Abstract
Contemporary prosthetic feet are generally optimized for either daily or high-level activities. Prosthesis users, therefore, often require multiple prostheses to participate in activities that span a range of mobility. Crossover feet (XF) are designed to increase the range of activities that can be performed with a single prosthesis. However, little evidence exists to guide clinical prescription of XF relative to traditional energy storing feet (ESF). The objective of this study was to assess the effects of XF and ESF on health outcomes in people with transtibial amputation. A randomized crossover study was conducted to assess changes in laboratory-based (endurance, perceived exertion, walking performance) and community-based (step activity and self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction) outcomes. Twenty-seven participants were fit with XF and ESF prostheses with standardized sockets, interfaces, and suspensions. Participants were not blinded to the intervention, and wore each prosthesis for one month while their steps were counted with an activity monitor. After each accommodation period, participants returned for data collection. Endurance and perceived exertion were measured with the Six-Minute Walk Test and Borg-CR100, respectively. Walking performance was measured using an electronic walkway. Self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction were measured with survey instruments. Participants also reported foot preferences upon conclusion of the study. Differences between feet were assessed with a crossover analysis. While using XF, users experienced improvements in most community-based outcomes, including mobility (p = .001), fatigue (p = .001), balance confidence (p = .005), activity restrictions (p = .002), and functional satisfaction (p < .001). Participants also exhibited longer sound side steps in XF compared to ESF (p < .001). Most participants (89%) reported an overall preference for XF; others (11%) reported no preference. Results indicate that XF may be a promising alternative to ESF for people with transtibial amputation who engage in a range of mobility activities.Trial registration: ClinicalTrials.gov NCT02440711
Highlights
Sophisticated prosthetic feet have been developed over the past three decades to enable users to participate in a variety of activities, including walking, running, and playing sports.[1]
Participants were not blinded to the intervention, and wore each intervention (i.e., XF and energy storing feet (ESF)) for at least one month to experience the function of each prosthetic foot across a range of settings and activities
Thirty-one people with transtibial amputation enrolled in the study and complete datasets were collected for 30 participants
Summary
Sophisticated prosthetic feet have been developed over the past three decades to enable users to participate in a variety of activities, including walking, running, and playing sports.[1]. ESF employ modern materials and geometric configurations designed to store and return energy in walking, much like a mechanical spring.[2] Prosthetic limbs with ESF allow users to return to an active lifestyle, but restrict running speed and aerobic performance compared to prosthetic feet designed for high speeds.[3] Running-specific feet (RSF), such as the Ossur Cheetah (Ossur hf, Reykjavik, Iceland), allow people with lower limb amputation to participate in demanding athletic activities.[4,5] While RSF are well-suited for running and sprinting, the absence of a heel and split keel decreases stability in standing, walking, and other low- and moderate-impact activities.[6] active users often require a primary prosthesis with an ESF and a sports prosthesis with an RSF or other specialized foot to participate optimally in a broad range of activities (Fig 2).[6,7]
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