Logo for the Journal of Rehab R and D

Volume 45 Number 9, 2008
   Pages 1317 — 1334

Abstract - Comparison of gait of persons with partial foot amputation wearing prosthesis to matched control group: Observational study

Michael P. Dillon, BPO(Hons), PhD;1* Timothy M. Barker, BE(Hons), PhD2

1National Centre for Prosthetics and Orthotics, Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia; 2Stryker Pacific, West End, Brisbane, Queensland, Australia

Abstract — Our understanding of the gait mechanics of persons with partial foot amputation and the influence of prosthetic intervention has been limited by the reporting of isolated gait parameters in specific amputation levels and limited interpretation and discussion of results. This observational study aimed to more completely describe the gait patterns of persons with partial foot amputation wearing their existing prosthesis and footwear in comparison with a nonamputee control group. Major adaptations occurred once the metatarsal heads were compromised. Persons with transmetatarsal and Lisfranc amputation who were wearing insoles and slipper sockets maintained the center of pressure behind the end of the residuum until after contralateral heel contact. This gait pattern may be a useful adaptation to protect the residuum, moderate the requirement of the calf musculature, or compensate for the compliance of the forefoot. Power generation across the affected ankle was virtually negligible, necessitating increased power generation across the hip joints. The clamshell devices fitted to the persons with Chopart amputation restored their effective foot length and normalized many aspects of gait. These persons' ability to adopt this gait pattern may be the result of the broad anterior shell of the socket, a relatively stiff forefoot, and immobilization of the ankle. The hip joints still contributed significantly to the power generation required to walk.

Key words: biomechanics, Chopart, gait, Lisfranc, metatarsophalangeal, orthosis, partial feet, partial foot, prosthesis, rehabilitation, transmetatarsal.

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