Return Feet Research Articles

Systematic Assessment of Prosthesis Stiffness on User Biomechanics Using the Lower Leg Trajectory Error Framework and Its Implication for the Design and Evaluation of Ankle-Foot Prostheses.

Advances in understanding the effects the mechanical characteristics of prosthetic feet on user biomechanics have enabled passive prostheses to improve the walking pattern of people with lower limb amputation. However, there is no consensus on the design methodology and criteria required to maximize specific user outcomes and fully restore their mobility. The Lower Leg Trajectory Error (LLTE) framework is a novel design methodology based on the replication of lower leg dynamics. The LLTE value evaluates how closely a prosthetic foot replicates a target walking pattern. Designing a prosthesis that minimizes the LLTE value, optimizes its mechanical function to enable users to best replicate the target lower leg trajectory. Here, we conducted a systematic sensitivity investigation of LLTE-optimized prostheses. Five people with unilateral transtibial amputation walked overground at self-selected speeds using five prototype energy storage and return feet with varying LLTE values. The prototypes' LLTE values were varied by changing the stiffness of the participant's LLTE-optimized design by 60%, 80%, 120%, and 167%. Users most closely replicated the target able-bodied walking pattern with the LLTE-optimized stiffness, experimentally demonstrating that the predicted optimum was a true optimum. Additionally, the predicted LLTE values were correlated to the user's ability to replicate the target walking pattern, user preferences, and clinical outcomes including roll-over geometries, trunk sway, prosthetic energy return, and peak push-off power. This study further validates the use of the LLTE framework as a predictive and quantitative tool for designing and evaluating prosthetic feet.

Biomechanical evaluation over level ground walking of user-specific prosthetic feet designed using the lower leg trajectory error framework

The walking pattern and comfort of a person with lower limb amputation are determined by the prosthetic foot’s diverse set of mechanical characteristics. However, most design methodologies are iterative and focus on individual parameters, preventing a holistic design of prosthetic feet for a user’s body size and walking preferences. Here we refined and evaluated the lower leg trajectory error (LLTE) framework, a novel quantitative and predictive design methodology that optimizes the mechanical function of a user’s prosthesis to encourage gait dynamics that match their body size and desired walking pattern. Five people with unilateral below-knee amputation walked over-ground at self-selected speeds using an LLTE-optimized foot made of Nylon 6/6, their daily-use foot, and a standardized commercial energy storage and return (ESR) foot. Using the LLTE feet, target able-bodied kinematics and kinetics were replicated to within 5.2% and 13.9%, respectively, 13.5% closer than with the commercial ESR foot. Additionally, energy return and center of mass propulsion work were 46% and 34% greater compared to the other two prostheses, which could lead to reduced walking effort. Similarly, peak limb loading and flexion moment on the intact leg were reduced by an average of 13.1%, lowering risk of long-term injuries. LLTE-feet were preferred over the commercial ESR foot across all users and preferred over the daily-use feet by two participants. These results suggest that the LLTE framework could be used to design customized, high performance ESR prostheses using low-cost Nylon 6/6 material. More studies with large sample size are warranted for further verification.

A novel pivot ankle/foot prosthesis reduces sound side loading and risk for osteoarthritis: a pragmatic randomized controlled trial.

