is a pictorial view of the dynamic variable geometry fitting system of the invention adapted to use with a prosthesis;  
         [0028]    [0028]FIG. 2 a  shows an intra-socket pressure trace of a transfemoral amputee walking on a hard floor;  
         [0029]    [0029]FIG. 2 b  shows an intra-socket pressure trace of a transtibial amputee walking on a hard floor;  
         [0030]    [0030]FIG. 3 a  is a schematic representation of the preferred embodiment control system of this invention for a single set pressure;  
         [0031]    [0031]FIG. 3 b  is a schematic representation of the preferred embodiment control system of this invention for a multiple set pressure;  
         [0032]    [0032]FIG. 4 a  shows pressure-displacement traces of an intra-socket bladder filled with air and liquid of a transfemoral amputee walking on a hard floor;  
         [0033]    [0033]FIG. 4 b  shows pressure-displacement traces of an intra-socket bladder filled with air and liquid of a transtibial amputee walking on a hard floor;  
         [0034]    [0034]FIG. 5 a  shows a top view of a bladder of this invention; and  
         [0035]    [0035]FIG. 5 b  shows a front view of a bladder of this invention; 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0036]    The preferred attachment system includes a set of variable-volume bladders that are adjusted in volume by a fluid-pumping mechanism actuated through ambulation without an external energy source and are automatically regulated. The system utilizes a bladder to pump fluid automatically from a reservoir through a fluid circuit to bladders and a control unit.  
         [0037]    The preferred attachment fitting system  8  of this invention, FIGS. 1 and 3 a , which is utilized to removable adhere a body appliance  9 , such as a prosthesis, to a body part or appendage, includes a reservoir  10 , one or more variable-geometry pumping bladders  12 , a plurality of variable-geometry pressure bladders  14 , an interconnecting network, and a control unit  16 . The aforementioned components work in cooperation to maintain a tight fit of the body appliance on, for example, a residuum (shown in phantom), or other body segment. The residuum is placed within a cavity, such as the socket cavity  54  with the body appliance  9 , while ambulating to relieve potential ischemia during stasis and to permit easy donning and doffing of a prosthesis  9 . The preferred attachment fitting system can be placed within and around a flexible or rigid vessel, such as the socket  18  and frame  20  of a lower-limb prosthesis (shown in phantom).  
         [0038]    The preferred fluid to use in the attachment fitting system  8  is an incompressible liquid such as water with antifreeze, such as calcium chloride added in cold weather to prevent freezing when the prosthesis is doffed. However, other low-viscosity, incompressible fluids such as isopropyl alcohol, light silicon oil or any other biocompatible, safe fluid may be employed. Alternative fluid embodiments include gels, multiphase fluids, or any other fluids with substantially incompressible properties are within the scope of this invention.  
         [0039]    For background information, about 80% of the volume of, for example, a TF residuum is soft tissue. When this tissue shrinks, by loss of liquid, the intra-socket void between the soft tissue of the limb and the shell of the socket must be filled with something else. For a standard fixed-volume socket, that “something else” will be air, which is immediately detectable by the amputee and significantly affects the fit and performance of the prosthesis. When the residual soft tissue shrinks in volume, it loses liquid to the lymph and vascular systems. The soft tissue contains no gas pockets; it is comprised of about 80% liquid, so it behaves physically like a liquid. Therefore, in order to approximate physiological conditions in the socket, the shrinkage void is back-filled with liquid in the present invention. Then the compliance, or compressibility, of the matter filling the socket will remain constant.  
         [0040]    In contrast, if the shrinkage void is filled with gas, the filling is 20,000 times more compressible (at 1 bar, 30° C.) than a liquid-fill. So the gas-filled bladder will expand and contract in volume in a fashion drastically different from soft tissue of the residuum. The pressure-displacement (P-D) compliance will be large, engendering excessive “pumping,” loose coupling of the socket to the anatomy and a feeling of insecurity. Insecurity is due to sloppiness of the joint between the anatomy and the mechanism, causing uncertainty as to where is the ambulating foot, and in addition, for the TF amputee, whether the knee joint is safely locked for weight-bearing during the stance phase of the walking cycle.  
