Johnson Louise, De Asha Alan R, Munjal Ramesh, Kulkarni Jai, Buckley John G
Division of Medical Engineering, School of Engineering, and Division of Allied Health Professions, School of Health Studies, University of Bradford, Bradford, United Kingdom.
J Rehabil Res Dev. 2014;51(3):429-37. doi: 10.1682/JRRD.2013.05.0126.
Most clinically available prosthetic feet have a rigid attachment or incorporate an "ankle" device allowing elastic articulation during stance, with the foot returning to a "neutral" position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p = 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the "toes down" foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping.
大多数临床上可用的假肢脚都有一个刚性连接装置，或者包含一个“脚踝”装置，在站立时允许弹性关节活动，并且在脚趾离地时脚会回到“中立”位置。我们研究了使用一种带有液压控制关节活动脚踝的脚，这种脚在脚趾离地时以及整个摆动过程中允许脚相对背屈，是否会增加最小脚趾间隙（MTC）。21名单侧胫骨截肢患者使用他们习惯的带有刚性或弹性关节连接装置的假肢脚以及一种带有液压脚踝连接装置的脚（hyA-F）完成了地面行走试验。在多个试验中评估了MTC和其他运动学变量。使用hyA-F时，双下肢的平均MTC均增加（p = 0.03）。在假肢侧，这部分是由于该装置在脚趾离地时处于完全背屈位置，这在整个摆动过程中减小了“脚趾向下”的脚角度（p = 0.01）。使用hyA-F时步行速度也增加了（p = 0.001），并且与假肢侧更大的摆动肢体髋关节屈曲相关（p = 0.04），这可能促成了平均MTC的增加。使用hyA-F时，假肢侧MTC的变异性增加（p = 0.03），但这并没有增加绊倒风险。