Background:Individuals with unilateral transtibial amputation are at risk of abnormal mechanical joint loading and development of osteoarthritis on sound side joint structures.Objectives:This study describes the spatiotemporal and kinetic and kinematic parameters related to osteoarthritis in participants while using (A) a solid-ankle cushioned-heel prosthesis (SACH), (B) a conventional energy storage and return (ESAR) foot prosthesis, and (C) a novel ESAR (N-ESAR) foot prosthesis.Study design:A pragmatic randomized controlled trial.Methods:K3–K4 ambulators used three feet in a 2-week randomized cross-over order. Kinetics of vertical ground reaction forces (vGRFs) and 3D kinematics of joint angles were integrated to provide normalized parameters. Data were analyzed using one way and mixed model Analysis of variance (ANOVAs) (p < 0.05) and Cohen d statistic.Results:Twenty participants, aged 40 ± 16 years with body mass index of 24.7 ± 3.6 kg/m2, experienced minimal change in the spatiotemporal parameters between feet. Participants using the N-ESAR foot prosthesis experienced reduced peak knee external adduction moment (p = 0.030), peak vGRFs (p < 0.001), and peak loading rate of vGRFs (p = 0.030). Peak knee flexion moments only changed when using the solid-ankle cushioned-heel prosthesis, in a positive direction (p = 0.014). Using the N-ESAR prosthesis also increased peak distal shank power during late stance phase (p < 0.001).Conclusions:A novel ankle/foot ESAR prosthesis reduces loading on the sound side. With extended use of the N-ESAR foot prosthesis, these findings may provide the prosthesis user with improved outcomes related to sound side loading and development of osteoarthritis.

Design and Analysis of The Energy Storage and Return (ESAR) Foot Prosthesis Using Finite Element Method

ABSTRACT. Disability issue has increased in recent years due to the high number of accidents and vascular disease. Loss of limb function for people with amputations often results in an abnormal gait. Energy Storage And Return (ESAR) foot prostheses provide an alternative to help improve gait and minimize metabolic energy expenditure during the walking phase of amputees. This study used 3 designs with models from the Catia V5 Software. The finite element method analysis used Ansys Workbench 18.1 software to evaluate the three designs with a loading of 1.2 times the user's body weight with a maximum weight of 70 kg in normal walking activities. The simulated material is carbon fiber prepreg which has tensile strength, Young's modulus, Poisson ratio, and density of 513.72 MPa, 77.71 GPa, 0.14, and 1.37 g/cm3. The decision-making matrix method is used to determine the best foot prosthesis design according to predetermined criteria. The highest value in the decision-making matrix is 76 in Design 3. The chosen design (Design 3) after gait cycle analysis has a maximum von Mises stress value of 76.956 MPa and the safety factor value for each gait cycle heel strike loading model is 1.0762; foot flat 3.2509; toe-off 6.6263.

Distribution of joint work during walking on slopes among persons with transfemoral amputation

Persons with above-knee amputation have increased energy consumption and greater difficulty in negotiating uphill and downhill slopes. Walking on slopes requires an adaptation of the positive and negative work performed by the joints of the lower limb to propel the center of mass. Modern prosthetic feet and knees can only partially adapt to changes in inclination, and the redistribution of joint work among persons with above-knee amputation is not described in the literature.Level, upslope and downslope walking (at 5% and 12% inclinations) were investigated for twelve subjects with transfemoral amputation fitted with an Energy Storing And Return foot (ESAR) and a Microprocessor controlled Prosthetic Knee (MPK) versus a control group of seventeen asymptomatic subjects. Lower limb joint and individual limb power and work were compared between prosthetic, contralateral and control limbs.The prosthesis dissipates less energy than the joints of the lower limb of the control group when descending the slope, but the demand on the contralateral limb is limited by a lower speed and step length. The huge deficit of positive work produced by the prosthetic ankle cannot be compensated by the residual hip during level and slope ascent which transfers the demand for energy production to the contralateral limb up to 40% on a 12% slope.This study highlights that prosthetic devices (ESAR foot and MPK) for persons with above-knee amputation present some limitations during slope walking that cannot be compensated by the residual hip and increase the work performed by the contralateral limb.

A Reduced-Order Computational Model of a Semi-Active Variable-Stiffness Foot Prosthesis.