         [0041]    Using the laws of gas and liquid responses to a pressure change, the P-D compliance may be calculated from intra-socket pressure data. A sample of intra-socket pressure data is illustrated in FIG. s  2   a  and  2   b  in which are plotted intra-socket pressures vs. time. FIG. 2 a  is from a TF amputee; FIG. 2 b  is from a TT amputee. The cycle time has been normalized for both. Pressure sensors were positioned in various intra-socket locations within the sockets of TF and TT amputees. The subjects then walked on a hard floor while pressure data were recorded. Data were averaged from many stride cycles to create the graphs in FIGS. 4 a  and  4   b . The pressure data were then transformed, by the perfect-gas and the liquid laws, into hypothetical bladder volume variations for a stride cycle when bladder filled volume equals a typical 10% of socket volume, FIGS. 4 a  and  4   b . Results are shown for air-filled and liquid-filled bladders, for TF (FIG. 4 a ) and TT (FIG. 4 b ). The plots have been averaged and time normalized as before. Note the great difference in compliance (compressibility) between air-filled bladders and liquid-filled bladders during a typical stride cycle.  
         [0042]    The P-D compliance may be calculated by dividing ΔVol, FIG. s  4   a  and  4   b , by the mean cross-sectional area of the socket (typically 0.018 m 2  for TF and 0.008 m 2  for TT) times the length. For example, the peak TT ΔVol/Vol in FIG. 4 b  is about 60% for air-filled and 1% for liquid-filled bladders. These ΔVols convert, for this TT socket (1000 ml), to P-D “pumping” strokes of 8 mm for air fill and 0.1 mm for liquid fill, respectively. With an 8 mm P-D stroke (and no mechanical retention), the TT socket of a suction-retention-only prosthesis fitted with an air-filled bladder probably would detach from the residuum. In contrast, the prosthesis fitted with a liquid-filled bladder as in the present invention would remain firmly attached.  
         [0043]    Raising the pressure in gas-filled bladders is thought by some to be the solution to reducing their compliance (compressibility). However, the compressibility of gas (dp/dVol) varies as p k+1/k  where k=ratio of specific heats. So, inflating the bladders to 3 bar (28.8 psig) would increase stiffness by only 3.25 times. Then the maximum bladder volume change (FIG. 4 b ) for air-filled TT bladders would decrease to 20%, which is still intolerable. Furthermore, this tactic is impossible because such pressure (which would need to be applied continually) would greatly exceed the ischemic limit (˜25 mm Hg above ambient), leading to tissue necrosis.  
         [0044]    Referring now to FIGS. 1, 3 a , and  3   b , the reservoir  10  is a fluid-container that is made of a flexible or rigid non-leaking material, such as a silicon or urethane, to maintain a reservoir internal pressure. The reservoir capacity for normal TF and TT are 200-300 ml and 100-250 ml, respectively. The reservoir  10  can be sealed or open to ambient depending on the predetermined reservoir pressure. The internal reservoir pressure is set for the particular application, suction or non-suction socket. For a suction socket in a lower-limb prosthesis, the reservoir pressure can be set at ambient pressure. For a non-suction socket, the reservoir pressure can be set to be above or below ambient pressure. The reservoir interior pressure can be set be various means, including conventional springs or bellows (not shown).  
         [0045]    In the preferred attachment system, the reservoir  10  also includes a reservoir filling means  22  to allow fluid to be added to or removed from the reservoir  10 . The reservoir filling means  22  is a septum (not shown). The septum is penetrated by a needle or other means to add or remove fluid.  
         [0046]    The reservoir  10  further includes an inlet/outlet  48  to feed fluid to the system during the pressurization cycle and to receive excess fluid from the system when the system pressure exceeds set pressure limits or when the pressure bladders  14  and pumping blade  12  are drained for body appliance removal.  
         [0047]    Additionally, an alternative embodiment of the reservoir may be fitted with a volume scale  36 , FIG. 1, to indicate the need for refill and in testing to serve as an indicator of fluid-consumption.  
         [0048]    In the preferred attachment fitting system  8 , the pumping bladder  12  is positioned such that it will experience a pressure below reservoir pressure (negative pressure), thereby drawing fluid from the reservoir  10 , and a pressure above reservoir pressure (positive pressure), thereby pumping to pressure bladders  14 , during some phase of the pumping cycle. An example of a pumping cycle is a walking cycle characterized by a stance phase (positive pressure) and a swing phase (negative pressure). There must be a sufficient difference in pressure created between the reservoir  10  and the pumping bladder such that fluid flows into the pumping bladder  12 . The pumping bladder  12  is positioned near the distal-end  52  of the socket  18  so that it will experience, in a suction socket during the swing phase of normal ambulation, a pressure below the reservoir pressure.  
