Foot In People Research Articles

Development of a measuring system for evaluating the bioelectric signals of the muscular apparatus of the feet in people with cerebral palsy

Development of a measuring system for evaluating the bioelectric signals of the muscular apparatus of the feet in people with cerebral palsy

Early screening for foot problems in people with diabetes is the need of the hour: ‘Save the Feet and Keep Walking Campaign’ in India

IntroductionEvidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk...

Associations of phosphorus concentrations with medial arterial calcification in lower-extremity arteries and diabetic foot in people with diabetes: a retrospective cross-sectional study

BackgroundThe aim of this study was to investigate the associations of blood phosphorus levels with the risk of developing medial arterial calcification (MAC) in lower-limb arteries and diabetic foot (DF) in diabetes patients. We sought to enhance the understanding of the pathophysiology of diabetic complications and develop strategies to mitigate diabetes-related risks.MethodsWe conducted a retrospective analysis of 701 diabetic patients from the Department of Endocrinology at Sun Yat-Sen Memorial Hospital (2019–2023). We utilized multimodel-adjusted logistic regression to investigate the associations of serum phosphorus levels and the risk of developing MAC and DF. Restricted cubic spline plots were employed to model the relationships, and threshold analysis was used to identify inflection points. Subgroup analyses were performed to explore variations across different demographics. The diagnostic utility of phosphorus concentrations was assessed via the C index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsOf the 701 patients (mean age 63.9 years; 401 (57.20%) were male), 333 (47.50%) had MAC, and 329 (46.93%) had DF. After controlling for numerous confounding variables, each one-unit increase in phosphorus concentrations was associated with an increased risk of developing MAC (OR 2.65, 95% CI 1.97–3.57, p < 0.001) and DF (OR 1.54, 95% CI 1.09–2.18, p = 0.014). Phosphorus levels demonstrated a linear risk association, with risk not being uniform on either side of the inflection point, which was approximately 3.28 mg/dL for MAC and varied for DF (3.26 to 3.81 mg/dL). Adding the phosphorus as an independent component to the diagnostic model for MAC and DF increased the C index, NRI, and IDI to varying degrees.ConclusionsElevated serum phosphorus levels are significantly associated with an increased risk of developing MAC and DF among diabetic people. These findings suggest that phosphorus management could be integrated into routine diagnostic processes to improve the identification and management of lower-extremity diabetic complications.Graphical abstract

Assessment of Foot Strike Angle and Forward Propulsion with Wearable Sensors in People with Stroke.

Effective retraining of foot elevation and forward propulsion is a critical aspect of gait rehabilitation therapy after stroke, but valuable feedback to enhance these functions is often absent during home-based training. To enable feedback at home, this study assesses the validity of an inertial measurement unit (IMU) to measure the foot strike angle (FSA), and explores eight different kinematic parameters as potential indicators for forward propulsion. Twelve people with stroke performed walking trials while equipped with five IMUs and markers for optical motion analysis (the gold standard). The validity of the IMU-based FSA was assessed via Bland-Altman analysis, ICC, and the repeatability coefficient. Eight different kinematic parameters were compared to the forward propulsion via Pearson correlation. Analyses were performed on a stride-by-stride level and within-subject level. On a stride-by-stride level, the mean difference between the IMU-based FSA and OMCS-based FSA was 1.4 (95% confidence: -3.0; 5.9) degrees, with ICC = 0.97, and a repeatability coefficient of 5.3 degrees. The mean difference for the within-subject analysis was 1.5 (95% confidence: -1.0; 3.9) degrees, with a mean repeatability coefficient of 3.1 (SD: 2.0) degrees. Pearson's r value for all the studied parameters with forward propulsion were below 0.75 for the within-subject analysis, while on a stride-by-stride level the foot angle upon terminal contact and maximum foot angular velocity could be indicative for the peak forward propulsion. In conclusion, the FSA can accurately be assessed with an IMU on the foot in people with stroke during regular walking. However, no suitable kinematic indicator for forward propulsion was identified based on foot and shank movement that could be used for feedback in people with stroke.

