Unilateral below-knee prosthesis users walking on uneven terrain: The effect of adding a toe joint to a passive prosthesis.

Lower limb prosthesis users cite uneven terrain as a challenging surface to walk on. We sought to determine whether adding a Flexible toe joint to a prosthetic foot would be preferred by unilateral below-knee prosthesis users relative to a Locked (non-articulating) toe joint for walking on uneven terrain. We also quantified lower limb joint kinetics for the Locked and Flexible toe joint configurations. Five of our nine participants preferred the Flexible toe joint when walking on uneven terrain, yet from a biomechanical standpoint, the reason for this is unclear. All participants exhibited reductions in prosthetic limb net positive hip joint work when walking with a Flexible toe joint (11%; p < 0.05). For other parameters (e.g., prosthetic side knee joint moments) we observed high inter-subject variation, which adds to a growing body of literature highlighting the need for subject-specific data analyses in lower limb prosthetics research.