         [0049]    However, the pumping bladder can be positioned anywhere within the socket  18  providing the pressure characteristics are maintained.  
         [0050]    A plurality of pressure bladders  14 , see FIGS. 1, 3 a , and  3   b , are placed such that fluid pumped from the pumping bladder  12  is channeled to discrete locations for volume management and controlled pressure. For TF sockets, the fully inflated volume of each pressure bladder  14  is approximately 100 ml. One or more pressure bladders  14  can be placed in the superficial groove between the vastus lateralis and biceps femoris (longhead) muscles to prevent rotation of the socket  18  on the residuum, as well as to secure the socket  18  to the residuum. For TT sockets, the pressure bladders  14  are usually smaller, approximately 30-40 ml volume fully inflated. One or more pressure bladders  12  are placed on the medial and lateral tibial aspects and above and below the femoral condyles. The size and shape of these pressure bladders  14  can be variable and determined by the prosthetist.  
         [0051]    As illustrated in FIGS. 1 and 3 a , the preferred embodiment control system  16  for attachment fitting system  8  includes a filter  34 , a plurality of pressure regulator(s)  26 , pressure relief regulator(s)  28 , leakage resistor(s)  24 , fluid bypass return  30 , connected by conduit(s)  42  and flow control valve(s)  32  to form a fluid circuit. The control system  16  illustrated in FIG. 3 a  regulates pressure in all of the bladders by a single pressure regular  26 .  
         [0052]    In the preferred attachment fitting system  8 , the pumping bladder  12  and pressure bladders  14  are constructed of a biocompatible medical grade urethane material that has a relatively low perfusion rate, approximately 1% of the bladder volume per day, to prevent the need for frequent refilling of the reservoir  10 . Higher perfusion rates are acceptable, but the amputee may be inconvenienced with more frequent fillings of the reservoir  10 . As shown in FIG. 5 a , All bladders include a bladder inlet  40  to receive the conduit  42 . An alternative material includes non-biocompatible urethane where the residuum is not in direct contact with bladder.  
         [0053]    For example, a 25 um (micron) commercially available filter  34  is placed in-line between the reservoir  10  and the pumping bladder  12  to prevent particulate debris from entering the bladders and potentially clogging the conduits  42 , pressure regulators  26 , pressure relief regulators  28 , and leakage resistors  24 .  
         [0054]    The pressure regulator(s)  26  are situated between the bladder(s)  12  and  14 , and the reservoir  10  to allow for excess fluid to return to the reservoir when the pressure exceeds a predetermined pressure. The pressure regulator(s)  26  are set to the highest comfortable level for the user, which allows the tightest comfortable fit. For lower-limb prostheses, the set pressure can be permanent or adjustable. TF amputees typically feel comfortable with equal pressure in 2-5 bladders within socket  18 . FIG. 3 a  shows a single, pressure regulator  26 , which sets the same pressure in all of the bladders because they are interconnected as shown. The control system  16  can use adjustable pressure regulators or ones with fixed set points. With the latter method, the pressure is adjusted in the bladders by exchanging pressure regulators with different set points until the user is satisfied. When amputees first start wearing the system, they usually prefer a lower pressure level than they do after several weeks of use. Adjustable pressure regulators allow for continuous modification of the set pressure level. Once a preferred pressure level has been established for each amputee, that pressure setting usually remains constant.  
         [0055]    The pressure relief regulator  28  and a leakage resistor  24  are placed in parallel with the pressure regulator  26 . The pressure relief regulator  28  is set to a value lower than the pressure regulator  26 . A leakage resistor  24  is designed to drop the pressure in the pressure bladders  14  to the set pressure of the pressure relief regulator  28 . For lower-limb prostheses, the pressure relief regulator  28  is set to approximately 0.5 psig. The leakage resistor  24  helps to prevent tissue ischemia. When ambulation is stopped, the leakage resistor  24  allows the pressure to drop below the ischemic limit (˜25 mm Hg above ambient) in a time span of a few minutes as fluid flows back to the reservoir  10  through the leakage resistor  24 . The pressure relief regulator  28  can be adjustable or with fixed set points.  
