• Decompression Technology
  • Puck Technology
  • Why Vacuum
  • Limb Health
  • Internal Vacuum Difference
  • What Puck is Right for Me?
  • Inside Scoop on Vacuum
  • Passive vs. Active Vacuum
  • Is this Covered By My Insurance
  • Where can I get Puck Technology?
  • Getting a good seal
  • FAQ
  • Clinical Papers

Patients Corner

Decompression Technology

The Problem…


Most prosthetic suspension system (pin locks, lanyards, sleeve, suction and even some old fashion vacuum systems actually compress your residual limb forcing valuable blood and lymph fluids out of the limb.

Typically patients have to”tighten” their socket through out the day by adding socks or by mechanically tightening the socket.

The effects of this process can be devastating to the health of the tissue and circulation in your residual limb.  Common problems with these out dated suspension methods are wounds, sores, callus formation, skin discoloration, blisters, ingrown hairs and a noticeable shrinking of the underlaying tissue in your residual limb.

Other problems with these suspension systems include pistoning, movement in the socket distraction (with modern electronic feet and knee units the weight of the prosthesis is higher-  when ambulating the prosthesis drops away from your limb, stretching your limb tissue as it does this), movement in the socket, lack of control, prosthetic rotation issues (the unwanted kind) and finally the prosthesis feeling heavy.

Many amputees accept the heavy feeling of a microprocessor knee or ankle because they want the technology- not realizing that with the proper suspension (Puck Decompression socket Technology), the weight of the leg becomes nominal and undetectable…


The Solution…




Introducing Puck Decompression Socket Technology:  The only system that can consistently reduce the air pressure on your limb.  By reducing the air pressure on your limb vital fluids such as blood, lymph and nutrients to flow into the residual limb allowing for a significant improvement in the tissue health and circulation.



Because the prosthesis has zero disconnect with the natural body, when you move your prosthesis will move.

Puck Technology



The concept of Puck Technology was invented by two prosthetists with over 50 years of combined experience in the industry. After trying multiple elevated vacuum systems, together they determined there had to be a better way.

The result is a modular, interchangeable, internal system that eliminates the recurring problem all other systems have…leaks.

Because Puck Technology is the only vacuum that is inside the socket, it is more efficient, consistent and reliable. Whether you choose the AirPuck, SmartPuck or VaporPuck, you can rely on this proven technology to provide the best suspension for your prosthesis.

Why Vacuum

Many clinical studies over the years have addressed the benefits of elevated vacuum for the amputee.

Some advantages include:

  • Improved proprioception
  • Increased circulation
  • Better gait dynamics
  • Eliminating “pistoning”
  • Rotation control
  • Faster wound healing
  • Volume stabilization
  • Moisture evacuation
  • Fitting short residual limbs


Limb Health

Negative pressure wound therapy has been proven clinically to promote faster healing of wounds. This technology is used every day in hospitals and in post-operative care.

The addition of this technology to the residual limb has done the same for patients who suffer from chronic skin break-down issues

Here is a quote from one prosthetist:

“Where skin health is concerned, we have seen many cases where sores that have been unresponsive to other methods have healed very quickly in the elevated vacuum system. This leads me to believe that elevated vacuum encourages good circulation in the limb.” – Bryon Backus, CP

Internal Vacuum Difference

All other elevated vacuum systems are external to the socket. This means that a hole must be drilled into the socket and a barb or tube added to the newly created evacuation port. This adds yet one more place for a potential leak.

Many times a prosthetist will have to spend hours searching for the exact point of the leak, causing you to have to spend more time in the office, and less time living your life.

Puck Technology is the only elevated vacuum that is built inside the socket, so there is only one possible place for a leak – the sleeve. This saves time and frustration for all parties.

Also the system is quieter and will run much less often because of its simple, internal design.

What Puck is Right for Me?

Every patient is different and your lifestyle will determine which Puck is best for you.

The AirPuck is a mechanical system which will require you to evacuated the air from your socket manually. However since there are no electronics, it can be immersed in water with no damage to the system.

The SmartPuck is the a computerized system that will maintain your chosen pressure settings automatically and is operated with an APP on your Smartphone.

The VaporPuck is an electric system that provides on-demand vacuum whenever you feel you need more.

Because all the Pucks are the same size, should you decide later on that you want a different one, your can keep using the same socket.

Inside Scoop on Vacuum

Elevated vacuum has numerous clinical benefits, but one of the greatest is the elimination of the “pendulum effect” some patients feel from their components. And as more advanced, bionic feet and knees fill the marketplace, the weight of these hi-tech options for patients will become a factor in fitting. Vacuum opens the doors for those who have felt they cannot handle any additional weight to their prosthesis.


Passive vs. Active Vacuum

Passive vacuum systems only provide negative pressure when acted upon by a mechanical pump. This creates daily fluctuations of internal socket pressure. Some systems, like the AirPuck can maintain a gradually decreasing vacuum setting for 8-10 hours. For many patients this fine for their daily activities.

Active systems, like the SmartPuck electronically maintain a constant pressure setting, resulting in the best possible environment for the residual limb.

Is this Covered By My Insurance

Elevated Vacuum is covered by Medicare and most private insurance companies, including Worker’s Compensation.

Coverage decisions will vary by carrier and by state, but the key is to be an advocate for your care. The Amputee Coalition of America(www.amputee-coalition.org) has multiple resources you can seek out to assist you in getting your prosthesis covered.

Where can I get Puck Technology?

There are multiple SmartPuck trained clinic across the country that can fit this technology for you. You can see the list here on our site.

If your current prosthetist would like to get certified, please have him/her contact us.

Getting a good seal

Sealing the SmartPuck is as easy making sure you have a good sleeve with no tears or holes. Having at least four inches of sleeve coverage on the lower part of your socket and another four directly contacting the silicone or urethane portion of your liner has shown to provide the “gold standard” for sealing the system.


1. I have a long residual limb, will the SmartPuck still work for me?

The build height of every Puck is the same, 1 and 7/8 of an inch. If you have this much clearance, the Puck will fit.

2. I don’t have a Smart device, can I still use the SmartPuck?

The SmartPuck has a back up magnet that will turn the device on and off in the WALK mode setting. A Smart device is recommend, but not required to operate it.

3. I am an Above-the-Knee amputee and been told that elevated vacuum is not an option for me?

Puck Technology is a great option for the above-the-knee amputee. Have your prosthetist contact us for tips on making your socket.

4. I am a bilateral amputee, can I operate two SmartPucks at the same time?

The free SmartPuck APP has a bilateral control feature allowing you to customize settings for either the left or right side and operate each from one device.

Clinical Papers

Below are links to several clinical papers going into further detail on the benefits of elevated vacuum:

  1. Residual limb wounds or ulcers heal in transtibial amputees using an active suction socket system. A randomized controlled study. http://www.ncbi.nlm.nih.gov/pubmed/22641248
  2. Outcomes Study of Transtibial Amputees Using Elevated Vacuum Suspension in Comparison With Pin Suspension. http://www.oandp.org/jpo/library/2011_02_078.as
  3. Elevated Vacuum Suspension Influence on Lower Limb Amputee’s Residual Limb Volume at Different Vacuum Pressure Settings. http://www.oandp.org/jpo/library/2010_04_252.asp
  4. Using Elevated Vacuum to Improve Functional Outcomes: A Case Report. http://www.oandp.org/jpo/library/2011_04_184.asp
  5. Vacuum Suspensionand its Effects on the Limb. http://www.ottobock.com/cps/rde/xbcr/ob_us_en/im_646d277_gb_vacuum_suspension.pdf