 Looking back on my life as an APT, I've experienced the full spectrum of prosthetics. Simple hydraulics to simple kind of mechanical knees to microprocessor computer knees. But what has not happened in my entire experience is any evolution of the socket technology. People aren't comfortable wearing their prosthetics. It's hard to do things with a positive attitude when and while you're in pain. A growing number of startups and researchers are finally taking a fresh look at prosthetic sockets using pumps, flexible liners, ski boot like ratchet systems or even surgical implants to improve on this long neglected component of artificial limb. One company earning praise for its advances is LimbInnovations, which has developed the Infinite Socket, a modular and adjustable version that can be quickly produced and continually adjusted. The San Francisco company was founded by orthopedic surgeon Andrew Pedgy and prosthetist Garrett Hurley, UCSF colleagues and surfing buddies who found they shared similar frustrations over the state of modern sockets. Patients generally say the Infinite Socket is more comfortable than the conventional version, allowing them to wear it for longer periods and engage in more rigorous activities. That includes Robert Spotswood. He lost his right leg in nearly his life in a car accident outside of Birmingham, Alabama when he was 16. He was eventually able to return to sports he loved before his accident, like rock climbing and soccer, and take on new ones. But with conventional sockets, he could only climb or play for short periods before the pain forced him to stop. This socket's actually enabled me to not only play 18 holes of golf, where previously I could only play nine, I could play back to back 18, I could play 36 in a day, I could play in a tournament for a weekend, I could turn around afterwards and go out that night, go to a nice dinner, walk around the city. I didn't know it at the time, but I wasn't doing the things that I would really want to do because I was in pain, I was uncomfortable. The upfront cost of a limb socket is currently about the same as a conventional one, but because it's adjustable, the infinite socket could potentially save money over the long run since patients won't need entirely new ones when they gain or lose muscle or weight. But it doesn't seem to meet the needs of every amputee. Dan Bershinski lost both of his legs in 2009 when he stepped on an IED during a tour in Afghanistan. For me, I found that I'm fortunate in that I actually don't seem to lose or gain volume all that much, so adjustability isn't my number one priority. Efficiency really is for me. He spent weeks getting fitted with the limb socket, but found it was considerably bulkier without being significantly more comfortable. Ultimately, after giving it a go for five or six sessions, a couple of hours each, I thought the technology was cool, but personally, the desire for me to chase that perfect fit through a limb socket just isn't there, and I feel like this is still the best use of my time and allows me to have the lifestyle that I need. Other organizations working to improve prosthetic sockets include Click Medical, which also relies on a ratchet system, and the Beth Project at MIT, which has developed a flexible silicon liner. Meanwhile, Bershinski himself is most interested in an emergent surgical option known as osseointegration, in which devices are implanted directly into the residual bone, allowing prosthetic limbs to snap on. It avoids the need for a socket altogether. It means patients can support their weight on solid bone instead of soft flesh. It is a risky procedure, however, prone to infection, and Bershinski is holding off for now. By having the implant go directly into the bone, you can actually get sensory feedback from the ground. You get the vibration of that foot striking the ground much more so than you do through a socket. So there's some really neat benefits there. Of course, any novel device or experimental procedure in the medical industry faces considerable challenges, from getting prosthetists to recommend them to convincing insurers to pay for them. But patients themselves are happy to finally see some progress in this crucial component of prosthetic limbs, addressing a very literal pain point in their lives. When you feel more comfortable just on a day-to-day basis, walking to work, getting in and out of your car, it just gives you the confidence to live more freely. And as a result, you end up pushing yourself. I've never been in better health. I've never been more excited to wear my leg on a day-to-day basis, more excited about new knee and feet technology. As an amputee, I always appreciate it when any company or entity is trying to push the boundaries and come up with something new. Limb isn't the only one working on that technology, and I think the industry will get there eventually. I think it has potential.
 Looking back on my life as an APT, I've experienced the full spectrum of prosthetics.
 Simple hydraulics to simple kind of mechanical knees to microprocessor computer knees.
