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Click on the above image to see a 360º rotation of the socket.

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Table of Contents:

3. In-Action Videos

4. Socket-less Socket™ ICON™ BK Overview

4. Ordering

https://vimeo.com/martinbionics/icon-bk-socket-soft-ordering

5. Selecting The Gel Liner

5. Tissue Management Options

https://vimeo.com/martinbionics/icon-bk-tissue-management

7. Suspension Options

https://vimeo.com/martinbionics/icon-bk-suspension-options

https://vimeo.com/martinbionics/icon-bk-making-thermoplastic-inner

8. ICON™ BK Fitting Instructions

https://vimeo.com/martinbionics/icon-bk-fitting-instructions

10. Posterior Lacing Selection

10. Aligning the Socket

11. Final Fabrication

11. Modifying a Conventional Socket Using the ICON™ BK Fitting Kit

13. Symes Fittings

https://vimeo.com/martinbionics/icon-symes-fitting

13. Donning the ICON™ BK

https://vimeo.com/martinbionics/icon-bk-donning-in-15-seconds

14. Increased Muscle Use

14. Socket-less Socket™ ICON™ BK Coding

14. Certificate of Training

15. FAQ’s and Technical Solutions

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Fitting the Socket-less Socket™ requires certified prosthetist training. Find the most recent and additional training resources at Socket-Soft.com or MartinBionics.com, as we update this document regularly. If you have any questions about the fitting, contact our clinical services team at 844-MBIONIC.

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ICON™ BK - Cycling

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ICON™ BK - Slow Motion Walking

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ICON™ BK - Range of Motion

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ICON™ BK - Skateboarding

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Interview with an ICON™ BK User

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ICON™ Bilateral Symes - Hiking

Socket-less Socket™ ICON BK™:

Similar to an “erector set for prosthetics”, the Socket-less Socket™ allows the clinical practitioner to customize the socket design in real-time to the user. Every aspect of the socket inc lud ing i t s shape, t i s sue management, and suspension can be selected and fit to the user’s needs.

Ordering:

All ICON™ BK’s are custom pre-fit out of the box, making the fitting process expedited and efficient.

Ordering Option 1 - Complete ICON™ BK: Mail us a well-fitting socket with established alignment and we will pre-fit the ICON BK™, which includes the final lamination. The pre-fit ICON™ BK’s fit should be 90% complete out-of-the-box. Simply micro-adjusted the fit in real-time, Loctite all screws, and deliver. See our “What to send us” requirements in the FAQ section.

Ordering Option 2 - ICON™ BK without lamination: The ICON™ BK is also available to order without the definitive lamination. Input limb measurements into our Socket-Soft™ Fitting Software (socket-soft.com), and Martin Bionics will pre-assemble the ICON™ BK based on the limb measurements, allowing you to attach it to your own test socket with modified trim lines. Watch the assembly instructions here: https://vimeo.com/martinbionics/icon-bk-assembly

The ICON BK™ can be fit to users ranging in sizes from pediatric to adult, petite to obese, and short limbs to long (including Symes). Custom configurations for heavier (250 lb+) users are also available.

Orders can be placed at 844-MBIONIC (844.624.6642), or through any of the following:

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https://vimeo.com/martinbionics/icon-bk-socket-

Ordering and Socket-Soft

Selecting the Gel Liner:

All fittings should integrate a gel liner, and many types and brands of liners may be used. The gel liner type will be selected based on the type of suspension and tissue management method that will be used for the fitting. You can use many different liner options, and can select various forms of suspension including pin, lanyard, SharkSkin™ Suspension, suction/vacuum, or velcro.

Tissue Management Options:

ICON™ BK fittings benefit from integrating a form of tissue management method to contain, control, and restrict the limb tissue. The tissue management method will be selected based on the end user’s selected suspension and individual needs.

Suspension Options Limb Type Corresponding Tissue Management Method

Zero-Lanyard™ with Ratchet.

Great for any limb length or shape, and can be used with Flower Distal Cup™ or locking liner.

AirHammock™ and/or gel liner with matrix

SharkSkin Suspension™ Possible sole suspension for long limbs (and Symes), or accessory suspension with other suspension methods to eliminate micro-movements in the socket.

AirHammock™ and/or gel liner with matrix

Velcro Suspension User’s with good cognitive abilities, and often used along with SharkSkin™.

AirHammock™ and/or gel liner with matrix

Suction Suspension, such as with a Seal-in liner

User’s who prefer to maintain traditional suction or vacuum suspension.

Thermoplastic distal cup, typically 1/2 - 2/3 length.

