Lower limb prosthetics

Below-knee (transtibial) prostheses – a prosthetic leg below the knee

Modern below-knee prostheses with a custom-made socket, silicone liner and vacuum suspension systems for a secure fit all day long.

Custom-made socket with a test fitting
Harmony (Ottobock) and Unity (Össur) vacuum systems
Dynamic feet such as the Pro-Flex XC
Gait training and regular follow-up
Contracted provider of EOPYY

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Below-knee prostheses: a prosthetist with the Harmony system, a user with two prostheses and a patient wearing a below-knee prosthesis

Below-knee (transtibial) amputation is the most common lower limb amputation. It is usually caused by diabetes or vascular disease, an accident or a congenital condition (e.g. phocomelia). Because the natural knee is preserved, a well-made below-knee prosthesis can give you a very natural gait.

At Hlamidis Orthopaedic Center in Thessaloniki we design every below-knee prosthesis to order, mainly with components from Össur and Ottobock, which we have chosen for their reliability and the good response of our patients.

What is a below-knee prosthesis made of?

Socket: the main part of the prosthesis, into which the residual limb fits. Its type is chosen according to the shape of your residual limb, the cause of the amputation and your activities.
Silicone liner: worn over the residual limb like a sock, it protects the skin and forms part of the suspension system.
Suspension system: a pin that “locks” into the base of the socket, a valve (suction) or a vacuum system.
Pylon and prosthetic foot: from simple feet to dynamic carbon-fibre feet with energy return.

How does the prosthesis stay on?

The old types of socket with straps have largely been replaced. Today the prosthetist fits a silicone liner over the residual limb and chooses the suspension mechanism:

Pin lock: the liner has a pin at its end that locks into the base of the socket. A simple, reliable system.
Valve – suction: the prosthesis is held in place by negative pressure via a valve.
Vacuum systems: Ottobock’s Harmony and Össur’s Unity create and maintain a vacuum inside the socket. The aim is for the socket to fit securely throughout the day, even when the volume of the residual limb changes.

Below-knee prosthesis with a transparent test socket, vacuum system and Pro-Flex foot — Test socket with a vacuum system and a dynamic Pro-Flex foot.

Dynamic feet: Pro-Flex XC and Unity

For active users we often combine Össur’s Pro-Flex XC foot with the Unity vacuum system. According to the manufacturer, the Pro-Flex family offers up to 27 degrees of ankle motion and energy return, with the aim of reducing the load on the sound leg. Unity provides vacuum suspension without the external sealing knee sleeve that other systems need.

The same foot does not suit everyone. An older user who needs stability and a young person who runs need different components. For those looking for a foot with electronic control, there is also the Proprio Foot bionic foot.

The process step by step

Assessment: we get to know you, examine your residual limb and discuss your goals. The choice is made together with your treating physician.
Measurements and cast: we take an impression of your residual limb in order to design the socket.
Test socket: we check the fit and make adjustments before final manufacture.
Delivery and training: in the training area at our premises, we teach you to put on the liner and the prosthesis and to walk safely.
Follow-up: we recommend a check-up at least every six months, because the residual limb changes, especially in the first year.

For the road from amputation back to everyday activity, see our guide after amputation: your first prosthesis.

Diabetes and below-knee prostheses

Many of our patients with a below-knee amputation have diabetes. In this case, protecting the skin of the residual limb and of the sound foot is equally important. We can also help you with diabetic shoes and insoles for your other foot.

Cost and EOPYY

The price of a below-knee prosthesis depends mainly on the type of socket, the suspension system and the foot. After your assessment we give you a written proposal itemised by component. Find out more in our article how much a prosthetic leg costs.

Is it covered by EOPYY? We are a contracted provider of EOPYY (ΕΟΠΥΥ), Greece’s national health insurance organisation. For people insured in Greece, the prosthesis is reimbursed per component, on a prescription from a doctor of the relevant specialty and with a 25% co-payment (Government Gazette (ΦΕΚ) B' 2106/2025, article 46). As an indication, the maximum reimbursable price according to FEK B' 1079/2022 is €1,150 for a carbon below-knee socket and €1,078 for a high-dynamic foot, replaced every 5 years, and €555 for a below-knee silicone liner, per year. See our EOPYY reimbursement page. This information is correct as of the date of the last update.

If you are not insured in Greece, EOPYY reimbursement does not apply; you can pay privately, and any cover depends on your own insurer’s rules. Contact us and we will give you the information you need for your case.

See all our options under lower limb prosthetics or contact us on +30 2310 282 894 to book an appointment at Egnatia 101.

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Below-knee prosthesis with the Össur Unity system – one of our patients in action

FAQ

Frequently asked questions

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What is a below-knee amputation?

It is a transtibial amputation, in which part of the lower leg is removed while the knee is preserved. It is the most common lower limb amputation and is usually caused by diabetes or vascular disease, an accident or a congenital condition. Because the knee still works, rehabilitation with a below-knee prosthesis is usually quicker than with an above-knee one.

How much does a below-knee prosthesis cost?

The cost depends on the socket, the suspension system (pin, valve or vacuum) and the foot. That is why we give you a written proposal after your assessment, together with a calculation of the EOPYY reimbursement if you are insured in Greece. You will find the cost factors explained in detail in our article how much a prosthetic leg costs.

What is the difference between Harmony and Unity?

Both are vacuum suspension systems for lower limb prostheses. Harmony is made by Ottobock, while Össur’s Unity works without an external sealing knee sleeve and is combined with Pro-Flex feet. Which one suits you depends on your residual limb and your activity level, and we decide together after an assessment.

How often are the silicone liner and the prosthesis replaced?

The silicone liner wears with daily use, and EOPYY provides for its replacement every year. The other components are usually replaced every 5 years, while the socket may need adjusting sooner if the volume of your residual limb changes. Regular check-ups help us spot this in good time.

Can I run or play sport with a below-knee prosthesis?

Many below-knee prosthesis users walk briskly, exercise or run, with the right components and proper training. For sporting activities there are dynamic and dedicated sports feet. The level of activity you can safely undertake is decided together with your treating physician and physiotherapist.