Distal tissue elongation is a common occurrence in transtibial sockets with locking liners. Various gel liner manufacturers offer matrix systems to reduce distal tissue elongation and limb pistoning during ambulation. However, these matrixes are not 100 percent effective. To mitigate the pistoning, elongating transtibial sockets distally becomes a necessity. This elongation results in the liner being distracted distally once donned and reduces socket pistoning.
To assure consistency in our facility where multiple people fill casts, I created a back-to-basics tutorial you may find helpful for your fabrication lab.