Cascade Orthopedics Supply Clinical Report, 2025

Written by Leslie Jackson, MSS, CP, Cascade & OrtoPed Clinical Specialist

Introduction

The prosthetic socket remains the most critical component in lower-limb prosthetic design, dictating both comfort and control. Traditional rigid sockets, though custom-molded, often lose their precision fit over time as limb volume fluctuates due to fluid shifts, temperature, or activity level. Adjustable sockets have emerged as an innovative solution, allowing clinicians and users to fine-tune fit dynamically. This report compares the adjustable-socket paradigm with traditional approaches and highlights three leading commercial systems—Blackfin Biomechatronics, Click Medical, and Martin Bionics.

Traditional vs. Adjustable Sockets

Rigid sockets—laminated or thermoformed—capture a static limb geometry and cannot adapt to short- or long-term volume changes.  As fit deteriorates, users compensate with socks, liners, or full socket replacements, chasing the ever-important proper fit. Adjustable sockets address these limitations through mechanical or pneumatic features that enable real-time modification of socket volume and compression. The result is greater comfort, improved suspension, and reduced soft-tissue stress. Adjustable technologies typically rely on movable panels, BOA-style dials, tensioning cables, or air/fluid bladders. As we look forward, undeniably advanced prototypes that incorporate digital feedback or motorized control will begin releasing to the market.  As of now though, most clinical systems remain mechanically actuated.

Blackfin Biomechatronics

Blackfin Biomechatronics, founded in Colorado, manufactures the SPINNER™ Volume Management System (VMS)—a precision-adjustable socket featuring internal sliding panels actuated via a low-profile dial. The SPINNER allows the user to move the socket wall inward or outward in small increments to accommodate volume change without affecting structural integrity. The mechanism is enclosed within the socket wall, minimizing snag hazards and maintaining a smooth profile.

Blackfin promotes the system as waterproof, lightweight, and maintenance-friendly, enabling ‘micro-adjustability’ for optimal skeletal stabilization and pressure relief (Blackfin Biomechatronics, 2024). Early clinical adoption has been positive, particularly among active transtibial users who experience frequent limb fluctuation.

Click Medical

Click Medical pioneered the RevoFit® Lamination Kit, the most widely adopted mechanical adjustability system in the U.S. prosthetics market. The RevoFit integrates adjustable panels into the socket wall, controlled by an external dial and tensioning cable. The patient can tighten or loosen the socket for comfort, activity, or limb-volume variation throughout the day. Its key advantage is user empowerment—allowing day-to-day modification without clinician intervention.

In April 2024, the U.S. Centers for Medicare & Medicaid Services introduced HCPCS L5783, recognizing user-adjustable volume management systems such as RevoFit for reimbursement (Click Medical, 2024). This development has accelerated clinical acceptance. The system is compatible with both transtibial and transfemoral designs and can be fabricated by most central fabrication facilities.

Martin Bionics

Martin Bionics developed the MB Adjust™ Kit, emphasizing flexibility, comfort, and reduced skin breakdown. The design replaces rigid lamination with lightweight struts and tensioning bands, allowing the socket to conform dynamically to the residual limb. The MB Adjust kit adds user-controlled tightening features, providing volume management without refabrication. Clinical data from Martin Bionics report up to 77% reduction in skin issues and 94% improvement in sitting comfort compared with conventional sockets (Martin Bionics, 2023).

The approach blends adjustable and minimalist design principles—reducing rigid containment while maintaining secure suspension. Its modular structure simplifies adjustments and replacement of components while maintaining overall socket geometry.

Comparative Insights

Across systems, three themes emerge:

Future Directions

Next-generation adjustable sockets are expected to integrate smart sensing, using digital pressure and volume sensors to automate fit adjustments. Advances in materials—lightweight carbon composites, flexible thermoplastics, and shape-memory polymers—will further reduce weight and improve responsiveness. As evidence mounts, adjustable technology is likely to become the new standard of care, emphasizing user autonomy and socket longevity.

Conclusion

Adjustable sockets represent a paradigm shift from static, technician-controlled fittings to dynamic, user-responsive systems. Patients with substantial volume changes and hard-to-fit residuums now have options for being fit that do not include excessive amounts of socks or other daily fitting aids. Companies such as Blackfin Biomechatronics, Click Medical, and Martin Bionics exemplify diverse mechanical approaches that share a unified goal: sustained comfort and function through adaptability. While challenges in cost, durability, and reimbursement persist, the clinical and quality-of-life benefits make adjustable sockets one of the most transformative innovations in contemporary prosthetics.

Have questions? Reach out to Leslie Jackson, MSS, CP at ljackson@cascade-usa.com

References