         [0056]    A fluid bypass return  30  allows rapid return of all fluid to the reservoir, emptying all bladders. The fluid bypass return  30  is a manually actuated preferably mechanical switch. Commercially available alternative methods of the fluid bypass return  30  include other mechanical or electromechanical switches or valves, thermally controlled switches, or magnetically controlled switches.  
         [0057]    Small conduits  42  connect the various system components allowing a closed loop fluid circuit. The conduit  42  is made of a pliable, durable material with an inner diameter (e.g., 1-2 mm bore) sized for a quick and smooth response to the pumping action and an outer diameter that is sized to fit snuggly within the bladder inlet  40  to avoid leaks, see FIG. 5 a  and FIG. 5 b.    
         [0058]    Flow control valves  32 , such as check valves, prevent fluid from flowing among the pressure bladders  14  and back into the pumping bladder  12 , and from the pumping bladder  12  back into the reservoir  10 .  
         [0059]    The pressure regulator  26 , pressure relief regulator  28 , and flow control valves  32  are commercially available mechanical valves which may be spring loaded, diaphragm style, or “duckbill” elastomer. Alternatives to physical valves include tuned valves, such as acoustic valves, thermally regulated valves or electrically operated valves, or magnetorheologic fluids well known in the art used in conjunction with magnetic fields, could perform the same function as the spring loaded mechanical valves.  
         [0060]    An alternative embodiment to the control system  16  is illustrated in FIG. 3 b . The alternative control system regulates pressure for each of the bladders  14  separately. Each of the bladders  14  are set at different levels by individual pressure regulators  26 , pressure relief regulators  28 , and flow bypass returns  30 . The system components are the same as the attachment system disclosed in FIG. 3 a.    
         [0061]    The control principle of this invention for example, in use with a lower limb prosthesis is to maintain set pressures in the pressure bladders  14 , which bear against a liner, such as Alpha® or a thin elastomer sheet, and then onto the residuum. Alternatively, the bladder  14  may bear directly against the residuum. The bladders  14 , fluid-filled completely, fill voids in the socket  18  and exert forces against the socket frame  20  and the residuum, which maintains the socket at a preset tightness. Generally, the tighter the socket, the lower the compliance between the prostheses and the anatomy. The residuum “pumping” (relative superior-inferior motion between socket and residuum), which can cause skin abrasion and lesions, is reduced the more natural the prosthesis feels and the more securely and competently the amputee can manipulate it. In order to achieve minimum compliance, the pressure in the bladders  14  is set to the highest comfortable level.  
         [0062]    Another feature of the control system  16  is that the pressures applied to the tissue must be relaxed during stasis (i.e., when not walking). Without the pressure fluctuations of ambulation, there is a threat of tissue ischemia (constricted capillaries stop blood flow) and consequent tissue necrosis. If a pressure higher than ˜25 mm Hg above ambient is applied to the skin for extended time periods, such as more than about 30 minutes, the compressed tissue is starved of blood flow from its capillaries. The control system  16  automatically relaxes the pressure against the tissue by a slow leak through leakage resistor(s)  24 , to below the ischemic limit if stasis is maintained for more than a few minutes. The pressure relief regulator  28  sets the resulting pressure in the bladder(s)  14 . The leakage resistor  24  provides a means for returning fluid to the reservoir  10  slowly without completely emptying the bladders  14 . In the absence of the leakage resistor  24 , the pressure in the pressure bladders  14  would remain at the set pressure until the fluid bypass return was activated or until fluid perfused through the pressure bladder wall.  
         [0063]    A further aspect of the control system  16  is that, when an amputee commences to walk again after stasis, the socket should be tight, despite the fact that the bladder pressures have been relaxed. Proper pressure magnitude and distribution in the socket are automatically maintained, for TF and TT sockets, for a tight fit during ambulation. During long-term sitting, it automatically lowers the pressure in bladder(s)  14  to less than the ischemic limit (˜25 mm Hg above ambient). Because of the incompressibility of the bladder fluid and of the tissue, and the rigidity of the socket  18 , this pressure relief is achieved by extracting a very small volume of fluid, approximately 0.5 ml, from each bladder through leakage resistor(s)  24  and pressure relief regulator(s)  28 . This means that the inside geometry of the socket should change little when the pressure in the bladders is relaxed, so that the prosthesis is not significantly loose on the residuum. Within approximately 10-20 steps after walking recommences, the control system  16  will adjust the bladders&#39; pressure to set point to produce an ideal fit for subsequent activity, at set pressure levels in the bladders against the residuum&#39;s tissue.  