Passive energy storage and return (ESR) feet are current performance standard in lower limb prostheses. A recently developed semi-active variable-stiffness foot (VSF) prosthesis balances the simplicity of a passive ESR device with the adaptability of a powered design. The purpose of this study was to model and simulate the ESR properties of the VSF prosthesis. The ESR properties of the VSF were modeled as a lumped parameter overhung beam. The overhung length is variable, allowing the model to exhibit variable ESR stiffness. Foot-ground contact was modeled using sphere-to-plane contact models. Contact parameters were optimized to represent the geometry and dynamics of the VSF and its foam base. Static compression tests and gait were simulated. Simulation outcomes were compared to corresponding experimental data. Stiffness of the model matched that of the physical VSF (R2: 0.98, root-mean-squared error (RMSE): 1.37 N/mm). Model-predicted resultant ground reaction force (GRFR) matched well under optimized parameter conditions (R2: 0.98, RMSE: 5.3% body weight,) and unoptimized parameter conditions (R2: 0.90, mean RMSE: 13% body weight). Anterior-posterior center of pressure matched well with R2 > 0.94 and RMSE < 9.5% foot length in all conditions. The ESR properties of the VSF were accurately simulated under benchtop testing and dynamic gait conditions. These methods may be useful for predicting GRFR arising from gait with novel prostheses. Such data are useful to optimize prosthesis design parameters on a user-specific basis.

Experimental characterization of the moment-angle curve during level and slope locomotion of transtibial amputee: Which parameters can be extracted to quantify the adaptations of microprocessor prosthetic ankle?

In case of transtibial amputation, the deficit resulting from the loss of the lower limb can be partly compensated with a prosthetic foot and adapted rehabilitation. New prosthetic feet have been developed for transtibial amputees to mimic ankle adaptability to varying terrain. Among them, Microprocessor Prosthetic Ankles (MPA) have a microprocessor to control an electric or a hydraulic actuator to adapt ankle kinematics in stairs and slopes. The objective is to investigate parameters extracted from the moment-angle curve (MAC) and use them to compare 3 MPA during level and slope locomotion against energy storing and return (ESR) foot. Five persons with lower limb transtibial amputation successively fitted with 3 MPA (Propriofoot™, Elan™, Meridium™) compared to their ESR foot. The participants had 2 weeks of adaptation before data acquisition and then a 3 week wash-out period. Range of motion, equilibrium point, hysteresis, late stance energy released, and quasi-stiffness were computed on level ground and 12% slope (upward and downward) thanks to the MAC at the ankle. The study shows the relevance of MAC parameters to evaluate the behavior of MPA. In particular, compared to ESR, all MPA tested in the present study demonstrated a better angle adaptation between walking conditions but a decrease of available energy for the propulsion. Among MPA, main results were: (i) for the Propriofoot™: an adaptation of the ankle angle without modification of the pattern of the MAC (ii) for the Elan™: a limited adaptation of the range of motion but a modification of the energy released (iii) for the Meridium™, the highest adaptation of the range of motion but the lowest available energy of propulsion. One of the main findings of the research is to show and quantify the relationship between range of motion and energy available when using different prosthetic feet in different walking conditions.

Functional performance differences between carbon fiber and fiberglass prosthetic feet.

Persons with lower limb amputation require increased functionality. The largest category of feet for active individuals with a transtibial amputation is energy storage and return (ESR) feet. These feet are typically constructed of carbon fiber composite materials. Recently, a prosthetic foot composed of a fiberglass composite has emerged in the market. However, there are no comparative studies of these devices. Compare the biomechanical performance and prosthesis-related quality of life when using a fiberglass prosthetic foot design compared with traditional carbon fiber ESR designs. This is a repeated-measures randomized cross-over trial. Gait analysis was performed on 10 experienced male subjects with unilateral transtibial amputations (K-level III) while walking on level ground and a ramp. Patient-reported outcomes were collected using the Prosthesis Evaluation Questionnaire. Gait data demonstrated increased ankle dorsiflexion (P < .01), similar ankle moments (P = .07), and increased ankle power generation (P = .01) when using the fiberglass foot. The increased power generation occurred at the correct time in the gait cycle such that the timing and magnitude of peak knee flexion was unaffected (P > .19). The fiberglass foot had greater energy absorption during gait (P = .01) with no difference in energy return (P = .37). The subjects expressed improved prosthesis-related quality of life with the fiberglass foot (P = .01). The findings of this study demonstrate that the new ESR foot comprising a fiberglass material had better performance than traditional designs using a carbon fiber material.