Prevalence, Incidence and Factors Associated with Diabetic Foot in People with Type 2 Diabetes: Systematic Review with Meta-Analysis.

Diabetic Foot is a severe chronic complication of diabetes and an important factor in the morbidity of diabetic people, resulting in high health costs and increased risk of death. To analyze the incidence, prevalence, and risk factors associated with diabetic foot in people with type 2 Diabetes Mellitus. Systematic literature review. Searches in MedLine via PubMed, LILACS, Web of Science, Scopus CINAHL, and Cochrane Library databases were performed. Inclusion of 52 studies. The R program, Metan packages, was used to calculate the meta-analysis. Given the heterogeneity of studies, the random effect was used to calculate the meta-analysis of risk factors. The meta-analysis showed that the prevalence of diabetic foot was 14% in a hospital setting and 5% in a community setting. The overall prevalence and incidence were 9% and 4%, respectively. Significant risk factors included time of DM (odds ratio [OR] =1.46, confidence interval [CI], 0.36-2.57, P = 0.009), smoking (OR = 1.46, CI, 1.16 -1.85, P< .001), glycated hemoglobin (OR = 0.96, CI, 0.50; 1.42, P< .001), peripheral arterial disease (OR = 3.38, CI, 2.07; 5.53, P < .001) and peripheral neuropathy (OR = 5.88, CI, 2.39-14.45, P<.001). Multidisciplinary monitoring, educational strategies, periodic foot examination for alterations, and early identification of risk factors are essential to prevent ulceration and reduce the disease burden.

Technical methods of improving the biomechanics of feet in people with diabetes

This article discusses the role of orthoses in correcting biomechanics for patients with diabetic foot syndrome. It also analyzes literature on the use of specialized orthopedic shoes to address biomechanical foot issues and complicated forms of diabetes mellitus. Today, the general requirements for designing orthopedic shoes for patients with diabetes are described: a stiff sole with an artificial cushion; a suitable volume, a wide sole, an insole without a memory function; a thermally changeable elastic material; a minimum number of seams in the lining; an elastic upper and lining material in the toe area of the shoe; an increased fullness and additional volume in the toe region of the shoe, an angle of the bevel at the toe end of the sole, and the ability to adjust the interior volume of the shoe by using a hard heel that is stabilized with additional softness from the lining, as well as a smooth, non-traumatic upper. Indications for orthopedic unloading in patients with diabetic foot syndrome are highlighted.There is a negative approach towards conservative methods of treating patients with diabetic feet, but amputation in these cases cannot be considered a positive outcome of treatment. Nearly 70 to 90 percent of ulcers in this patient group heal without amputation. Techniques using specially designed shoes are less expensive and more cost-effective than limb loss. The use of orthotic shoes in diabetic foot patients serves as a method of both correction and rehabilitation.

Definition of thermal indicators for the study of thermoregulation alterations in the foot of people living within diabetic peripheral neuropathy: A proof of concept

AimsThis study investigates how diabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms using a thermal camera, spectral thermal analysis and a physical test. MethodsThe plantar skin temperature of all participants was measured using a thermal camera following a 6-min walking exercise. The data were subjected to frequency decomposition, resulting in two frequency ranges corresponding to endothelial and neurogenic mechanisms. Then, 40 thermal indicators were evaluated for each participant. ROC curve and statistical tests allowed to identify indicators able to detect the presence or absence of diabetic peripheral neuropathy. ResultsThe study included 33 participants living with diabetes. The results revealed that a 6-min walk exercise increased plantar foot temperature and highlighted a significant difference between people living with diabetes with and without peripheral neuropathy (p < 0.01). The results also revealed the advantages of using thermal images rather than single point measurements. ConclusionsDiabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms. This link can be highlighted after a dedicated 6-min walk exercise, enabling to activate these mechanisms, and measuring with a thermal camera the temporal plantar skin temperature. Assessment of this link gave best results by filtering the thermal signal in the neurogenic range.

