Standing balance measured as sway and standing time both on one and two legs, was studied by use of a stable force platform (Kistler) in 36 patients aged 48–87 years with trans-tibial amputation and 27 healthy subjects matched for age. The aim of the study was to compare postural function in standing in two groups with unilateral trans-tibial amputations, separating vascular disease from trauma. Results revealed that the vascular group had a significantly increased sway in the lateral direction compared with the healthy group, when standing on both feet close together for 30 seconds, looking straight ahead or blindfolded (p values ranging from 0.003 to 0.02). In the sagittal direction the trauma amputees had a significantly decreased sway when looking straight ahead, compared to the vascular and healthy groups (p values = 0.03). No significant differences in the lateral or sagittal direction were seen among the three groups when comparing standing on one leg. There was a significant difference, however, in the standing time in the one-leg standing test of the vascular group when compared with the trauma and healthy groups (p values ranging from 0.0009 to 0.02). In contrast to the vascular group, all subjects in the trauma and healthy groups from 48 to 59 years could stand on the healthy leg for 30 seconds when looking straight ahead, and from 60 to 79 years they could stand for 5 seconds. None in the vascular or trauma group older than 80 years could stand on the healthy leg for 5 seconds. The standing balance of the vascular amputees was found to be inferior to that of the trauma amputees. In conclusion, vascular and trauma trans-tibial amputees should not be considered as an entity in test situations or rehabilitation programmes.

Walking speed, stance duration and ground reaction forces were studied with the use of a stable force platform (Kistler) in 24 male trans-tibial amputees and 12 healthy subjects matched for sex and age. The aim of the study was to compare the gait performance of two groups with unilateral trans-tibial amputations for either vascular disease or trauma and also to compare the results of the two groups with the results of a group of healthy subjects. Multiple linear regression analysis was used to compare the stance duration and the ground reaction forces in relation to walking speed. The vascular and traumatic amputees had significantly reduced walking speeds compared with the healthy subjects, 0.85±0.2 m/s and 0.99±0.2 m/s. respectively, as compared to 1.42±0.2 m/s. By comparing the vascular and traumatic amputees with the healthy subjects in relation to walking speed, it was shown that the gait performance of the vascular amputee differed from that of the traumatic amputee, a difference that was not caused by the reduced walking speed. The active forces during push off on both the healthy (p = 0.02) and the prosthetic leg (p = 0.003) in the trauma group were not found in the vascular group. This disparity could be an effect of the systemic disease. It may be argued that the results of this study contribute to the understanding of the reduced walking ability of the vascular amputee and should be borne in mind when planning rehabilitation.

ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.

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