Characterizing adaptations of prosthetic feet in the frontal plane.

Energy-storage and return feet incorporate various design features including split toes. As a potential improvement, an energy-storage and return foot with a dedicated ankle joint was recently introduced allowing for easily accessible inversion/eversion movement. However, the adaptability of energy-storage and return feet to uneven ground and the effects on biomechanical and clinical parameters have not been investigated in detail. To investigate the design-related ability of prosthetic feet to adapt to cross slopes and derive a theoretical model. Mechanical testing and characterization. Mechanical adaptation to cross slopes was investigated for six prosthetic feet measured by a motion capture system. A theoretical model linking the measured data with adaptations is proposed. The type and degree of adaptation depends on the foot design, for example, stiffness, split toe or continuous carbon forefoot, and additional ankle joint. The model used shows high correlations with the measured data for all feet. The ability of prosthetic feet to adapt to uneven ground is design-dependent. The split-toe feet adapted better to cross slopes than those with continuous carbon forefeet. Joints enhance this further by allowing for additional inversion and eversion. The influence on biomechanical and clinical parameters should be assessed in future studies. Knowing foot-specific ability to adapt to uneven ground may help in selecting an appropriate prosthetic foot for persons with a lower limb amputation. Faster and more comprehensive adaptations to uneven ground may lower the need for compensations and therefore increase user safety.

Spatio temporal parameters and symmetry in subjects ascending and descending a ramp, using three different prosthetic feet

This study aimed at evaluating spatiotemporal parameters (STP) and symmetry index (SI), commonly used for evaluating amputee gait for routine clinical use, in individuals with unilateral transtibial amputations wearing energy storage and return (ESAR) feet with fixed ankles, prosthetic feet with adaptive ankles (PFAA) and prosthetic feet with microcontrolled adaptive ankles (PFAA-MC) in ramp ascent and descent. Thirteen individuals with transtibial amputations walked up and down a ramp. The STPs were measured in the amputated and intact legs and the relationship between them was quantified using the SI. The results showed that the use of PFAA-MC decreases walking speed in ramp descent (P < 0.018). However, this was the only parameter that showed a significant change. Hence, the differences in the amputees’ gait pattern when using the above-mentioned prostheses may not be reflected by STP and their SI.

Energy storing and return prosthetic feet improve step length symmetry while preserving margins of stability in persons with transtibial amputation

BackgroundEnergy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet.AimTo investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis.MethodsFifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet.ResultsPush-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability.ConclusionCompared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.

O 011 – Ankle power and energy cost during level and slope walking with Energy Storage and Return feet in transtibial amputees

O 011 – Ankle power and energy cost during level and slope walking with Energy Storage and Return feet in transtibial amputees

Increasing prosthetic foot energy return affects whole-body mechanics during walking on level ground and slopes

Prosthetic feet are designed to store energy during early stance and then release a portion of that energy during late stance. The usefulness of providing more energy return depends on whether or not that energy transfers up the lower limb to aid in whole body propulsion. This research examined how increasing prosthetic foot energy return affected walking mechanics across various slopes. Five people with a uni-lateral transtibial amputation walked on an instrumented treadmill at 1.1 m/s for three conditions (level ground, +7.5°, −7.5°) while wearing a prosthetic foot with a novel linkage system and a traditional energy storage and return foot. The novel foot demonstrated greater range of motion (p = 0.0012), and returned more energy (p = 0.023) compared to the traditional foot. The increased energy correlated with an increase in center of mass (CoM) energy change during propulsion from the prosthetic limb (p = 0.012), and the increased prosthetic limb propulsion correlated to a decrease in CoM energy change (i.e., collision) on the sound limb (p < 0.001). These data indicate that this novel foot was able to return more energy than a traditional prosthetic foot and that this additional energy was used to increase whole body propulsion.