The value of loss of protective pain sensation in predicting afirst ulceration of the foot in people with diabetes.

To determine both the risk of first ever ulcer (FEU) and its time to onset in a population which had loss of protective sensation (LOPS) in the foot either with or without loss of protective pain (LOPP). People with diabetes and LOPS without history of FEU presenting in a specialist clinic were included. LOPP was diagnosed by reduced vibration perception and pain perception by using a pinprick simulator. Participants were followed by routine foot checks, phone interview or by letter until the occurrence of a FEU, death or the end of observation period. Survival functions in LOPP strata were compared by log rank test. The hazard ratio (HR) of an FEU in people with compared to people without LOPP was estimated using Cox regression. Time to first ulcer was estimated using the framework of an accelerated failure time (AFT) model. One hundred and thirty participants were followed up for a median of 48.3 months. Pain perception was lost in 55.4%. Eighteen people with LOPP developed a FEU (25.0%) as opposed to six (10.3%) of those with no LOPP (p = 0.02). Age-sex-adjusted HR for FEU was 3.0 (p = 0.02) for people with compared to people without LOPP. Age-sex-adjusted time to FEU for people with LOPP was approximately half (p = 0.03) than people without LOPP. It is suggested that estimation of LOPP is included in routine practice because of its high predictive value for a FEU.

Stepping up foot care: assessment over foot care knowledge and behavior among individuals with diabetes of risk levels

BackgroundDiabetic foot is a global threat to public health, as it can lead to infections and amputations and cause significant pain and economic costs for patients. Diabetic foot patients in northern China have more severe local ulcers, worse prognosis, and longer disease duration.ObjectiveThis study assessed the foot risk levels and foot care knowledge and behavior status of people with diabetes with different foot risk levels, and investigated the factors that influence the occurrence of high-risk foot in diabetes.MethodsThis cross-sectional survey included 410 hospitalized people with diabetes. Demographic and disease-related data and foot risk stratification status were collected using investigator-designed questionnaires. Foot care knowledge and behavior questionnaires were also used.ResultsAmong the 410 participants, a total of 367 cases were classified as high-risk feet, among which 135 cases were rated as grade 1, 202 cases grade 2, and 30 cases grade 3. Foot care knowledge surveys revealed low scores in the areas of shoe and sock selection, foot and footwear examination, and management of foot problems. Foot care behavior surveys showed low scores in the areas of foot and footwear examination, management of foot problems, and foot injury risk behavior. One-way ANOVA revealed significant differences in foot care behaviors among patients with different foot risk classifications (p < 0.05), while no significant differences were observed in foot care knowledge scores. Multivariate logistic regression analysis showed that age, history of cerebrovascular disease, and foot care behavior scores were factors influencing the occurrence of high-risk foot in people with diabetes.ConclusionThe results of this study showed a high prevalence of high-risk foot in diabetics; The knowledge and behavior of foot care in diabetics with different foot risk levels were both at a moderately low level; There were differences in foot behavior scores among patients with different foot risk classes, but, counter-intuitively, no significant differences in foot care knowledge. The study found that advanced age, history of cerebrovascular disease, and low foot care behavior scores are risk factors for high-risk foot in diabetes. Therefore, it is necessary to screen patients with diabetes for high-risk feet and implement targeted interventions according to the results.

Effects of high-profile crossover feet on gait biomechanics in 2 individuals with Syme amputation.