 But what has not happened in my entire experience is any evolution of the socket technology.
 People aren't comfortable wearing their prosthetics.
 It's hard to do things with a positive attitude when and while you're in pain.
 A growing number of startups and researchers are finally taking a fresh look at prosthetic
 sockets using pumps, flexible liners, ski boot like ratchet systems or even surgical
 implants to improve on this long neglected component of artificial limb.
 One company earning praise for its advances is LimbInnovations, which has developed the
 Infinite Socket, a modular and adjustable version that can be quickly produced and continually
 adjusted.
 The San Francisco company was founded by orthopedic surgeon Andrew Pedgy and prosthetist Garrett
 Hurley, UCSF colleagues and surfing buddies who found they shared similar frustrations
 over the state of modern sockets.
 Patients generally say the Infinite Socket is more comfortable than the conventional
 version, allowing them to wear it for longer periods and engage in more rigorous activities.
 That includes Robert Spotswood.
 He lost his right leg in nearly his life in a car accident outside of Birmingham, Alabama
 when he was 16.
 He was eventually able to return to sports he loved before his accident, like rock climbing
 and soccer, and take on new ones.
 But with conventional sockets, he could only climb or play for short periods before the
 pain forced him to stop.
 This socket's actually enabled me to not only play 18 holes of golf, where previously I
 could only play nine, I could play back to back 18, I could play 36 in a day, I could
 play in a tournament for a weekend, I could turn around afterwards and go out that night,
 go to a nice dinner, walk around the city.
 I didn't know it at the time, but I wasn't doing the things that I would really want
 to do because I was in pain, I was uncomfortable.
 The upfront cost of a limb socket is currently about the same as a conventional one, but
 because it's adjustable, the infinite socket could potentially save money over the long
 run since patients won't need entirely new ones when they gain or lose muscle or weight.
 But it doesn't seem to meet the needs of every amputee.
 Dan Bershinski lost both of his legs in 2009 when he stepped on an IED during a tour in
 Afghanistan.
 For me, I found that I'm fortunate in that I actually don't seem to lose or gain volume
 all that much, so adjustability isn't my number one priority.
 Efficiency really is for me.
 He spent weeks getting fitted with the limb socket, but found it was considerably bulkier
 without being significantly more comfortable.
 Ultimately, after giving it a go for five or six sessions, a couple of hours each, I
 thought the technology was cool, but personally, the desire for me to chase that perfect fit
 through a limb socket just isn't there, and I feel like this is still the best use of
 my time and allows me to have the lifestyle that I need.
 Other organizations working to improve prosthetic sockets include Click Medical, which also
 relies on a ratchet system, and the Beth Project at MIT, which has developed a flexible silicon
 liner.
 Meanwhile, Bershinski himself is most interested in an emergent surgical option known as osseointegration,
 in which devices are implanted directly into the residual bone, allowing prosthetic limbs
 to snap on.
 It avoids the need for a socket altogether.
 It means patients can support their weight on solid bone instead of soft flesh.
 It is a risky procedure, however, prone to infection, and Bershinski is holding off for
 now.
 By having the implant go directly into the bone, you can actually get sensory feedback
 from the ground.
 You get the vibration of that foot striking the ground much more so than you do through
 a socket.
 So there's some really neat benefits there.
 Of course, any novel device or experimental procedure in the medical industry faces considerable
 challenges, from getting prosthetists to recommend them to convincing insurers to pay for them.
 But patients themselves are happy to finally see some progress in this crucial component
 of prosthetic limbs, addressing a very literal pain point in their lives.
 When you feel more comfortable just on a day-to-day basis, walking to work, getting in and out
 of your car, it just gives you the confidence to live more freely.
 And as a result, you end up pushing yourself.
 I've never been in better health.
 I've never been more excited to wear my leg on a day-to-day basis, more excited about
 new knee and feet technology.
 As an amputee, I always appreciate it when any company or entity is trying to push the
 boundaries and come up with something new.
 Limb isn't the only one working on that technology, and I think the industry will get there eventually.
 I think it has potential.