         [0064]    A further aspect of the control system  16  is that the fluid should be able to be discharged from all of the bladders rapidly. This is achieved with the fluid bypass return  30 . For example, doffing prosthesis at night is ubiquitous among amputees because the residuum tissue and socket must be washed every day and because resting in bed at night without the confinement of the prosthesis is preferred. In order to doff and don the prosthesis easily, the fluid bypass return  30  creates maximum intra-socket volume by draining all of the fluid from the bladders around the pressure relief regulator, which otherwise would have maintained fluid in the bladder to a preset level. After donning in the morning, the fluid bypass return  30  is closed. Then, after the amputee takes 10-20 steps, the set pressure(s) is re-established automatically in each bladder  14  as fluid is pumped from the reservoir  10  to the pumping bladder  12  to the bladder(s)  14  as previously described. If, during the day there is any loss of fluid from the bladders due to perfusion through the bladder walls, the bladders are automatically refilled by the control system  16  to the set pressure(s)of the pressure regulator(s)  26  as soon as the amputee walks.  
         [0065]    The present invention serves a number of additional advantageous functions over the existing art such as compensation for neural dysfunction. Vascular dysfunction, usually caused by arteriosclerosis, is the cause of about 75% of TT amputations. Neural dysfunction often accompanies vascular dysfunction; then the TT amputee will have little or no pain response to warn of ischemia. Sores and ulcers are a common outcome. The dynamic fitting system actually will replace the dysfunctional nerves&#39; function by eliminating ischemia (caused by pinching off the capillary blood flow) and so should eliminate tissue necrosis (ulcers) from undetected and excessive socket pressure.  
         [0066]    Alternative methods for pumping the fluid include electronic activation, electromechanical activation, and magnetohydrodynamic actuation. All of these methods can be used individually or in combination.  
         [0067]    An alternative embodiment to a multi-bladder pumping and pressure system is a single bladder system, shown in FIG. 3 c , designed to perform the equivalent functions. The single bladder  38  is an integral pumping and pressure bladder. The single bladder will draw fluid from the reservoir to maintain a predetermined pressure within the same bladder while being regulated by pressure regulators and resistors as disclosed in the preferred attachment system. The single bladder will be configured to the amputee&#39;s residuum for maximum comfort and securement to the socket.  
       Mode of Operation  
       [0068]    A lower-limb amputee whose suction socket prosthesis is fitted with the preferred system  8  would don their prosthesis by placing their residuum in the socket  18 . The fluid bypass return  30 , could be open or closed, and there could be fluid in the pressure bladders  14 , or the pressure bladders  14  could be empty.  
         [0069]    Prior to walking, the fluid bypass return  30 , is closed, eliminating this return path for fluid to the reservoir  10 . As the amputee walks, pressure in the system fluctuates above and below reservoir pressure. When pressure is below reservoir pressure, fluid is drawn from the reservoir  10  into the pumping bladder  12 . When pressure is above reservoir pressure, fluid in forced from the pumping bladder  12  to the pressure bladders  14  through the conduits  42 .  
         [0070]    Pressure in the pumping bladders  12  and pressure bladders  14  will not exceed the pressure set in the pressure regulator  26 . Fluid is continuously returned to the reservoir  10 , through the leakage resistor  24 , as long as the pressure is above the set pressure of the pressure relief regulator  28 .  
         [0071]    The prosthesis can be removed at anytime the user desires. If the system is still pressurized and there is not enough volume in the socket  18  for the residuum to be removed, the fluid bypass return  30  can be actuated, thereby returning substantially all of the fluid in the pressure bladders  14  and the pumping bladders  12  to the reservoir  10 .  
         [0072]    Although the invention has been described with respect to various embodiments, it should be realized this invention is also capable of a wide variety of further and other embodiments within the spirit and scope of the appended claims. Although the system is illustrated with a leg prosthetic, the dynamic variable geometry fitting system is adaptable to other body appliances such as ski boot, boots (including sports boots), shoes, sneakers, prosthetic appliance, orthopedic appliance, brace, or body part wrap, and virtually anything that is designed to be worn on a body part.