Prosthetic Foot Selection for Individuals with Lower-Limb Amputation: A Clinical Practice Guideline

Abstract

IntroductionThis guideline was developed to present current evidence and to provide associated clinical recommendations on prosthetic foot selection for individuals with lower-limb amputation.MaterialsNAMethodsThe guideline is based upon the best available evidence as it relates prosthetic foot selection during the provision of definitive lower-limb prostheses. Where possible, recommendations are drawn from Cochrane Review, meta-analysis, systematic and narrative literature reviews, and published evidence-based guidelines. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations.ResultsRecommendation 1: For patients ambulating at a single speed who require greater stability during weight acceptance because of weak knee extensors or poor balance, a single-axis foot should be considered. Recommendation 2: Patients at elevated risks for overuse injury (i.e., osteoarthritis) to the sound-side lower limb and lower back are indicated for an energy-storage-and-return (ESAR) foot to reduce the magnitude of the cyclical vertical impacts experienced during weight acceptance. Recommendation 3: Neither patient age nor amputation etiology should be viewed as primary considerations in prosthetic foot type. Recommendation 4: Patients capable of variable speed and/or community ambulation are indicated for ESAR feet.ConclusionsThese clinical practice guidelines summarize the available evidence related to prosthetic foot selection for individuals with lower limb amputation. The noted clinical practice guidelines are meant to serve only as “guides.” They may not apply to all patients and clinical situations.

Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial

“…Furthermore, the combination of vascular disease and aging also results in poor physical strength and balance, impaired neuromuscular coordination, and increased risk for falls. Consequently, it is of prime importance to prescribe an optimal/reliable prosthesis to maximize ambulation safety and restore the ability of older vascular amputees to independently perform physical tasks of daily living [ 7 – 10 ].…”

Cycling in people with a lower limb amputation

“…A dynamic foot increases the likelihood of cycling, in contrast to a SACH foot [ 5 ]. After a LLA, people who have the potential to walk with varying speeds and on various terrains are recommended to use a dynamic foot rather than a SACH foot [ 24 ]. This suggests that cyclists may already have a higher functional level in general.…”

Obstacles to Prosthetic Care—Legal and Ethical Aspects of Access to Upper and Lower Limb Prosthetics in Germany and the Improvement of Prosthetic Care from a Social Perspective

“…Numerous such CPGs can be found published online for different kinds of prosthetic care, providing advisory information for practitioners. For example, for knee prosthetics there is a CPG informing about the specific advantages of microprocessor-controlled vs. other prosthetic knees and conclusions that can be drawn for knee selection for a user [43]. This information can guide the decision of the doctor whether a user might benefit from microprocessor-controlled knees.…”

“…[55][56]. CPGs tend to be rather heterogeneous guideline documents [47], which may be produced by (national) medical associations and health organisations or departments [45,46,48], but also othe players in the health care system such as hospitals [43,49] and insurance companies [44]. In any case, they are not binding for care providers however.…”