Abstract-The gait characteristics of persons with unilateral transtibial amputations are fairly well documented in the literature. However, much less is known about the gait of persons with bilateral transtibial amputations. This study used quantitative gait analysis to investigate the gait characteristics of 19 persons with bilateral transtibial amputations. To reduce variability between subjects, we fitted all subjects with Seattle Lightfoot II feet 2 weeks before their gait analyses. The data indicated that subjects walked with symmetrical temporospatial, kinematic, and kinetic parameters. Compared with nondisabled controls, the subjects with amputations walked with slower speeds and lower cadences, had shorter step lengths and wider step widths, and displayed hip hiking during swing phase. Additionally, compared with the nondisabled controls walking at comparable speeds, the subjects with amputations demonstrated reduced ankle dorsiflexion and knee flexion in stance phase, reduced peak ankle plantar flexor moment, reduced positive ankle power (i.e., energy return) in late stance, and increased positive and negative hip power. These results demonstrate the deficiencies in current prosthetic componentry and suggest that further research is needed to enhance prosthesis function and improve gait in persons with amputations.

Objective: To determine if the provision of prosthetic ankle motion improves walking performance in persons with bilateral transtibial amputations. Design: Cross-over experimental design in which nineteen persons with bilateral transtibial amputations were fitted with Endolite Multiflex Ankles (flexion unit) and Otto Bock Torsion Adapters (torsion unit) to increase relative motion between the prosthetic foot and socket in the sagittal and transverse planes, respectively. Quantitative gait analyses were performed on subjects as they walked with four prosthetic configurations: baseline without flexion or torsion units, with only the flexion unit, with only the torsion unit, and with both the flexion and torsion units. Data were compared with a control group of fourteen able-bodied subjects. Results: The flexion unit increased ankle sagittal plane motion (6°-7°) and increased positive ankle power (about 0.17 watt/kg). The torsion unit increased transverse plane ankle range of motion by 1°-2°. Responses from questionnaires indicated that 14 of the 19 subjects preferred the prosthetic configuration that included both the flexion and torsion units. Further, the subjects perceived that the increased prosthetic ankle motion was particularly beneficial for improving stability while they walked on uneven terrain. Conclusions: Both the subjective and objective results suggest that prosthetic foot and ankle components that allow for greater sagittal and transverse plane rotations provide substantial benefit during walking and should be considered for persons with bilateral transtibial amputations. Nonetheless, clinicians should perform individual and appropriate assessments of patients to insure that they capable of using components that may improve mobility while possibly sacrificing some degree of stability.

Objectives To examine differences in gait characteristics between persons with bilateral transtibial amputations due to trauma and peripheral vascular disease (PVD); and to compare that with data from able-bodied controls that were previously collected and maintained in a laboratory database. Design Observational study of persons with bilateral transtibial amputations. Setting A motion analysis laboratory. Participants Nineteen bilateral transtibial amputees. Intervention No experimental intervention was performed. To standardize the effect of prosthetic foot type, subjects were fitted with Seattle Lightfoot II feet 2 weeks prior to quantitative gait analyses. Main Outcome Measures Temporospatial, kinematic, and kinetic gait data were recorded and analyzed. Results Results showed that the PVD and trauma subjects’ freely selected walking speeds were 0.69m/s and 1.11m/s, respectively, while that of able-bodied control subjects was 1.20m/s. When data were compared on the basis of freely selected walking speed, numerous differences were found in temporospatial, kinematic, and kinetic parameters between the PVD and trauma groups. However, when data from similar speeds were compared, the temporospatial, kinematic, and kinetic gait data demonstrated no statistically significant differences between the 2 amputee groups. Though not statistically significant, the PVD group displayed increased knee (P=.09) and hip (P=.06) flexion during swing phase, while the trauma group displayed increased pelvic obliquity (P=.06). These actions were believed to represent different strategies to increase swing phase foot clearance. Also, the PVD group exhibited slightly greater hip power (P=.05) prior to toe-off. Conclusions Many of the differences observed in the quantitative gait data between the trauma and PVD groups appeared to be directly associated with their freely selected walking speed; the trauma group walked at significantly faster freely selected speeds than the PVD group. When their walking speeds were matched, both amputee groups displayed similar gait characteristics, with the exception that they might utilize slightly different strategies to increase foot clearance.