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The effect of prosthetic foot stiffness on foot-ankle biomechanics and relative foot stiffness perception in people with transtibial amputation

  • Elizabeth G. Halsne
    Affiliations
    Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA

    Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA
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  • Joseph M. Czerniecki
    Affiliations
    Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA

    Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA
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  • Jane B. Shofer
    Affiliations
    Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
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  • David C. Morgenroth
    Correspondence
    Corresponding author.
    Affiliations
    Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA

    Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA
    Search for articles by this author

      Highlights

      • Prosthetic feet are available in different stiffnesses
      • There is limited evidence to guide stiffness selection during foot prescription
      • Prosthetic foot stiffness is associated with foot-ankle biomechanics changes
      • Perception of prosthetic foot stiffness was not consistent with stiffness category order

      Abstract

      Background

      Prosthetic feet are available in a range of stiffness categories, however, there is limited evidence to guide optimal selection during prosthetic foot prescription. The aim of this study was to determine the effect of commercial prosthetic foot stiffness category on foot-ankle biomechanics, gait symmetry, community ambulation, and relative foot stiffness perception.

      Methods

      Participants were fit in randomized order with three consecutive stiffness categories of a commonly-prescribed prosthetic foot. Prosthetic foot roll-over shape and ankle push-off power and work were determined via data collected during walking in a motion analysis laboratory. Step activity was recorded during community use of each foot. Self-reported perception of relative foot stiffness was assessed with an ad hoc survey.

      Findings

      Seventeen males with transtibial amputation completed the study. Prosthetic foot roll-over radius increased with increased prosthetic foot stiffness categories (p < 0.001). Both prosthetic ankle push-off peak power and work decreased with increased foot stiffness categories (p = 0.002). There was no association between prosthetic foot stiffness category and step length symmetry or steps per day. When assessed post-accommodation, there was no association between relative foot stiffness perception and the stiffness category across prosthetic foot conditions.

      Interpretation

      Prosthetic foot stiffness category was significantly associated with changes in prosthetic foot-ankle biomechanical variables, however, was not associated with changes in gait symmetry or community ambulation. Relative prosthetic foot stiffness perception after accommodation was generally inconsistent with the order of prosthetic foot stiffness categories.

      Clinical relevance

      While there were quantifiable differences in prosthetic foot-ankle biomechanics across stiffness categories, no significant differences were detected in gait symmetry or mean daily step count in the community. Furthermore, after community use, participants perceptions of relative stiffness across feet were generally inconsistent with the order of prosthetic foot stiffness categories. These findings raise questions as to whether changes in commercial prosthetic foot stiffness category (within a clinically relevant range) affect subjective and objective measures relevant to successful outcomes from prosthetic foot prescription.

      Keywords

      Abbreviations:

      TTA (transtibial amputation), ESR (energy-storage and return), VAPSHCS (VA Puget Sound Health Care System), GRF (ground reaction force), CI (confidence interval), RR&D (Rehabilitation Research & Development), IRB (institutional review board)
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