Sorry, but a prostheticist falls usually into 4 categories:
1. Someone who has a fascination with prostheses - a Pinocchio so to speak who can never understand what they are, because he or she does not wear them.
2. A person not smart enough for medical school, mechanically inclined, but wanted to be something close to being in the medical profession.
3. A second generation prostheticist - like a shoe maker's son whose father was one, and made a good living at it or saw the potential in the business - sometimes unfortunately often a fraud who knows he cannot deliver what he must promise to keep a client.
4. An amputee himself who became a prostheticist after he had trouble with the prosthetic industry himself.
Obviously this is a harsh analysis, but true and you need to look for number 4 if you can. The socket is the key to a good prostheses, and it is as much an art as it is guess work. To an amputee who is a prostheticist, it is close to second nature - he wears one and often makes his own prosthetic and knows things that two-legged practitioners cannot.
Now there are some experienced guys out there yes, but it still comes down to making money and billing to keep the business afloat and the doors open and lights on. Make no mistake about that. The bigger the company the more like to be a fraudulent operation.
Today osseointegration is threatening the prosthetic industry. It currently does not have FDA approval, and thus is not found in America; however it is only a matter of time. With osseointegration, no longer is the socket a requirement and it is actually cheaper to permanently implant an extension to the bone to attach the prosthetic to. Sounds Frankenstein'ish, yes, hey no more than putting in a dental implant in ones jaw to attach a fake tooth to. It is done everyday all day long in Dentists' offices around the world.
The problem is and always has been the manufacture of a good comfortable socket. prostheticists throw around words and beliefs like they know what they are talking about - and they have no clue. Make no mistake about it - ALL prostheticists with two good legs LIE, and they have to - because they cannot truthfully and expertly answer a question about something they have never experienced, and can never experience.
Two of the worse misnomers in the industry are: 1. Oh, you'll get use to it, and it will callous up after a while, AND; 2. You need good ischial containment. BOTH are bull, and I had a second generation prostheticist admit to me these misnomers serve a purpose to cover up a screw up and/or to mystify the socket building process more than anything else. What you need is a good "plug" fit and soft distal bearing weight on the end of the stump. That is to say - even pressure all around and an a pad on the bottom as you sink deeper over the shrinkage which occurs from wearing it for a few hours.
This is the "secret formula" no two legged prostheticist can figure. Only an amputee prostheticist can look at the size of a person and guess pretty accurately how much their limb will shrink over a day and know how to build it comfortably.
The way the prosthetic industry has compensated for this is to keep the parts and materials away from the amputees themselves who would get smart enough to build legs for each other and improve the socket. You can see exactly how the osseointegration surgery is done here => http://pnrg.ucsd.edu/osseointegration.htm Dr. Rickard Branemark pretty much pioneered this, and has run into International impediment after impediment, because the various prosthetic industry lobby groups want to call it voo doo medicine as it it would take away the mainstay of their industry - the socket making - bad, good, or other.
But today the medical establishment is under the cross hairs of cost containment - and the prosthetic industry is fraught with fraud and like the automatic transmission business, full of black magic terms. The biggest prosthetic house in America - and yes even the world - is leading a serious push to keep osseointegration at bay.
They would be reduced to an auto parts store cash and carry pre-manufactured high competition parts. Oooppppss. Here is the real deal. As an amputee, you are on your own. do not be afraid to tell the prostheticist they cannot know certain things and the book is not always right. Here's one to think about. . . . "why do they cut reliefs in the back side of AK sockets?"
They tell you it is so you can sit down and whole host of crap. The truth is - it is so the socket will loose fit sooner than later from the liner stretching, and you will have to come back for another sooner. Stay tuned