Relating minimum toe clearance to prospective, self-reported, trip-related stumbles in the community

Abstract

Individuals with transtibial amputation are at increase risk of falling. The absence of an ankle joint and the associated musculature in these individuals can reduce clearance between the prosthetic foot and ground during the swing phase of gait, which may increase the risk of stumbling and in turn falling. To associate minimum toe clearance during gait in the laboratory with community-based, trip-related stumbles by individuals with transtibial amputation using conventional feet. Prospective cohort design; following quantitative gait analysis, participants completed electronic surveys to prospectively report stumbles and falls for 1 year thereafter. General community with gait analysis conducted within a motion analysis laboratory and prospective tracking of stumbles occurring in the community. A volunteer sample of eight unilateral, transtibial amputees that were K3 or K4 level ambulators and current patients at a local prosthetic clinic. All participants completed the entire 1-year follow-up study. Prosthetic-side minimum toe clearance while walking on a level treadmill at self-selected speed and self-reported trip-related stumbles in the community. Minimum toe clearance was defined as a local minimum of the vertical displacement of the toe from toe-off to heelstrike relative to its position during midstance. Prosthetic-side minimum toe clearance was more than 50% lower for participants who reported one or more trip-related stumbles on that side compared with participants who reported zero trip-related stumbles on the prosthetic side (minimum toe clearance = 12.3 ± 0.8 mm vs 25.6 ± 5.4 mm, respectively; p = 0.036). This is the first study relating laboratory-based measures to prospective stumbles by prosthesis users. The results suggest that prosthesis users with low minimum toe clearance may be at increased risk of experiencing a trip-related stumble in the community. Given that frequent stumbling increases the risk of falling, future work is warranted on the effectiveness of interventions focused on minimum toe clearance on reducing fall risk. Clinical relevance Interventions to increase minimum toes clearance, which could include prescription of active dorsiflexing prostheses or gait training, may help reduce the risk of trip-related falls for individuals who report a history of trip-related stumbles.