Dr. Öğr. Üyesi Görkem Kıyak
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Prosthetics & Orthotics
Below knee prosthesis
What a below knee (transtibial) prosthesis is, how the socket, liner, pylon and foot work together, how fitting and gait training proceed, how foot and suspension options differ, approximate costs in Turkey against the UK, US and Germany, how long the adaptation takes, risks and how to choose a prosthetics centre.
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Below knee prosthesis: what it is and how it works
A below knee prosthesis, also called a transtibial prosthesis, is an artificial lower leg for people whose leg has been amputated between the knee and the ankle. Because the person keeps their own knee, walking uses the natural knee joint and the prosthesis replaces the shin and the foot. It has four main parts. The socket is a custom-made shell that fits over the residual limb (the stump) and carries your weight. The liner is a soft silicone or gel sleeve worn between skin and socket for cushioning. The pylon is a light tube, often carbon or titanium, that forms the shin. The foot is the artificial foot and ankle that absorb the step and push off. A suspension system, such as a pin-lock, a seal-in liner, suction or a vacuum pump, holds the leg on. Prosthetic and orthotic centres in Turkey make and fit these within the wider field of orthopedics treatments in Turkey.
This guide explains how a below knee prosthesis is made and fitted, which options exist, what it costs compared with the UK, US and Germany, how long adaptation takes and how to check a clinic. A prosthesis is not surgery in itself: the amputation and healing of the residual limb come first.
When can a below knee prosthesis be fitted?
Fitting depends on healing and limb shape. After a below knee amputation the wound must close and stitches or staples come out, usually at two to three weeks. Swelling then reduces over weeks, helped by compression wraps or a shrinker sock, and the limb shape stabilises over about two to six months. Many centres fit a first or "preparatory" prosthesis at about six to twelve weeks, and make a definitive prosthesis after the volume has settled. Earlier fitting is sometimes possible with a rigid dressing or an immediate post-operative prosthesis, at a surgeon's discretion. Weight changes of a few kilos, a long-standing amputation or a poor-fitting socket can alter the fit, so the limb is re-measured whenever it changes.
How is a below knee prosthesis made and fitted?
- Assessment. The prosthetist examines the residual limb, skin, scars, knee strength and range of movement, your activity level and goals, and your other health conditions.
- Measuring and casting. The limb is measured and either cast in plaster or scanned in 3D to create a shape of the limb.
- Test socket. A clear or temporary socket is made first so the prosthetist can check pressure points and the fit in the limb while you stand.
- Alignment and gait training. The pylon and foot are aligned so you can walk, and a physiotherapist teaches you to stand, step, turn and walk on slopes and stairs.
- Definitive socket. The final socket, usually laminated in carbon or resin, is finished once the fit is right.
A first fitting commonly takes several days to two weeks, because adjustments are made as you learn to walk. Digital scanning and 3D printing now shorten some steps, though not the need for a test socket.
What feet, sockets and suspension systems exist?
The foot is the part that changes how walking feels, and it is chosen according to activity level.
| Foot type | Suited to | Typical limits |
|---|---|---|
| Basic (single-axis or SACH) | Limited or indoor walking, first prosthesis | Little spring; less natural stride |
| Energy-storing carbon foot | Daily walking, work, uneven ground, moderate sport | Needs the right stiffness for your weight |
| Hydraulic or microprocessor ankle | High activity, slopes and stairs, long walking | More expensive; needs battery or maintenance |
Suspension changes comfort too. A pin-lock liner is simple and widely used; a suction or vacuum socket holds the limb more firmly and reduces movement between limb and socket, though it needs a good skin and limb condition. Running blades and water legs are separate designs for sport and swimming. A prosthetist should explain why a component suits you, not simply offer the most advanced one.
Does a below knee prosthesis work? What the evidence says
Most people with a below knee amputation and a well-fitting prosthesis can walk, climb stairs and return to work, and many go on to sport. Keeping the knee joint makes walking more efficient than with an above-knee prosthesis. The evidence is clear that the quality of the socket fit and structured gait training matter more than the price of the foot. The prosthesis is not a replacement for the leg: some people have phantom limb sensations, skin irritation or changes in volume through the day, and the leg needs repair and replacement over time. Realistic expectations come from your prosthetist and an experienced physiotherapist, who can assess your strength and balance.
Below knee prosthesis cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for one prosthesis, not hospital quotes. In the UK the NHS supplies a standard prosthesis free of charge, so the UK figures refer to private provision of more advanced components. Prices depend on the foot, the socket type, the suspension, the materials and the number of fitting sessions.
| Country | Approximate cost range |
|---|---|
| Turkey | €2,500 – €14,000 |
| United Kingdom (private) | €4,000 – €22,000 |
| United States | €9,000 – €50,000 |
| Germany | €6,000 – €30,000 |
The low end covers a functional prosthesis with a standard foot; the high end covers advanced carbon or microprocessor components and a vacuum socket. A package normally includes the assessment, casting or scan, the test socket, the definitive prosthesis, adjustments, gait training and liners; ask whether spare liners, a second socket, repairs and the cost of resizing are included.