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THINK FORWARD: Using a velcro-compatible fabric-covered liner such as the Willow Wood Spirit Liner provides a platform for integrating other tissue management and suspension options such as the Flower Distal Cup™, Fabric Inner Socket™, or SharkSkin™ to be attached (each available upon request). However, using a locking liner with an integrated matrix such as the Otto Bock Skeo 6Y75 or 6Y77 Locking Liner provides a more simplified tissue management and suspension option. The Skeo Liners works well with SharkSkin Suspension.

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Tissue Management Options

Managing the tissue is one of the most important factors in achieving a successful fitting. Some users prefer an “off road shocks” softer feel (less tissue containment), while others prefer a “street racing shocks” feel (more containment). If the limb tissue tends to press into the openings, as may be found especially with larger limbs with soft tissue, it may be helpful to better contain the tissue by spanning additional AirHammock™ petals across the openings of the Socket-less Socket™ structure, or use a gel liner with more embedded matrix (less stretch). For long or extra large limbs you can add an additional band of cross connectors circumferentially around the medial and lateral sides of the socket to provide additional support and control of the limb.

Gel Liner Dynamics - The primary tissue management method is through the gel liner itself. A liner with integrated matrix such as the Otto Bock Skeo 6Y70 liner (less stretch) may offer sufficient containment by itself. More stretchy liners like the Willow Wood Spirit Liner may benefit from integrating other tissue management methods to control/contain the limb tissue.

AirHammock™ - The AirHammock™ Modular Inner Socket™ provides similar tissue containment as a traditional flexible inner socket but maintains the full volume accommodation abilities that the Socket-less Socket™ uniquely offers. Its modularity allows for various numbers and sizes of AirHammock™ petals to be integrated to the common distal receptacle. In many cases just the three posterior AirHammock™ petals are all that is needed, although additional petals can be modularly attached within the openings along the medial and lateral aspects of the limb as needed.

Thermoplastic Inner Socket™ - A thermoplastic inner socket can be used to contain the limb tissue, and is often used when suction or vacuum are desired. (https://vimeo.com/martinbionics/icon-bk-making-thermoplastic-inner). Trim the posterior trim line to just below the posterior blue pads to help maintain p r o x i m a l b r i m c o n f o r m i t y a n d v o l u m e accommodation. See more at: https://vimeo.com/235623325

Integrating a traditional flexible inner socket is a great way to take advantage of the ICON™ BK design, but maintain the familiar feel and containment of a conventional socket for challenging cases.

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Suspension Options:

Unlike conventional fitting methods where changing suspension strategies typically requires re-casting the limb, or fabricating a new test socket, the ICON BK™ allows you to quickly test various suspension types within the same socket.

Zero-Lanyard™ - The ICON™ BK can be ordered with the Zero-Lanyard™ upon request, which offers a zero-build-height, as it uses the laminating place as the lanyard guide. The ratchet can be mounted to the cross connectors (above middle image), or can be repositioned and mounted along the pylon or foot distal to the socket (above right image), to provide a more streamlined appearance.

Pin Systems - Pin systems work great with the ICON™ BK. Any pin system can be integrated, though using a pin system with a standard four hole attachment such as the Bull-Dog pin system, offers a simple-to-integrate solution (right). Some users find that using a pin system provides more perceived stability than a lanyard offers, especially on shorter limbs.

SharkSkin Suspension™ - The unique SharkSkin™ material has unidirectional friction which allows the limb to easily slide into the socket, but helps prevent it from sliding out until the socket is loosened for doffing. It is sometimes used as sole suspension for long limbs such as Symes, but is typically used as accessory suspension along with pins, lanyards, or Velcro. In most fittings it is used to reduce micro-movements within the socket by spreading the suspension forces 360º around the limb, and significantly increases the perceived lock about the limb.

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https://vimeo.com/martinbionics/icon-bk-

Suspension Options

S u c t i o n a n d V a c u u m Suspension - A thermoplastic inner socket can be used if suction or vacuum suspension is desired such as with a Seal-In liner type. This approach does decrease the inherent volume accommodation that the Socket- less Socket™ uniquely offers, but is still a great path. See more at: https://vimeo.com/martinbionics/bk-thermoplastic-inner-socket

Socket Fitting Instructions:

F i t t ing the ICON™ BK i s accompl i shed by s imply micro-adjusting the position a n d s p a n o f t h e c r o s s connectors around the limb. All fittings will include a form of suspension and tissue management to contain and control the limb tissue.

