Gait Analysis and Energy Cost of Below-Knee Amputees Wearing Six Different Prosthetic Feet

Barth, Daryl G.; Schumacher, Lukas; Thomas, Susan

doi:10.1097/00008526-199212000-00001

Cited by 79 publications

(47 citation statements)

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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%

“…2. We excluded studies involving subjects with vascular amputation to avoid the possible confounding influences of their increased cost of walking, additional health problems, and reduced fitness [17][18]20]. 3.…”

Section: Methodsmentioning

confidence: 99%

“…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%

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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: Methodsmentioning

confidence: 99%

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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“…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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Prescription of prosthetic ankle-foot mechanisms after lower limb amputation

Hofstad

Linde

Limbeek

et al. 2004

Cochrane Database of Systematic Reviews

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There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle-foot mechanism. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. In prescribing prosthetic-ankle foot mechanisms for lower-limb amputees, practitioners should take into account availability, patient functional needs, and cost.

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Gait Analysis and Energy Cost of Below-Knee Amputees Wearing Six Different Prosthetic Feet

Cited by 79 publications

References 0 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

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

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation

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