Prosthetic treatment options for people with ankle disarticulation (i.e., Syme amputation) are limited. Prosthetic feet designed for people with Syme amputation are often low profile to accommodate build-height restrictions, resulting in decreased energy return during gait. High-profile crossover feet that attach to the posterior proximal aspect of the prosthetic socket can bypass these restrictions and may promote a more physiologic gait pattern. To compare level-ground gait biomechanics and patient-reported outcomes between crossover and traditional energy-storing feet in people with Syme amputation. Within-participant pilot study. Both participants were fit with energy-storing and crossover feet and were randomized to the order they used the feet. Participants used each foot for 2 weeks before assessment. Step length symmetry, prosthetic ankle range of motion, prosthetic-side energy return, and peak sound-side loading were determined from motion capture data obtained in a laboratory. Mobility and balance confidence were measured using standardized patient-reported outcome measures. Foot preference was assessed with an ad hoc survey. Two participants with Syme amputations completed the study. Prosthetic ankle peak dorsiflexion and push-off power increased with the crossover foot compared with the energy-storing foot for both participants. Both participants reported an overall preference of the crossover foot. Changes in patient-reported outcomes did not exceed published minimum detectable change values. Crossover feet increased prosthetic ankle range of motion and energy return compared with traditional energy-storing feet in this pilot investigation of 2 participants. Crossover feet seem to promote physiologic gait and may be a promising alternative to traditional low-profile feet for people with Syme amputation.

Myth or truth: investigation of the jumping ability of Tunga penetrans (Siphonaptera: Tungidae).

Female sand fleas (Tunga penetrans Linnaeus, 1758, Siphonaptera: Tungidae) cause a severe parasitic skin disease known as tungiasis. T. penetrans is a small flea, measuring less than 1 mm in length. The females of this species burrow into the skin of human and animal hosts and mostly affect the feet. This has led to the anecdotal assumption that T. penetrans, unlike its relatives in the Siphonaptera family, would have a limited jumping ability potentially not reaching higher body parts. However, there is no data supporting this. This study evaluated the jumping capabilities of T. penetrans for height and distance using sticky tapes. The vertical jump of the female T. penetrans ranged from 4.5 to 100 mm with a mean of 40 mm whereas the vertical jump of the male T. penetrans ranged from 1.2 to 138 mm with a mean of 46 mm. The horizontal jump of the female T. penetrans ranged from 18 to 138 mm with a mean of 64 mm and that of the male ranged from 9 to 251 mm with a mean of 80 mm. Based on the literature, fleas of various species have been described as jumping vertically 50-100 times their size and horizontally 5-100 times their size. In this respect, sand fleas appear to have equal expert jumping abilities to their relatives. Their aggregation on people's feet is not likely a result of their poor jumping ability but might be an adaptation to the host's behavior which would require further investigations.

Examination of Feet in People with Diabetes

Diabetic foot is a common complication of diabetes and leads to considerable morbidity and mortality. Neuropathy, deformity, infection and ischemia play a key role in the pathogenesis of diabetic foot ulcer. A multidisciplinary team approach by a nurse, physician, diabetic foot surgeon and the caregiver as well as close monitoring can prevent foot complications. Proper foot care, foot hygiene, annual foot examination and correct choice of footwear are main factors in preventing foot problems, ulceration and amputations. Physicians play a lead role in early detection and prevention of foot problems. This article will focus on how to perform foot examination in routine clinical practice.

Senam Kaki Sebagai Upaya Pencegahan Diabetic Foot pada Penderita Diabetes Mellitus Tipe 2

Nurses are one of the health teams whose role is to help DM sufferers to prevent diabetic foot, one of which is by teaching DM sufferers to do foot exercises. Foot exercise is an activity or physical exercise performed by patients with diabetes mellitus by moving their feet. One of the goals is to help improve blood circulation in the legs, to prevent diabetic ulcer. Community service activities with the theme "foot exercise as an effort to prevent diabetic foot in people with type 2 diabetes mellitus" have been carried out in collaboration with the Prolanis team at the Karang Pule Health Center in Mataram. The method used is education, demonstration, and then all participants practice how to do leg exercises. This activity was carried out as a concrete manifestation of the involvement of nurses in efforts to prevent diabetic foot in patients with type 2 DM. From this activity, it can be concluded that all participants could practice how to do foot exercises and they were active and enthusiastic about participating in all activities until the end. Based on the explanation above, it is necessary to carry out periodic foot exercise activities and monitor/examine ABI in an effort to prevent diabetic foot complications in type 2 DM patients.

