socket and foot mechanics that are invaluable for the athlete, and these are the focus of today's high-tech prosthetics companies: fit – athletic/active amputees, or those with bony residua, may require a carefully detailed socket fit; less-active patients may be comfortable with a 'total contact' fit and gel liner energy storage and return – storage of energy acquired through ground contact and utilization of that stored energy for propulsion energy absorption – minimizing the effect of high impact on the musculoskeletal system ground compliance – stability independent of terrain type and angle rotation – ease of changing direction weight – maximizing comfort, balance and speed suspension – how the socket will join and fit to the limb other the buyer is also concerned with numerous other factors: cosmetics cost ease of use size availability cost and source freedom high-cost in the usa a typical prosthetic limb costs anywhere between $15,000 and $90,000, depending on the type of limb desired by the patient. with medical insurance, a patient will typically pay 10%–50% of the total cost of a prosthetic limb, while the insurance company will cover the rest of the cost. the percent that the patient pays varies on the type of insurance plan, as well as the limb requested by the patient. in the united kingdom, much of europe, australia and new zealand the entire cost of prosthetic limbs is met by state funding or statutory insurance. for example, in australia prostheses are fully funded by state schemes in the case of amputation due to disease, and by workers compensation or traffic injury insurance in the case of most traumatic amputations. the national disability insurance scheme, which is being rolled out nationally between 2017 and 2020 also pays for prostheses. transradial (below the elbow amputation) and transtibial prostheses (below the knee amputation) typically cost between us $6,000 and $8,000, while transfemoral (above the knee amputation) and transhumeral prosthetics (above the elbow amputation) cost approximately twice as much with a range of $10,000 to $15,000 and can sometimes reach costs of $35,000. the cost of an artificial limb often recurs, while a limb typically needs to be replaced every 3–4 years due to wear and tear of everyday use. in addition, if the socket has fit issues, the socket must be replaced within several months from the onset of pain. if height is an issue, components such as pylons can be changed. not only does the patient need to pay for their multiple prosthetic limbs, but they also need to pay for physical and occupational therapy that come along with adapting to living with an artificial limb. unlike the reoccurring cost of the prosthetic limbs, the patient will typically only pay the $2000 to $5000 for therapy during the first year or two of living as an amputee. once the patient is strong and comfortable with their new limb, they will not be required to go to therapy anymore. throughout one's life, it is projected that a typical amputee will go through $1.4 million worth of treatment, including surgeries, prosthetics, as well as therapies. low-cost low-cost above-knee prostheses often provide only basic structural support with limited function. this function is often achieved with crude, non-articulating, unstable, or manually locking knee joints. a limited number of organizations, such as the international committee of the red cross (icrc), create devices for developing countries. their device which is manufactured by cr equipments is a single-axis, manually operated locking polymer prosthetic knee joint. table. list of knee joint technologies based on the literature review. name of technology (country of origin)brief descriptionhighest level of evidence icrc knee (switzerland)single-axis with manual lockindependent field atlas knee (uk)weight-activated frictionindependent field pof/otrc knee (us)single-axis with ext. assistfield dav/seattle knee (us)compliant polycentricfield limbs international m1 knee (us)four-barfield jaipurknee (india)four-barfield lcknee (canada)single-axis with automatic lockfield none provided (nepal)single-axisfield none provided (new zealand)roto-molded single-axisfield none provided (india)six-bar with squattingtechnical development friction knee (us)weight-activated frictiontechnical development wedgelock knee (australia)weight-activated frictiontechnical development sathi friction knee (india)weight-activated frictionlimited data available low-cost above-knee prosthetic limbs: icrc knee (left) and lc knee (right) a plan for a low-cost artificial leg, designed by sébastien dubois, was featured at the 2007 international design exhibition and award show in copenhagen, denmark, where it won the index: award. it would be able to create an energy-return prosthetic leg for us $8.00, composed primarily of fiberglass. prior to the 1980s, foot prostheses merely restored basic walking capabilities. these early devices can be characterized by a simple artificial attachment connecting one's residual limb to the ground. the introduction of the seattle foot (seattle limb systems) in 1981 revolutionized the field, bringing the concept of an energy storing prosthetic foot (espf) to the fore. other companies soon followed suit, and before long, there were multiple models of energy storing prostheses on the market. each model utilized some variation of a compressible heel. the heel is compressed during initial ground contact, storing