Who is a good candidate for treatment in Turkey, and who is not?
People with a healed below knee amputation, a stable limb volume, healthy skin, enough strength in the hip and knee and the wish to walk with a prosthesis are suited. Care is needed if the wound has not healed, there is infection, the limb is changing in volume because of fluid retention, there is a knee contracture that prevents a good alignment, or the person has severe heart or lung disease or a medical condition that stops safe walking. Diabetes and circulation problems require extra skin care. Share your surgical report and recent photographs of the limb with the centre before you travel.
Below knee prosthesis recovery: how long until you walk well?
Learning to walk is a process of weeks to months rather than days. In the first days you stand between parallel bars and shift weight; within one to two weeks most people walk with walking aids, and over the first three months the leg is used for longer periods as skin, muscle and balance adapt. Wear starts at one to two hours and builds up as the skin tolerates pressure. A new prosthesis usually needs several adjustments in the first months, because the limb continues to shrink. Many people use the prosthesis all day by three to six months, though timelines depend on age, fitness and the cause of amputation. A shrinker sock or sleeve at night and daily skin checks help.
How long do you need to stay in Turkey?
Plan about two to three weeks for a first prosthesis: assessment, casting, test socket, alignment, definitive socket and gait training. A replacement socket for a stable limb may be done in about one week. Because limb shape changes, it is wise to arrange follow-up with a prosthetist at home and to agree who adjusts the leg and who stocks the liners and parts. Upper-limb replacement is a different field with its own components; see our guide to prosthetic arm. Short flights are fine; bring the prosthesis in hand luggage and wear a liner to avoid skin problems.
Risks and problems with a below knee prosthesis
The common problems are skin irritation, blisters, pressure sores, sweating and rashes in the liner, socket discomfort, back or hip pain from altered walking, and falls. Poor fit can cause wounds that need time off the leg, and for people with diabetes or poor circulation a sore can become serious. Phantom limb pain is separate from the prosthesis and is treated by the medical team. The NHS, the British Association of Prosthetists and Orthotists and the International Society for Prosthetics and Orthotics advise a prosthetist who is registered or certified, a test socket before the definitive one and regular reviews. See the surgeon or prosthetist at once if there is an open wound, a hot red area, fever or sudden change in limb shape.
How to choose a prosthetics centre, and red flags
Choose a centre with a certified prosthetist and prosthetic technician, an in-house workshop, physiotherapists who give gait training and a clear plan for adjustments. Check whether the prosthetist has treated your type of amputation and activity level. Red flags include a price quoted without any information about your limb, pressure to choose the most advanced foot, no test socket, no follow-up plan for when limb volume changes and no information about spare parts. Read how our process works and request a written plan through our free quote page.
Questions to ask the clinic:
- Which foot, socket and suspension do you suggest for my activity level, and why?
- Does the price include a test socket, adjustments and gait training?
- How many days do I need, and is a second visit usual?
- Who adjusts or repairs the leg when I am home, and are parts available?
- What is the warranty on the socket and components?
Hospitals with Orthopedics in Turkey
Frequently asked questions
It is an artificial lower leg for people whose leg has been amputated between the knee and ankle. It consists of a custom socket, a liner, a pylon that forms the shin and an artificial foot, held on by a suspension system.
Approximate ranges are €2,500 to €14,000 in Turkey, against about €4,000 to €22,000 for private provision in the UK. The price depends on the foot, socket, suspension and the number of fitting sessions.
Once the wound has healed and swelling has settled, commonly at about six to twelve weeks for a first prosthesis. Limb shape keeps changing for months, so a definitive prosthesis is made later.
Most people walk with aids within one to two weeks of fitting and use the leg for longer periods over three to six months. Timelines depend on age, fitness and the cause of amputation.
A well-fitted socket should be comfortable, though the skin needs time to adapt and mild soreness is common at first. Persistent pain or sores mean the fit needs adjusting.
Sockets often need replacing every one to three years as the limb changes, and components such as the foot and liner wear with use. Regular reviews keep the fit and alignment correct.
A below knee prosthesis lets you keep your own knee, which makes walking more efficient. An above knee prosthesis needs an artificial knee joint and more energy to walk.
Yes, with the right components. Running blades and waterproof prostheses are designed for sport and swimming, and your prosthetist can advise on suitable designs and training.
Common problems are skin irritation, blisters, pressure sores, sweating and poor fit as the limb changes. People with diabetes or poor circulation need regular skin checks and early review of any wound.
Plan about two to three weeks for a first prosthesis, to allow for casting, a test socket, alignment and gait training. A replacement socket for a stable limb may take about a week.
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