Does Decreasing Below-Knee Prosthesis Pylon Longitudinal Stiffness Increase Prosthetic Limb Collision and Push-Off Work During Gait?

Abstract

Investigations have begun to connect leg prosthesis mechanical properties and user outcomes to optimize prosthesis designs for maximizing mobility. To date, parametric studies have focused on prosthetic foot properties, but not explicitly longitudinal stiffness that is uniquely modified through shock-absorbing pylons. The linear spring function of these devices might affect work performed on the body center-of-mass during walking. This study observed the effects of different levels of pylon stiffness on individual limb work of unilateral below-knee prosthesis users walking at customary and fast speeds. Longitudinal stiffness reductions were associated with minimal increase in prosthetic limb collision and push-off work, but inconsistent changes in sound limb work. These small and variable changes in limb work did not suggest an improvement in mechanical economy due to reductions in stiffness. Fast walking generated greater overall center-of-mass work demands across stiffness conditions. Results indicate limb work asymmetry as the prosthetic limb experienced on average 61% and 36% of collision and push-off work, respectively, relative to the sound limb. A series spring model to estimate residuum and pylon stiffness effects on prosthesis energy storage suggested that minimal changes to limb work may be due to influences of the residual limb which dominate the system response.