Adding a toe joint to a prosthesis: walking biomechanics, energetics, and preference of individuals with unilateral below-knee limb loss

Abstract

Toe joints play an important functional role in able-bodied walking; however, for prosthesis users, the effect of adding a toe joint to a passive prosthetic foot remains largely unknown. The current study explores the kinematics, kinetics, rate of oxygen consumption and user preference of nine individuals with below-knee limb loss. Participants walked on a passive prosthetic foot in two configurations: with a Flexible, articulating toe joint and with a Locked-out toe joint. During level treadmill gait, participants exhibited a decrease in Push-Off work when using the Flexible toe joint prosthesis versus the Locked toe joint prosthesis: 16% less from the prosthesis (p = 0.004) and 10% less at the center of mass level (p = 0.039). However, between configurations, participants exhibited little change in other gait kinematics or kinetics, and no apparent or consistent difference in the rate of oxygen consumption (p = 0.097). None of the traditional biomechanical or metabolic outcomes seemed to explain user preference. However, an unexpected and intriguing observation was that all participants who wore the prosthesis on their dominant limb preferred the Flexible toe joint, and every other participant preferred the Locked configuration. Although perhaps coincidental, such findings may suggest a potential link between user preference and limb dominance, offering an interesting avenue for future research.

Design and optimization of a new integrated hip and knee prosthesis structure

“…The length of the HDP knee joint O knee‐N from the acetabular O hip can be expressed asAccording to the properties of parallelograms and the spatial layout shown in Figure 1, taking into account 5 and, 6 we obtainThe distance between the hip and knee joints of the new HDP structure remains constant regardless of the movement of the prosthesis, allowing the new HDP to mimic natural human movement accurately.…”

“…Among the various prosthetic options, single‐axis hip disarticulation prostheses (HDPs) are commonly used, with the axis of rotation typically positioned anterior to the residual limb at a 45° angle to the coronal plane 1 . Unfortunately, these prostheses' highly asymmetrical lower limb alignment leads to abnormal gait patterns and potential long‐term health issues 4–6 . While several studies have explored advanced intelligent prosthetic control techniques for restoring natural lower limb motion, current designs struggle to accurately replicate biological joint motion characteristics 7–9 .…”

“…1 Unfortunately, these prostheses' highly asymmetrical lower limb alignment leads to abnormal gait patterns and potential long-term health issues. [4][5][6] While several studies have explored advanced intelligent prosthetic control techniques for restoring natural lower limb motion, current designs struggle to accurately replicate biological joint motion characteristics. [7][8][9] Helix3D is a four-bar multi-center joint with hydraulics that provides controlled motion resistance during the stance and swing phases.…”

Biomechanical Impacts of Toe Joint With Transfemoral Amputee Using a Powered Knee-Ankle Prosthesis

“…This has led researchers to attempt increasing push-off assistance by attempting to replace the action of the MTP joints by adding a toe-joint. A study by McDonald et al ( 2021 ) added a toe-joint to a passive ankle-foot prosthesis and found no significant differences in kinetics and kinematics. However, a passive foot with a flexible toe-joint by Honert et al ( 2020 ) showed there was a difference using a custom foot with a wider base, longer arch, and a toe-joint.…”

Finding a Natural Fit: A Thematic Analysis of Amputees’ Prosthesis Setting Preferences during User-Guided Auto-Tuning

“…Traditionally, amputees’ preferences for prostheses were measured through discrete-choice questions (Hafner et al, 2007; Kahle et al, 2008; McDonald et al, 2021), simple rating (Andrysek et al, 2021), ranking (Klodd et al, 2010), or questionnaire (Raschke et al, 2015). These measures were usually used in between-device comparisons to assess the general perception of the overall performance of the prosthesis but cannot provide information on the preferences for the specific settings.…”