The Cross Connectors have numbered holes (0-19) which are 1/2" apart. The distance between holes "0" and "1" however is 3/4”, allowing for down to a 1/4” resolution in adjustability. The medial and lateral cross connectors lengths should place the posterior panels in the posterior “corners” of the socket, and the panels should remain parallel to each other. This helps provide anterior-posterior support. In final fabrication the multi-hole cross connectors can be swapped for the smooth version for a more streamlined look.

Socket-Soft™ and Pre-Fitting Clinical Services™ establishes the correct starting position for the cross connectors, and their general positions and orientations are purposed. Adjustments will likely just need to be to the span of the cross connectors, although if needed, the cross connectors can be re-positioned or they can be heat modified and flared to provide additional conformity.

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THINK FORWARD: During the fitting periodically check the connections of the thumb screw and truss nuts to make sure they are tight. The user could fall if a thumb screws comes disconnected from the truss nut while the user is pressing weight into the socket. Each will be secured with Loctite before completion.

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Fitting Instructions

https://vimeo.com/martinbionics/icon-bk-making-

Making a Thermoplastic Inner Socket

The Anatomical Positioning of the ICON™ BK socket should fit around the limb similar to how a conventional socket should fit - MPT to distal end. The internal socket length is adjustable and the AirHammock™ petals and receptacle can be re-positioned more proximal or distal, resulting in a shorter or longer socket. If the interior of the socket is too short, you can re-assemble the posterior panels using longer AirHammock™ petals, and lower the AirHammock™ distal receptacle position as needed.

By design, the sensitive areas of the residual limb should rest in open free space areas with no rigid structure to hit. The sensitive distal Tibia and Tibial Crest should rest within the anterior cutout opening, and the distal AirHammock™ receptacle provides a ‘hammock-like’ distal cushioning, so that there is no longer a rigid distal end to contact. Likewise, the sensitive Fibular Head should be positioned within the open area along the lateral side of the limb, typically between the middle lateral cross connector and the carbon fiber lamination.

The Conforming Posterior Brim is designed to comfortably contour to match the body shape, versus the sensitive hamstring tendons having to fit against a rigid static conventional brim. The hamstring tendons should rest in between the three posterior foam pads. The posterior brim can be shifted in position side to side or up and down through cross connector length adjustments. The truss nuts that mount the posterior brim swivels should be at roughly the same height level as the mid patellar tendon (MPT) with the socket in 5 degrees of flexion.

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Posterior Lacing Selection:

The lacing system can be modularly selected and replaced based to the users needs. Input limb measurements into Socket-Soft.com to provide an image of the lacing pattern based on the limb size.

The ICON™ BK comes with a low profile lacing system (left images) to tighten the posterior panels. This can be replaced with a BOA™ ratchet (available through Martin Bionics), or other lacing systems of your choice. The low profile lacing offers increased durability and is lower profile than the BOA. It also provides a more even pull of the laces. Watch it in action at: https://vimeo.com/martinbionics/bk-low-profile-lacing

Make sure that the limb tissue is sufficiently contained during loading. If additional containment is needed, watch the Lacing Options video for additional tricks at https://vimeo.com/martinbionics/bk-lacing

Aligning the Socket:

Attach the foot to the socket with a 4-hole pyramid (not included) with standard BK socket alignment principles. When attaching the 4-hole pyramid, make sure that the lanyard cord remains in the slot between the Zero-Lanyard™ plate and lamination and still slides easily.

The ICON™ BK should have similar alignment as the well-aligned socket that was provided for initial fabrication. However, if changes to the alignment are needed, all conventional alignment tools are able to be used within the fitting, as its distal mounting uses a standard 4-hole pattern. Offset plates, flexion contracture plates, slides, and the like may still be helpful tools to establish final alignment.

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Final Fabrication:

The final fabrication can be completed in your own clinic. Simply swap the multi-hole cross connectors by drilling the corresponding holes in the smooth version at the same length, and Loctite all truss nuts. If you fabricate the definitive lamination in your clinic, make sure the lamination is strong enough to not flex under load, considering the frame trim lines.

Modifying a Conventional Socket using the ICON™ BK Fitting Kit:

Clone a well fitting and aligned conventional socket shape, or take a new cast of the limb over the liner. Extend the socket length distally 1/2”-1” by doing a buildup on the plaster model, and create a flat distal surface for the 4-hole laminating plate to rest into. Extending the socket length eliminates a rigid distal end by allowing the AirHammock™ to suspend the limb similar to a conforming hammock. Mark new trim lines similar to the images above.

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THINK FORWARD: Make sure that the truss nuts are not clamped against the cross connectors, but rather allowed to swivel freely to prevent backing out.