energy which is then returned during the latter phase of ground contact to help propel the body forward. since then, the foot prosthetics industry has been dominated by steady, small improvements in performance, comfort, and marketability. with 3d printers, it is possible to manufacture a single product without having to have metal molds, so the costs can be drastically reduced. jaipur foot, an artificial limb from jaipur, india, costs about us$40. open-source robotic prosthesis star wars themed "hero arm" by open bionics there is currently an open-design prosthetics forum known as the "open prosthetics project". the group employs collaborators and volunteers to advance prosthetics technology while attempting to lower the costs of these necessary devices. open bionics is a company that is developing open-source robotic prosthetic hands. they utilize 3d printing to manufacture the devices and low-cost 3d scanners to fit them onto the residual limb of a specific patient. open bionics' use of 3d printing allows for more personalized designs, such as the "hero arm" which incorporates the users favourite colours, textures, and even aesthetics to look like superheroes or characters from star wars with the aim of lowering the cost. a review study on a wide range of printed prosthetic hands, found that although 3d printing technology holds a promise for individualised prosthesis design, and it is cheaper than commercial prostheses available on the market, yet more expensive than mass production processes such as injection molding. the same study also found that evidence on the functionality, durability and user acceptance of 3d printed hand prostheses is still lacking. low-cost prosthetics for children artificial limbs for a juvenile thalidomide survivor 1961–1965 in the usa an estimate was found of 32,500 children (<21 years) had a major paediatric amputation, with 5,525 new cases each year, of which 3,315 congenital. carr et al. (1998) investigated amputations caused by landmines for afghanistan, bosnia and herzegovina, cambodia and mozambique among children (<14 years), showing estimates of respectively 4.7, 0.19, 1.11 and 0.67 per 1000 children. mohan (1986) indicated in india a total of 424,000 amputees (23,500 annually), of which 10.3% had an onset of disability below the age of 14, amounting to a total of about 43,700 limb deficient children in india alone. few low-cost solutions have been created specially for children. examples of low-cost prosthetic devices include: pole and crutch this hand-held pole with leather support band or platform for the limb is one of the simplest and cheapest solutions found. it serves well as a short-term solution, but is prone to rapid contracture formation if the limb is not stretched daily through a series of range-of motion (rom) sets. bamboo, pvc or plaster limbs this also fairly simple solution comprises a plaster socket with a bamboo or pvc pipe at the bottom, optionally attached to a prosthetic foot. this solution prevents contractures because the knee is moved through its full rom. the david werner collection, an online database for the assistance of disabled village children, displays manuals of production of these solutions. adjustable bicycle limb this solution is built using a bicycle seat post up side down as foot, generating flexibility and (length) adjustability. it is a very cheap solution, using locally available materials. sathi limb it is an endoskeletal modular lower limb from india, which uses thermoplastic parts. its main advantages are the small weight and adaptability. monolimb monolimbs are non-modular prostheses and thus require more experienced prosthetist for correct fitting, because alignment can barely be changed after production. however, their durability on average is better than low-cost modular solutions. cultural and social theory perspectives a number of theorists have explored the meaning and implications of prosthetic extension of the body. elizabeth grosz writes, "creatures use tools, ornaments, and appliances to augment their bodily capacities. are their bodies lacking something, which they need to replace with artificial or substitute organs?...or conversely, should prostheses be understood, in terms of aesthetic reorganization and proliferation, as the consequence of an inventiveness that functions beyond and perhaps in defiance of pragmatic need?" elaine scarry argues that every artifact recreates and extends the body. chairs supplement the skeleton, tools append the hands, clothing augments the skin. in scarry's thinking, "furniture and houses are neither more nor less interior to the human body than the food it absorbs, nor are they fundamentally different from such sophisticated prosthetics as artificial lungs, eyes and kidneys. the consumption of manufactured things turns the body inside out, opening it up to and as the culture of objects." mark wigley, a professor of architecture, continues this line of thinking about how architecture supplements our natural capabilities, and argues that "a blurring of identity is produced by all prostheses." some of this work relies on freud's earlier characterization of man's relation to objects as one of extension. notable users of prosthetic devices marie moentmann (1900–1974), child survivor of industrial accident terry fox (1958–1981), canadian athlete, humanitarian, and cancer research activist oscar pistorius (born 1986), south african former professional sprinter