Self-care of the feet in people with type 2 diabetes. A qualitative study

ObjectiveTo understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. MethodQualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. ResultsA final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. ConclusionsThe nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.

Edukasi Perawatan Kaki pada Penderita Diabetes Mellitus di Wilayah Kerja Puskesmas Syamtalira Aron

&#x0D; &#x0D; &#x0D; &#x0D; A serious complication that is often found in people with Diabetes Mellitus (DM) is diabetic foot ulcers. One of the primary prevention efforts for complications of diabetes mellitus such as the risk of neuropathy and foot ulcers is to provide health education about foot care for people with diabetes mellitus to increase knowledge and skills in performing routine and independent foot care. The target of this community service program is people with diabetes mellitus in the working area of the Syamtalira Aron Health Center, Syamtalira Aron District, totaling 25 people. The problem encountered is that DM sufferers still lack information about how to properly and correctly treat diabetic feet. There is no health team that provides direct education to DM sufferers about diabetic foot care techniques. The method used in this activity is to provide education and simulation/practice of diabetic foot exercises using power point media and distributing leaflets about the management and care of feet in people with DM. After educational activities and foot care simulations were carried out on November 14 and 15 2022 there was an 80% increase in knowledge in the good category and after the foot exercise simulation/exercise there was an increase in skills in doing foot care, namely 96%. This shows the target achievement in accordance with the expected results. The output that is expected to be achieved from this activity is that this program can provide benefits to the community, especially the target audience, thereby increasing the quality of human resources and the results can be published nationally with the ISSN and e-ISSN.&#x0D; &#x0D; &#x0D; &#x0D;

Flexible Lead-Free Piezoelectric Ba0.94Sr0.06Sn0.09Ti0.91O3/PDMS Composite for Self-Powered Human Motion Monitoring.

Piezoelectric wearable electronics, which can sense external pressure, have attracted widespread attention. However, the enhancement of electromechanical coupling performance remains a great challenge. Here, a new solid solution of Ba1-xSrxSn0.09Ti0.91O3 (x = 0.00~0.08) is prepared to explore potential high-performance, lead-free piezoelectric ceramics. The coexistence of the rhombohedral phase, orthorhombic phase and tetragonal phase is determined in a ceramic with x = 0.06, showing enhanced electrical performance with a piezoelectric coefficient of d33~650 pC/N. Furthermore, Ba0.94Sr0.06Sn0.09Ti0.91O3 (BSST) is co-blended with PDMS to prepare flexible piezoelectric nanogenerators (PENGs) and their performance is explored. The effects of inorganic particle concentration and distribution on the piezoelectric output of the composite are systematically analyzed by experimental tests and computational simulations. As a result, the optimal VOC and ISC of the PENG (40 wt%) can reach 3.05 V and 44.5 nA, respectively, at 138.89 kPa, and the optimal sensitivity of the device is up to 21.09 mV/kPa. Due to the flexibility of the device, the prepared PENG can be attached to the surface of human skin as a sensor to monitor vital movements of the neck, fingers, elbows, spine, knees and feet of people, thus warning of dangerous behavior or incorrect posture and providing support for sports rehabilitation.