Standing on slopes \u2013 how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task

BackgroundConventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees.MethodsFour unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of −10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group.ResultsDifferences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques.ConclusionsA prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.

Design and Analysis of 3D Printable Foot Prosthesis

3D printing manufacturing process has the possibilities to produce individual medical devices, especially implants and prosthesis with short production time. The aim of this study is to design a 3D printable Energy Storage and Return (ESAR) foot prosthesis for transtibial amputees with a novel geometry. The criteria of the prosthesis were 3D printable, low cost, simply geometry and satisfying mechanical properties for low activity use. The finite element analysis of the designed foot prosthesis was conducted in each of the three support phases of the walking cycle (controlled plantarflexion, controlled dorsiflexion, powered plantarflexion or push-off phase). Besides of the simulations the prototype was printed by fused deposit modeling (FDM) technology, used ABS material and the produced prototype was investigated in quasi-static and cyclic compression. It can be stated after the investigation (simulation and test) that the 3D printed prototype fulfill the requirements and it can be used as passive ESAR foot prosthesis.

Performance and environmental factors related to the main locomotor outcome in persons with an unilateral transtibial amputation equipped with energy storage and return feet

Objective. To assess performance and environmental factors in persons with an Unilateral TransTibial amputation (UTTA) equipped with an Energy Storage And Return (ESAR) foot. Method . Prosthetic Profile of the Amputees (PPA) questionnaire was sent to 295 adults with an UTTA. Results . Seventy-eight questionnaires met all criteria. The main locomotor outcome, was optimal in 51% of cases. The performance that best predicted the optimal main locomotor outcome was the ability to walk alone outside in inclement weather (OR [95%CI] = 36 [9.65–136.16]). The most predictive environmental factor was the acceptance of the amputation by the family and friends (OR [95%CI] = 6 [1.17–30.72]). Conclusions . A marked proportion of persons with UTTA showed a suboptimal walking performance at least 6 months after the attribution of an ESAR foot.

Performance and environmental factors related to the main locomotor outcome in persons with an unilateral transtibial amputation equipped with energy storage and return feet

Objectif. &#201;valuer les facteurs performance et environnement chez les Personnes atteintes d&#8217;une Amputation Transtibial Unilat&#233;rale (PATU) &#233;quip&#233;es d&#8217;un Pied proth&#233;tique &#224; Stockage/Restitution d&#8217;&#201;nergie (PSRE). M&#233;thode. Le questionnaire Profil Proth&#233;tique de l&#8217;Amput&#233; (PPA) a &#233;t&#233; envoy&#233; &#224; 295 personnes avec un PSRE. R&#233;sultats. Soixante-seize questionnaires r&#233;pondaient &#224; tous les crit&#232;res. Le niveau optimal de locomotion a &#233;t&#233; observ&#233; dans 51 % des cas. Les items des facteurs performance et environnement qui pr&#233;disaient le mieux le niveau optimal de locomotion &#233;taient respectivement la &#171; capacit&#233; de marcher seul dehors dans les intemp&#233;ries &#187; (OR [95 %CI] = 36 [9,65&#8211;136,16]) et &#171; l&#8217;acceptation de l&#8217;amputation par la famille et les amis &#187; (OR [95 %CI] = 6 [1,17&#8211;30,72]). Conclusion. Une proportion consid&#233;rable de PATU montre une performance sous optimale de marche, 6mois apr&#232;s l&#8217;attribution d&#8217;un PSRE.

Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.

