Qualitative investigation into the functional problems of transtibial prostheses when amputees perform agricultural work

Abstract

Background: A significant number of Colombian farmers who are transtibial amputees are civilian victims of landmines. Current prostheses are inadequately adapted for agricultural work, resulting in functional challenges in this context. Objective(s): This study aims to analyze and categorize the functional problems of transtibial prostheses in the Colombian agricultural context, incorporating perspectives from prosthesis users, manufacturers, and designers. Study Design: Descriptive qualitative research involving 49 transtibial amputees using prostheses and 18 professionals engaged in prosthesis design, manufacture, or prescription. Methods: Participants were interviewed. Each interview was transcribed, and a conventional content analysis was conducted to identify functional problems with transtibial prostheses in agricultural settings. Results: Interviewees reported that sockets become loose from residual limbs, and soft sockets and socks are prone to damage and maladjustment. The prosthetic foot undergoes stress due to stiffness, causing cracks and accelerated deterioration. Fastening screws loosen, break, and rust, while cosmetic foam retains moisture, perforates, and deteriorates in sunlight. Prosthesis deterioration is exacerbated by weather, moisture, mud, tall grass, and uneven or sloping terrain. Conclusions: Prosthesis designs should facilitate sweat drainage or quick drying to address issues with soft sockets and socks. Sockets should be padded to minimize residual limb injuries. Durable, low-cost, and easily replaceable soft sockets are essential for farming environments. Additionally, farmers need a prosthetic foot that flexes when caught in brush or walking on uneven/inclined surfaces, allowing movement in two physiological planes without compromising strength and durability.