Andrag Lizanne, Derman Wayne, Cockcroft John, Runciman Phoebe
Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
International Olympic Committee (IOC) Research Centre, Stellenbosch, South Africa.
Prosthet Orthot Int. 2025 Apr 1;49(2):148-158. doi: 10.1097/PXR.0000000000000395. Epub 2024 Oct 29.
Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking.
A blinded, randomized control trial was conducted in a group of K3-K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances ( p < 0.05) and Cohen d .
Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m 2 ) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force ( p = 0.02) and external knee adduction moment ( p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side ( p < 0.01).
Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals' ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.
健侧负重是骨关节炎发展的一个风险因素，在单侧经胫骨截肢（UTTA）患者正常步速行走时使用先进假肢，该风险因素已被证实会降低。然而，关于快步行走时负重情况的描述相对较少。因此，本研究的目的是描述UTTA患者在快步行走时使用不同踝/足假肢的生物力学负重情况。
对一组K3 - K4级步行者进行了一项双盲随机对照试验，他们采用2周随机交叉设计使用3种不同的假脚（1. 实心踝缓冲后跟假脚[SACH]，2. 标准储能与回能假脚[ESAR]，3. 新型ESAR假脚[N - ESAR]）。收集了参与者快步行走时的时空和动力学数据。使用混合模型和单因素方差分析（p < 0.05）以及科恩d值进行数据分析。
20名UTTA患者（年龄：40 ± 16岁；身高：1.76 ± 0.09米；体重指数：24.72 ± 3.63千克/平方米）参与了本研究。不同假脚之间的时空数据变化极小。当参与者使用N - ESAR假脚时，健侧的垂直地面反作用力峰值（p = 0.02）和膝关节外展力矩（p = 0.02）较低，假肢侧的小腿远端功率较高（p < 0.01）。
总体而言，与正常步速行走相比，快步行走导致健侧负重力量更高。然而，与ESAR和SACH假脚相比，使用N - ESAR假肢在UTTA患者快步行走时降低了健侧的生物力学负重。与其他假脚相比，N - ESAR假脚从正常步速到快步行走时生物力学负重的百分比变化也更大，这可能是因为个体在使用N - ESAR假肢时能够达到更快的行走速度。应进行纵向干预研究以进一步探究使用先进假肢的潜在益处。