Approximately 683 persons engaged in military service experienced transtibial amputation (TTA) related to recent war in Iraq and Afghanistan. Military TTAs function at a level beyond basic ambulation. No empirical data demonstrate which higher functioning prosthetic feet maximize injured service personnel's ability to continue performing at a level commensurate with return to duty. This study's purpose was to determine which of three high-functioning, energy-storing prosthetic feet maximize performance and preference in a field obstacle course (OC) and to quantify physical performance differences between TTAs and high-functioning nonamputees. A randomized, double-blind, repeated measures experimental design compared three prosthetic feet (Ossur Variflex, Endolite Elite Blade, and Ossur Re-Flex Rotate) during performance on a field OC. TTAs accommodated with study feet and the OC before assessment. 14 TTAs and 14 nonamputee controls completed the course. Subjective and objective performance differences were compared across feet conditions and between groups. Total OC completion times were similar between prosthetic feet: Elite-Blade (419 seconds ± 130), Variflex (425 seconds ± 144), and Re-Flex Rotate (444 seconds ± 220). Controls' OC completion time (287.2 seconds ± 58) was less (p ≤ 0.05) than TTA times. In total, controls had faster completion times (p ≤ 0.05) compared to all prosthetic feet conditions in 13/17 obstacles. Re-Flex Rotate had 2 additional obstacles different (p ≤ 0.05) than controls and required more time to complete. Median RPE values were lower (p ≤ 0.05) for controls than TTA regardless of foot. Regarding foot preference for OC completion, 7/14 (50%) preferred Elite Blade, 5/14 (36%) preferred Re-Flex Rotate, and the remaining 2/14 (14%) preferred Variflex. Controls completed the OC faster and with less effort than TTAs regardless of prosthetic foot. No clear differences in prosthetic feet emerged during OC completion; however, individual task performance, perceived effort, and preference resulted in trends of slight performance improvement with and preference for Elite Blade, a dual function energy-storing and return foot combined with vertical shock absorption. Understanding how to maximally improve performance in such functional tasks may allow service members to best sustain physical fitness, return to their military occupational specialty and possibly in-theater duty.

Biomechanical features of level walking by transtibial amputees wearing prosthetic feet with and without adaptive ankles

This study aimed to evaluate the kinematics and kinetics of the lower limb in both the intact and amputated leg in individuals with transtibial amputations wearing Energy storage and return feet (ESRFs) with fixed ankles and Prosthetic feet with adaptive ankles (PFAAs) during level walking. Three individuals with transtibial amputations walked on level ground wearing their own ESRFs and PFAAs. Spatiotemporal parameters, kinematics, and kinetics of the lower-extremity joints were measured in the amputated and intact legs. There were differences in the kinematics of the joints in the amputated leg and of the ankle in the intact leg between ESRFs and PFAAs. Differences in joint moments, power, and stiffness in most joints in both legs and braking impulse were found between ESRFs and PFAAs. Thus, although it was a pilot study with three subjects, ankle angle control mechanisms (ESRFs: Fixed ankle vs. propriofoot: Mechanical motor vs. elan and echelon: Hydraulic actuator) might affect biomechanical features during level walking.

Transtibial amputee gait efficiency: Energy storage and return versus solid ankle cushioned heel prosthetic feet.

Energy storage and return (ESR) feet have long been assumed to promote metabolically efficient amputee gait. However, despite being prescribed for approximately 30 yr, there is limited evidence that they achieve this desired function. Here, we report a meta-analysis of data from 10 studies that met our selection criteria to determine whether amputee walking with ESR feet is more efficient than with conventional solid ankle cushioned heel (SACH) feet. Additionally, the data were tested for a relationship with walking speed since it has been suggested ESR feet might perform better at higher speeds. The raw data are highly variable because of differences in study protocols; therefore, we normalized the data and found a statistically significant difference (p < 0.001) between ESR and SACH feet. However, the magnitude of this difference is small, with the cost of transport (COT) with ESR feet being 97.3% of the cost with SACH feet. No relationship between ESR COT and speed was found (p = 0.19). We hypothesize that the small but statistically significant difference between ESR and SACH feet may not constitute a functionally significant improvement in COT, possibly related to the limited push-off power provided by ESR feed compared with nondisabled ankles.