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ICON™ BK Assembly

(A) Pull a check socket, and mount the 4-hole plate distally and connect the pyramid adaptor below the socket. Drill a hole for the lanyard cord to exit and assemble, or install a pin-lock receiver if desired.

(B) Mount the proximal cross connectors to the posterior proximal corners of the socket ears, placing the posterior brim truss nut connector at the MPT level.

(C) AirHammock™ petals may be used along the anterior socket wall to soften the trim line edges. Attach them using the same mounting holes as the cross connectors, and suspend the anterior side of the AirHammock™ receptacle from the anterior petals. Position the anterior AirHammock™ petals along the anterior socket wall in the correct position to place the distal AirHammock™ receptacle flat and even on its distal end, and mark the drill the 1/4” mounting holes (yellow circles) to line up with the middle and distal cross connectors which will mount to these same holes (see images on pages 9 and 11). You can skive the proximal end of the anterior AirHammock™ petals to ease the transition. Alternatively, a relief for these petals can be built into the cast model before pulling the check socket.

(D) Mount the anterior cross connectors through the socket wall and to the AirHammock™ petals. Mount the lanyard (if using) to either the cross connector as shown or can mount it to the pylon or foot section below the socket.

Ensure that the lamination or check socket has sufficient strength to not flex under load for the users weight and activity level. Orthotrans Stiff or Thermalyn Stiff, or equivalent, works well for the check socket material.

Adjust the span of the three sets of cross connectors to allow the circumferential span of the ICON™ BK components to appropriately fit around the limb. Refer also to the Fitting Instructions section above for additional fitting details.

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A B C D

Symes Fittings:

The advantages of adjustability and dynamic materials that the ICON™ BK uniquely offers are even more advantageous for Symes. where the bulbous distal end creates challenges in conventional sockets. Donning is simple, and the socket is light, cool, and breathable.

Fitting the ICON™ Symes is fundamentally no different than for a BK, except that the socket components are longer to match the limb.

Distally, the AirHammock™ receptacle can be used, or a custom molded thermoplastic distal cup can be made to more accurately match the contouring of the weight bearing distal end (https://vimeo.com/martinbionics/icon-bk-making-thermoplastic-inner). The AirHammock™ petals are connected to the distal cup the same as if using the receptacle.

Donning the ICON™ BK/Symes:

The ICON™ BK can be donned in sitting or in standing. Since the limb tissue no longer has to be pulled or pushed into a confined bucket, the donning process should be no more challenging than putting on a pair of sneakers. Simply a t t a c h a n y n e c e s s a r y suspension aids (such as a lanyard), tighten the proximal posterior strap until it is snug, then tighten the lace adjustor to comfort.

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Symes Fittings

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Donning

Increased Muscle Use:

In conventional sockets, users often complain that they feel like their limb muscles are hitting a rigid wall when they try to flex. Conventional sockets do not promote muscle contraction during walking, and a typical amputee experiences considerable limb muscle atrophy over time. Through the Socket-less Socket’s™ dynamic materials and open structure, the muscles are free to flex and results in the user feeling like they are using their limb muscles similar to how they used to use them when walking with a sound limb.

Many Socket-less Socket™ users find that for the first few days of walking in the ICON™ BK that their limb muscles feel like they are being used more, and can feel tired at first. Within a few days the muscles acclimatize to being used again and the feeling goes away. Many users declare that their limb feels stronger and looks more muscular after a few weeks of use. The inherent adjustability that the ICON™ BK uniquely offers allows the socket to remain fitting well, while accommodating for increased muscle growth.

Socket-less Socket™ ICON™ BK Coding:

The Socket-less Socket™ ICON™ BK is fabricated from a well-fitting and aligned custom molded conventional socket. It’s assembly has numerous possible configurations including selecting various forms of suspension and tissue management options. You will bill according to the socket design you make for your patient, using existing BK or Symes coding. For many fittings the coding will be similar to conventional socket codes. Responsibility for accurate coding lies solely with the provider treating the patient.

Certification of Training and CEU Credits:

To fit the Socket-less Socket™, prosthetists must fill out the certificate of training form by clicking the button below.

Through completing this training you are eligible to receive 1 CEU credit from the American Board for Certification. Click the button below, input your name and credential numbers, and we’ll send you a quiz for CEU credits.

I have read and understood the ICON™ BK/Symes training instructions, and am clinically certified to fit and align prosthetics. I understand that as a clinically

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“I actually feel as I’m walking that the musc les in my residual limb are trying to perform as they used to when I had my original foot.” Joel Goltry, ICON™ BK User

certified prosthetist I am solely responsible for ensuring that the ICON™ BK/Symes socket is appropriately fit and aligned to the end-user.

