Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 3, 2014
   Pages 429 — 438

Abstract — Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

Louise Johnson, PhD;1–2 Alan R. De Asha, MSc;1 Ramesh Munjal, FRCS;3 Jai Kulkarni, FRCS;4 John G. Buckley, PhD1*

1Division of Medical Engineering, School of Engineering, and 2Division of Allied Health Professions, School of Health Studies, University of Bradford, Bradford, United Kingdom; 3Mobility & Specialised Rehabilitation Centre, Northern General Hospital, Sheffield, United Kingdom; 4Disablement Services Centre, University Hospital of South Manchester, Manchester, United Kingdom

Abstract — Most clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p = 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping.

Key words: amputation, dorsiflexion, gait, hydraulic ankle, prosthesis, toe clearance, transtibial, tripping, unilateral, walking speed.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.3
This article and any supplementary material should be cited as follows:
Johnson L, De Asha AR, Munjal R, Kulkarni J, Buckley JG. Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle. J Rehabil Res Dev. 2014;51(3):429–38.
http://dx.doi.org/10.1682/JRRD.2013.05.0126
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