Kent Jenny A, Carnahan Kristin J, Stine Rebecca L, Hansen Andrew H, Esposito Elizabeth Russell, Major Matthew J
Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA.
Department of Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Disabil Rehabil. 2023 Jan;45(2):322-329. doi: 10.1080/09638288.2021.2022782. Epub 2022 Jan 3.
Prosthesis geometry and behaviour limit the footwear options available to women. Using a commercially available prosthetic foot that permits user-alignment to accommodate shoes with different heel heights, we investigated the effect of footwear on gait kinematics, with and without adjustment for differences in heel-forefoot differential.
Three women with transtibial amputation walked at a self-selected pace, first in an athletic shoe (prosthetist-aligned; baseline condition), then (i) in a flatter shoe without realigning the prosthesis, and (ii) in flat and heeled shoes following user re-alignment. Kinematics in each condition were compared to baseline.
Baseline gait patterns were highly variable across participants. Gait was slower in comparison to baseline in all conditions, but movement compensations varied across participants. An increased lower limb extension tendency was evident with the misaligned prosthesis. With user re-alignment to accommodate the shoe there were fewer deviations from baseline, however kinematic differences remained in both the flat and heeled shoes.
The user-alignment feature of the prosthetic foot reduced the effect of a change in footwear on kinematics, and permitted walking in heeled shoes when it might otherwise not be possible. Persistence of some deviations suggests differences in walking task demand remained despite adjustment.Implications for rehabilitationPermitting prosthesis users to don footwear of choice may improve body image, well-being and quality of life following amputation.Prosthetic feet that permit user ankle adjustment can reduce gait deviations associated with a change in footwear heel height, although kinematic adaptations are individual.
假肢的几何形状和性能限制了女性可选择的鞋类。我们使用一种市售的假脚，该假脚允许使用者进行调整以适配不同鞋跟高度的鞋子，研究了鞋类对步态运动学的影响，同时考虑了足跟-前脚掌差异的调整与否。
三名经胫骨截肢的女性以自我选择的速度行走，首先穿着运动鞋（假肢技师调整好的；基线状态），然后（i）穿着较平的鞋子且不重新调整假肢，以及（ii）在使用者重新调整后穿着平底鞋和高跟鞋。将每种情况下的运动学与基线进行比较。
不同参与者的基线步态模式差异很大。与基线相比，所有情况下的步态都较慢，但不同参与者的运动补偿各不相同。假肢未对齐时，下肢伸展趋势增加明显。在使用者重新调整以适配鞋子后，与基线的偏差减少，然而平底鞋和高跟鞋的运动学差异仍然存在。
假脚的使用者调整功能减少了鞋类变化对运动学的影响，并使得在其他情况下可能无法实现的穿着高跟鞋行走成为可能。一些偏差的持续存在表明，尽管进行了调整，但行走任务需求的差异仍然存在。
允许假肢使用者选择穿着自己喜欢的鞋子可能会改善截肢后的身体形象、幸福感和生活质量。允许使用者调整踝关节的假脚可以减少与鞋跟高度变化相关的步态偏差，尽管运动学适应是因人而异的。