Knowledge about Diabetic Foot Care is Related to the Ability to Care for Feet in People with Diabetes Mellitus

The most common complication in people with diabetes mellitus is diabetic foot problems. Efforts to prevent diabetic foot problems can be prevented with proper foot care. Checking the foot every day, whether there are wounds or bleeding, cleaning the foot every day, cutting nails, using comfortable shoes or slippers, and immediately contacting a doctor if the foot is injured. The purpose of this study identified the relationship between knowledge about diabetic foot care and the ability to care for the feet in people with diabetes mellitus. This study used a type of correlation research with a cross-sectional design. The subjects of this study were people with diabetes mellitus, who totaled 26 respondents. Data collection using questionnaires that are distributed to respondents. Univariate data analysis using frequency distribution and bivariate using chi-square. The result shows a relationship between knowledge about diabetic foot care and the ability to care for feet in people with diabetes mellitus. This research contributes to providing knowledge to people with diabetes mellitus. This knowledge contributes to motivating foot care activities to prevent diabetic foot injuries.

Management of the Diabetic Foot in People with Diabetes Mellitus Older than 65 Years

Introduction: Diabetic foot is the infection, ulceration or destruction of the deep tissues of the foot in patients with diabetes mellitus. This pathology occurs when there are high levels of glucose in the blood, as well as other factors such as high blood pressure and hypercholesterolemia. These factors cause damage to the vessels and nerves, producing medium and long-term complications. This is a health problem that affects diabetic patients throughout their lives. Objective: To know the different techniques and strategies that allow to carry out an appropriate management of the diabetic foot. Methodology: A narrative review was carried out between November 2021 and July 2022 in the different databases of Pubmed (Medline), Scielo, Scopus and Web of Science (WOS), with a search string that combined the keywords derived from thesauri, namely Descriptors of Health Sciences (DeCS) and Medical Subject Headings (MeSH), combined with the Boolean operators “AND”, “NOT” and “NOT”. Results: After applying the article selection criteria and evaluating the quality of the methodology, a total of 22 articles were obtained. The results affirm the existence of promising therapies for the treatment of diabetic foot ulcers such as negative-pressure therapy and hyperbaric oxygen therapy. It is highlighted that the use of therapeutic footwear and health education are deficient aspects that must be reinforced. Conclusions: After comparing the different articles, it was possible to determine that negative-pressure therapy and hyperbaric oxygen therapy should be promoted as they are suitable for the treatment of diabetic foot ulcers. In addition, therapeutic footwear is a baseline in the diabetic foot approach. On the other hand, it is necessary to reinforce interdisciplinary work in this area and health education for patients suffering from this disease.

The Efficacy of Exercise Training for Cutaneous Microvascular Reactivity in the Foot in People with Diabetes and Obesity: Secondary Analyses from a Randomized Controlled Trial.

It is unclear if cutaneous microvascular dysfunction associated with diabetes and obesity can be ameliorated with exercise. We investigated the effect of 12-weeks of exercise training on cutaneous microvascular reactivity in the foot. Thirty-three inactive adults with type 2 diabetes and obesity (55% male, 56.1 ± 7.9 years, BMI: 35.8 ± 5, diabetes duration: 7.9 ± 6.3 years) were randomly allocated to 12-weeks of either (i) moderate-intensity continuous training [50–60% peak oxygen consumption (VO2peak), 30–45 min, 3 d/week], (ii) low-volume high-intensity interval training (90% VO2peak, 1–4 min, 3 d/week) or (iii) sham exercise placebo. Post-occlusive reactive hyperaemia at the hallux was determined by laser-Doppler fluxmetry. Though time to peak flux post-occlusion almost halved following moderate intensity exercise, no outcome measure reached statistical significance (p > 0.05). These secondary findings from a randomised controlled trial are the first data reporting the effect of exercise interventions on cutaneous microvascular reactivity in the foot in people with diabetes. A period of 12 weeks of moderate-intensity or low-volume high-intensity exercise may not be enough to elicit functional improvements in foot microvascular reactivity in adults with type 2 diabetes and obesity. Larger, sufficiently powered, prospective studies are necessary to determine if additional weight loss and/or higher exercise volume is required.

Biomechanical comparison of a 3D-printed prosthetic foot with conventional feet in people with transtibial amputation: A prospective cohort study.

The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. In principle, 3D-printed feet have advantages over conventional "off the shelf" feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.