Mueller Emily, Major Matthew J
Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, IL, USA.
Northwestern University Department of Biomedical Engineering, Evanston, IL, USA.
J Prosthet Orthot. 2024 Jul;36(3):e49-359. doi: 10.1097/jpo.0000000000000501.
In non-impaired human locomotion, sagittal-plane slope adaptation of the foot-ankle complex is a volitional function driven by neuromotor control to support upright posture and forward ambulation. Loss of this adaptation due to transtibial amputation can lead to instability and compensatory motions as most commercially-available prosthetic feet do not permit automatic slope adjustments. A selection of slope-adaptive feet (SAF) have been developed to promote biomimetic ankle motion while ambulating over slopes. This review evaluated the current literature to assess the effects of SAF prostheses on sloped gait performance in unilateral transtibial prosthesis users.
Four databases (PubMed, Embase, CINAHL, IEEE Xplore) were searched on April 28, 2022, for relevant articles. Search keywords covered the general terms "transtibial," "amputation," "slope," "adaptive," and "gait", and included articles comparing a SAF prosthesis to a non-SAF prosthesis condition. Data were extracted for analysis and results were grouped according to outcomes to identify trends and aid interpretation of slope adaptation effects on gait.
Of the 672 articles screened, 24 met the selection criteria and were included in this review, published between 2009 and 2022. The non-SAF condition included dynamic response feet and SAF prostheses with the adaptability function inactive. Outcomes included biomechanical variables (joint dynamics, gait symmetry, toe clearance), clinical outcome measures, and energy expenditure. All SAF demonstrated some form of foot-ankle slope gradient adaptability, but effects on other joint dynamics were inconsistent. Minimum toe clearance during incline and decline walking was greater when using SAF compared to non-SAF in all reporting studies.
Results generally suggest improvements in gait quality, comfort, and safety with use of SAF compared to non-SAF during slope walking. However, variations in tested SAF and walking gradients across studies highlight the need for research to elucidate walking condition effects and advantages of specific designs.
Slope-adaptive prosthetic feet may improve user gait quality and comfort and enhance gait safety by increasing minimum toe clearance. Patients who encounter slopes regularly should be considered as potential users of SAF if indicated appropriately.
在正常人体运动中，足踝复合体矢状面坡度适应性是一种由神经运动控制驱动的自主功能，以支持直立姿势和向前行走。由于胫骨截肢导致这种适应性丧失会导致不稳定和代偿性运动，因为大多数市售假脚不允许自动坡度调整。已经开发了一系列坡度自适应假脚（SAF），以促进在斜坡上行走时的仿生踝关节运动。本综述评估了当前文献，以评估SAF假肢对单侧胫骨截肢假肢使用者斜坡步态性能的影响。
于2022年4月28日在四个数据库（PubMed、Embase、CINAHL、IEEE Xplore）中搜索相关文章。搜索关键词涵盖“胫骨”、“截肢”、“斜坡”、“自适应”和“步态”等通用术语，并包括将SAF假肢与非SAF假肢情况进行比较的文章。提取数据进行分析，并根据结果进行分组，以识别趋势并有助于解释坡度适应性对步态的影响。
在筛选的672篇文章中，24篇符合选择标准并被纳入本综述，发表时间为2009年至2022年。非SAF情况包括动态响应假脚和适应性功能未激活的SAF假肢。结果包括生物力学变量（关节动力学、步态对称性、趾间隙）、临床结局指标和能量消耗。所有SAF都表现出某种形式的足踝坡度梯度适应性，但对其他关节动力学的影响并不一致。在所有报告的研究中，与非SAF相比，使用SAF时上坡和下坡行走期间的最小趾间隙更大。
结果总体表明，与非SAF相比，在斜坡行走时使用SAF可改善步态质量、舒适度和安全性。然而，各研究中测试的SAF和行走坡度的差异凸显了开展研究以阐明行走条件影响和特定设计优势的必要性。
坡度自适应假脚可通过增加最小趾间隙来改善使用者的步态质量和舒适度，并提高步态安全性。如果适应证合适，经常遇到斜坡的患者应被视为SAF的潜在使用者。
