EFFECTS OF A PROSTHETIC FOOT WITH INCREASED CORONAL ADAPTABILITY ON CROSS-SLOPE WALKING
Open Access
- 4 January 2021
- journal article
- Published by University of Toronto Libraries - UOTL in CANADIAN PROSTHETICS & ORTHOTICS JOURNAL
- Vol. 4 (1)
- https://doi.org/10.33137/cpoj.v4i1.35206
Abstract
BACKGROUND: Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The uneven ground and the resulting functional leg length discrepancy in this situation requires adaptability of both user and prosthesis. OBJECTIVE(S): This study investigated the effects of a novel prosthetic foot that offers adaptability on cross-slope surfaces, using instrumented gait analysis and patient-reported outcomes. Moreover, the results were compared with two common prosthetic feet. METHODOLOGY: Twelve individuals with unilateral transtibial amputation and ten able-bodied control subjects participated in this randomized cross-over study. Participants walked on level ground and ±10° inclined cross-slopes at a self-selected walking speed. There were three prosthetic foot interventions: Triton Side Flex (TSF), Triton LP and Pro-Flex LP. The accommodation time for each foot was at least 4 weeks. The main outcome measures were as follows: frontal plane adaptation of shoe and prosthetic foot keel, mediolateral course of the center of pressure, ground reaction force in vertical and mediolateral direction, external knee adduction moment, gait speed, stance phase duration, step length and step width. Patient-reported outcomes assessed were the Activities Specific Balanced Confidence (ABC) scale, Prosthetic Limb Users Survey of Mobility (PLUS M) and Activities of Daily Living Questionnaire (ADL-Q). FINDINGS: The TSF prosthetic foot adapted both faster and to a greater extent to the cross-slope conditions compared to the Triton LP and Pro-Flex LP. The graphs for the mediolateral center of pressure course and mediolateral ground reaction force showed a distinct grouping for level ground and ±10° cross-slopes, similar to control subjects. In the ADL-Q, participants reported a higher level of perceived safety and comfort when using the TSF on cross-slopes. Eight out of twelve participants preferred the TSF over the reference. CONCLUSION: The frontal plane adaptation characteristics of the TSF prosthetic foot appear to be beneficial to the user and thus may enhance locomotion on uneven ground – specifically on cross-slopes. Layman's Abstract Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The adaptability of prostheses is limited. Users alter gait strategies to cope with uneven ground. The prosthetic foot is a central component of a lower limb prosthesis. This study investigated if a novel prosthetic foot with greater adaptability is beneficial on cross-slopes. Twelve individuals with transtibial amputation (ITTAs) took part in the study. In addition, ten abled-bodied persons were measured as controls. The ITTAs were fitted with the novel foot and a reference foot. The accommodation time for each foot was four weeks at least. Afterwards gait data and patient-reported outcomes were assessed. The analyzed gait data showed clear differences in terrain compliance for the measured feet. The novel foot adapts both faster and to a greater extent to the cross-slope conditions. The self-reported outcome measures revealed better comfort and perceived safety when using the adaptive foot concept in comparison to the commercial reference. These results suggest that the adaptation characteristics of the novel foot concept are beneficial to the user. Thus, it may enhance locomotion on uneven ground such as cross-slopes. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35206/28052 How To Cite: Altenburg B, Ernst M, Maciejasz P, Schmalz T, Braatz F, Gerke H, Bellmann M. Effects of a prosthetic foot with increased coronal adaptability on cross-slope walking. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.7. https://doi.org/10.33137/cpoj.v4i1.35206 Corresponding Author: Björn Altenburg, Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany. E-Mail: Bjoern.altenburg@ottobock.com ORCID ID: https://orcid.org/0000-0002-3484-4346Keywords
This publication has 18 references indexed in Scilit:
- General scheme to reduce the knee adduction moment by modifying a combination of gait variablesJournal of Orthopaedic Research, 2016
- Functional level assessment of individuals with transtibial limb loss: Evaluation in the clinical setting versus objective community ambulatory activityJournal of Rehabilitation and Assistive Technologies Engineering, 2016
- Characterizing mobility from the prosthetic limb user’s perspectiveProsthetics and Orthotics International, 2015
- Evaluation of a Powered Ankle-Foot Prosthetic System During WalkingArchives of Physical Medicine and Rehabilitation, 2012
- Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritisAnnals Of The Rheumatic Diseases, 2011
- Energy Expenditure of Transfemoral Amputees Walking on a Horizontal and Tilted Treadmill Simulating Different Outdoor Walking ConditionsProsthetics and Orthotics International, 2010
- Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: Reduced walking speedArthritis & Rheumatism, 2004
- Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritisAnnals Of The Rheumatic Diseases, 2002
- Influence of static prosthetic alignment on standing posture and walking in transtibial amputeesDer Orthopäde, 2001
- Leg length discrepancy — an experimental study of compensatory changes in three dimensions using gait analysisGait & Posture, 2000