Physiological Measurements of Walking and Running in People With Transtibial Amputations With 3 Different Prostheses

Abstract

Study Design: A 3-factor (foot type, speed, and mode of ambulation) repeated-measures experimental design was used. Objectives: To compare the differences in energy expenditure, gait efficiency, and relative exercise intensity in persons with transtibial amputations with various prostheses. Background: There is a need for improved prosthetic designs to accommodate physically active persons with lower-extremity amputations. Methods and Measures:We used progressive speeds of treadmill walking (53.64, 67.05, 80.46, 93.87, and 107.28 rnlmin) and running (120.69, 134.1, and 147.51 mlmin) with 3 different types of prostheses: the Solid Ankle Cushion Heel (SACH) foot, the Flex-Foot (FF), and the Re-Flex Vertical Shock Pylon NSP) prosthesis. Five physically active men with unilateral transtibial amputations served as subjects (aged 31.6 5 4.28 years). Results:The following statistically significant differences (improvements) between the Re-Flex VSP versus the FF and the SACH foot were found. Energy cost: walking (5%), running (1 1%); gait efficiency: walking (6%), running (9%); relative exercise intensity: walking (4%), running (5%). However, we found no significant differences between the FF and the SACH. Conclusions: The Re-Flex VSP appears to have a positive effect on energy cost, efficiency, and relative exercise intensity compared with the other prosthetic foot types during walking and running. ) Orthop Sports Phys Ther 1999;29:52&533.

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

“…However, this reduction is very small, with the mean cost of amputee walking across all ESR feet being 97.3 percent of that with a SACH foot. This confirms what only a few studies have shown with statistical significance (p < 0.05) [12][13]. The majority of studies have failed to obtain statistically significant results [3][4]6,[14][15][16][17][18], probably because of insufficient statistical power to detect such small differences.…”

“…We required the studies to contain metabolic cost of walking data, either per minute or per meter. After the application of the four additional criteria, we identified nine articles [3,4,[12][13][14][15][16][17][18]] from Hofstad et al's [19] systematic review that contained the necessary data for our meta-analysis. In addition, we identified only one article (Mengelkoch et al [6]) published after the systematic review that contained the relevant data and met the necessary selection criteria for the normalization method.…”

“…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].…”

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

“…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].…”

“…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].…”