Abstract-Five solid-ankle experimental prosthetic feet were used in this double-blind randomized crossover study to determine the effects of forefoot flexibility on gait of 14 unilateral transtibial prosthesis users. Flexibility in experimental feet was altered by changing the number of flexural hinges in their forefoot sections. When experimental prosthetic foot conditions were compared, measured prosthetic ankle dorsiflexion range of motion increased as much as 3.3° with increasing flexibility (p < 0.001) and the foot's anterior moment arm (measured as the effective foot length ratio) increased as much as 23% of the foot length with decreasing flexibility (p < 0.001). Subjects also showed increases in the difference between sound and prosthetic ankle moments as high as 0.53 Nm/kg in late stance phase of walking as flexibility decreased (p < 0.001). The difference between first peaks of the vertical ground reaction forces on the sound and prosthetic sides increased as much as 9% of body weight when subjects used the foot with the greatest flexibility (p = 0.001). The results of this study suggest solid-ankle prosthetic foot designs with overly flexible forefoot sections can cause a "drop-off" effect in late stance phase and during the transition of loading between prosthetic and contralateral limbs.

Abstract-The investigators conducted a double-blind randomized crossover study to determine the effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of 13 unilateral transtibial prosthesis users. Five experimental feet were fabricated for use in the study: F1, F2, F3, F4, and F5. F1 was most flexible, F5 was least flexible, and F3 was designed to conform to a biomimetic ankle-foot rollover shape. The experimental feet were modeled after the Shape&Roll prosthetic foot (originally produced by Northwestern University, Chicago, Illinois; now in public domain) but had different numbers of saw cuts within the forefoot members, allowing more or less flexibility during walking. Participants walked at the same comfortable, freely selected speed on the treadmill for 7 min with each foot while energy expenditure was measured. No significant difference was found in oxygen cost (mL O 2 /kg/m) between the different feet (p = 0.17), and the order of use was also not significant (p = 0.94). However, the preference ranking was significantly affected by the flexibility of the feet (p = 0.002), with the most flexible foot (F1) ranking significantly poorer than feet F3 (p = 0.003) and F4 (p = 0.004). Users may prefer prosthetic feet that match the flexibility of an intact ankle-foot system, even though we did not detect an energetic benefit at freely selected speeds.