The Effects of Prosthetic Foot Design on Physiologic Measurements, Self-Selected Walking Velocity, and Physical Activity in People With Transtibial Amputation

Hsu, Mei‐Yu; Nielsen, David H.; Lin, Suh-Jen; Shurr, Donald G.

doi:10.1016/j.apmr.2005.07.310

Cited by 97 publications

(83 citation statements)

References 20 publications

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“…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. The lack of a relationship between speed and normalized ESR COT (Figure 2(b)) was unexpected because it has previously been suggested that ESR feet may only be effective compared with SACH feet at higher walking speeds [3,12].…”

Section: Discussionsupporting

confidence: 79%

“…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.…”

Section: Methodsmentioning

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%

See 2 more Smart Citations

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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Section: Discussionsupporting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Thus, PWA using the bionic prosthesis experienced normative ankle mechanics and push-off work in their trailing leg ( figure 4), yet did not incur the full metabolic penalty associated with producing that work. Also, PWA using the bionic prosthesis preferred to walk at the same velocity as non-amputees, suggesting that use of the bionic prosthesis improved functional ability [12,47]. Although use of the battery powered prosthesis normalized metabolic cost in PWA compared with non-amputees, it did not augment metabolic cost below normative levels (figure 3a).…”

Section: Discussionmentioning

confidence: 98%

Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

2011

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Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biological ankle during level-ground walking, specifically providing the net positive work required for a range of walking velocities. We compared metabolic energy costs, preferred velocities and biomechanical patterns of seven people with a unilateral transtibial amputation using the bionic prosthesis and using their own passiveelastic prosthesis to those of seven non-amputees during level-ground walking. Compared with using a passive-elastic prosthesis, using the bionic prosthesis decreased metabolic cost by 8 per cent, increased trailing prosthetic leg mechanical work by 57 per cent and decreased the leading biological leg mechanical work by 10 per cent, on average, across walking velocities of 0.75-1.75 m s 21 and increased preferred walking velocity by 23 per cent. Using the bionic prosthesis resulted in metabolic energy costs, preferred walking velocities and biomechanical patterns that were not significantly different from people without an amputation.

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“…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]. The results of these studies suggest inconsistent effects on energy expenditure in persons using various types of prosthetic feet.…”

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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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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The Effects of Prosthetic Foot Design on Physiologic Measurements, Self-Selected Walking Velocity, and Physical Activity in People With Transtibial Amputation

Cited by 97 publications

References 20 publications

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

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

Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

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

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