FAQ’s and Technical Solutions

1. Is this socket just for those with large volume changes? Conventional sockets are rigid, heavy, and trap heat. The Socket-less Socket™ designs uniquely offers user-adjustable volume accommodation, is lightweight, and breathable - qualities that most amputees desire. It has been successfully fit to all limb types - Short limbs to long, large limbs to small, geriatric to athletic, and on those with a lot of volume change to those without volume change. We’ve found that even those who do not fluctuate in volume (less than 2 ply per day) love the ability to micro-adjust the socket fit in real-time.

2. What amount of volume change can the Socket-less Socket™ accommodate? The Socket-less Socket accommodates for a large amount of volume change. In some cases a ‘sock-ply equivalent’ of 10+ ply up or down will still maintain the same comfortable feel. The comfort of our sockets does not change with volume change as in conventional sockets. In conventional sockets, the comfort of the fit degrades over time as the limb size changes. The Socket-less Socket™ however should largely remain comfortable up until the time a new socket is fabricated.

3. Can you fit short limbs with the Socket-less Socket™ cX™? Yes, the Socket-less Socket™ works well with short limbs to long.  The method of suspension may be selected based on limb length as well. For instance, for very short transtibial limbs, suction or vacuum may provide added security, just as in conventional sockets, though can be configured within the Socket-less Socket™.  

4. Is the Socket-less Socket™ good for a geriatric population? Yes, the Socket-less Socket™ is simple to donn in sitting or in standing, and does not require

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Fitting the Socket-less Socket™ requires certified prosthetist training. Find the most recent and additional training resources at Socket-Soft.com or MartinBionics.com, as we update this document regularly. If you have any questions about the fitting, contact our clinical services team at 844-MBIONIC.

socket-soft.com/training-registration-icon-bk

pushing or pulling soft tissue into a contained bucket as conventional sockets require. If an end user is able to tie their shoes, they should be able to donn the Socket-less Socket™ designs with ease.

5. What is the life expectancy of the Socket-less Socket™? Is it durable? The dynamic and conformable materials used in the Socket-less Socket™ system are incredibly durable and are designed to give a long life-expectancy. The brim’s webbing for instance is designed and rated for close to 5000 pounds of force, which is made of a material that is similar to a seat-belt, but thinner. We see very few durability related issues, but if something were to break, our unique modularity allows the socket to be repaired quickly and easily and is often field serviceable even if away from your prosthetist. More importantly, the socket should remain comfortable for much longer than a traditional socket, as the user-adjustable conformable materials match the socket to the user, versus the user’s limb having to match to a static piece of plastic. The human body is very dynamic, and making the socket’s fit dynamic as well provides a long lasting comfortable socket.

6. “What to send us” for an ICON™ BK pre-fitting with definitive lamination? If Martin Bionics is doing the definitive ICON™ BK lamination then simply mail us a well-fitting and aligned conventional socket and we can go straight to the definitive lamination. As an alternative path, we can incorporate the ICON™ BK into your test socket for the fitting process, and then you can mail that back to us for the definitive lamination once the test socket fitting is complete.

Make sure the existing socket uses the same type or size of liner you intend to use in the ICON™ BK fitting. Martin Bionics is not able to make socket modifications such as downsizing, upsizing, or modifying a cast. If incorporating a pin system, our Autoclave lamination process only allows us to do a single stage lamination with 4 hole adaptor, so using a pin system such as the 4-hole mounted Bulldog lock will be necessary. We are not able to incorporate other lock mechanism that need to be laminated in place.

Warranty and Credits

Thorough review of the Socket-less Socket™ training materials has a significant impact on the success of the socket fitting. Martin Bionics will support your Socket-less Socket™ clinical fittings to ensure that every fitting is as successful as possible. In the event there are challenges in the fitting process, we can join you via a Skype or FaceTime call, where we can typically help diagnose and resolve the issue with specific socket fitting suggestions.

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If the socket is ultimately not the correct configuration for the end-user, we can re-configure the socket components to match to another user at no charge. Alternatively you can send in the socket for a full credit toward any of our other products or socket configurations.

While we rarely find the need to repair or replace socket sub-components, the modularity of the Socket-less Socket™ allows it to be easily repaired. Martin Bionics will support replacement parts if premature wear and tear are found based on a flaw in Martin Bionics workmanship. If a user-specific custom lamination is incorrectly fabricated in fit or alignment due to Martin Bionics fault, it may be re-fabricated for the customer.

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