Comparison of Energy Cost and Gait Efficiency During Ambulation in Below-Knee Amputees Using Different Prosthetic Feet???A Preliminary Report

Nielsen, David H.; Shurr, Donald G.; Golden, Jane C.; Meier, Kenneth

doi:10.1097/00008526-198810000-00006

Cited by 108 publications

(59 citation statements)

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“…Results would possibly differ when prosthetic systems are used that also incorporate flexible shank regions, such as those found in the Flex-Foot (Össur; Reykjavik, Iceland). However, as mentioned earlier, several studies have still found no difference in energy expenditure when the Flex-Foot is used compared with the SACH foot [4][5][6].…”

Section: Discussionmentioning

confidence: 89%

“…Energy cost and expenditure also correlate with level of amputation [2] and residual limb length [3] and have more recently been used in attempts to quantify differences between prosthetic feet within a population of prosthesis users. Three previous investigations on unilateral transtibial prosthesis users reported reduced energy expenditure with the use of energy storage and return (ESAR) prostheses compared with the solid-ankle cushioned heel (SACH) foot [4][5][6]. Seven other reports found no difference in energy expenditure with the use of the SACH and ESAR feet in persons with unilateral transtibial amputation [7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users

Klodd

Hansen²,

Fatone

et al. 2010

JRRD

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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.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users

Klodd

Hansen²,

Fatone

et al. 2010

JRRD

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show abstract

“…Subjects often feel that the energy storing feet enable them to walk faster and maintain a more stable movement pattern, resulting in a strong preference for the dynamic feet over the more conventional models (Nielsen et al, 1989;Torburn et al, 1990). This lack of relationship between subject perception and biomechanical measures may indicate that other compensations, such as those that have not yet been examined, occur during locomotion with individuals with amputations.…”

Section: Introductionmentioning

confidence: 99%

A comparison of two prosthetic feet on the multi-joint and multi-plane kinetic gait compensations in individuals with a unilateral trans-tibial amputation

Underwood

Tokuno

Eng

2004

Clinical Biomechanics

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Objective-To determine the effects of two different prosthetic feet on the three-dimensional kinetic patterns of both the prosthetic and sound limbs during unilateral trans-tibial amputee gait.Design-Eleven individuals with a unilateral trans-tibial amputation participated in two walking sessions: once while using the conventional SAFE foot, the other while using the dynamic Flex foot.Background-Despite the wide variation in the design of prosthetic feet, the benefits of these prostheses remain unclear.Methods-During each test session, peak joint moments and powers in the sagittal, transverse and frontal planes were examined, as subjects walked at a comfortable speed.Results-The majority of the kinetic differences that occurred due to the changing of prosthetic foot type were limited to ankle joint variables in the sagittal plane with greater peak moments and power during propulsion for the Flex foot compared to the SAFE foot. However, effects were also found at joints proximal to the prosthesis (e.g. knee) and differences were also found in the kinetics of the sound limb.Conclusion-The dynamic Flex foot allowed subjects to rely more heavily on the prosthetic foot for propulsion and stability during walking with minimal compensations at the remaining joints.Relevance-Determining the biomechanical differences between the conventional and dynamic prosthetic feet may advocate the use of one prosthetic foot type over another. This information, when used in conjunction with subjective preferences, may contribute to higher functioning and greater satisfaction for individuals with a lower limb amputation.

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“…Compared with that of nondisabled subjects, the gait of individuals with amputation is more costly per minute and per meter [3][4][5][6]; the latter often referred to as cost of transport (COT). Furthermore, the higher up the leg the amputation, the higher the COT becomes [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…Some articles have found a statistically significant, albeit small, improvement in COT with ESR versus SACH feet [12][13]. Most studies, however, have failed to demonstrate any statistically significant differences [3,4,6,[14][15][16][17][18]. In the most recent systematic review of the literature, Hofstad et al's Cochrane review found "a small trend towards the Flex-foot (a type of ESR foot) in comparison with the SACH foot for .…”

Section: Introductionmentioning

confidence: 99%

Transtibial amputee gait efficiency: Energy storage and return versus solid ankle cushioned heel prosthetic feet

Gardiner¹,

Bari

Howard³

et al. 2016

J Rehabil Res Dev

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Abstract-Energy storage and return (ESR) feet have long been assumed to promote metabolically efficient amputee gait. However, despite being prescribed for approximately 30 yr, there is limited evidence that they achieve this desired function. Here, we report a meta-analysis of data from 10 studies that met our selection criteria to determine whether amputee walking with ESR feet is more efficient than with conventional solid ankle cushioned heel (SACH) feet. Additionally, the data were tested for a relationship with walking speed since it has been suggested ESR feet might perform better at higher speeds. The raw data were highly variable because of differences in study protocols; therefore, we normalized the data and found a statistically significant difference (p < 0.001) between ESR and SACH feet. However, the magnitude of this difference is small, with the cost of transport (COT) with ESR feet being 97.3% of the cost with SACH feet. No relationship between normalized ESR COT and speed was found (p = 0.19). We hypothesize that the small but statistically significant difference between ESR and SACH feet may not constitute a functionally significant improvement in COT, possibly related to the limited push-off power provided by ESR feet compared with nondisabled ankles.

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Comparison of Energy Cost and Gait Efficiency During Ambulation in Below-Knee Amputees Using Different Prosthetic Feet???A Preliminary Report

Cited by 108 publications

References 0 publications

Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users

Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users

A comparison of two prosthetic feet on the multi-joint and multi-plane kinetic gait compensations in individuals with a unilateral trans-tibial amputation

Transtibial amputee gait efficiency: Energy storage and return versus solid ankle cushioned heel prosthetic feet

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