Benefits of an increased prosthetic ankle range of motion for individuals with a trans-tibial amputation walking with a new prosthetic foot

Background: Individuals with trans-tibial amputation show a greater peak prosthetic ankle power (push- off) when using energy storing and returning (ESAR) prosthetic feet as compared to solid-ankle cushion-heel feet. ESAR feet further contribute to the users' body support and thus limit prosthetic ankle motion. To improve ankle motion, articulating prosthetic feet have been introduced. However, articulating feet may diminish push-off. Research question: Does a novel prosthetic foot, with a serial layout of carbon fibre leaf springs, connected by a multi-centre joint construction, have advantages in kinematics and kinetics over a conventional ESAR prosthetic foot? > Methods: Eleven individuals with unilateral trans-tibial amputation were fitted with the novel foot (NF) and a conventional ESAR Foot (CF) and underwent 3D gait analysis. As an additional power estimate of the prosthetic ankle, a unified, deformable, segment model approach was applied. Eleven matched individuals without impairments served as a reference. Results: The NF shows an effective prosthetic ankle range of motion that is closer to a physiologic ankle range of motion, at 31.6 degrees as compared to 15.2 degrees with CF (CF vs. NF p = 0.003/NF vs. Reference p = 0.171) without reducing the maximum prosthetic ankle joint moment. Furthermore, the NF showed a great increase in prosthetic ankle power (NF 2.89 W/kg vs. CF 1.48 W/kg CF vs. NF p = < 0.001) and a reduction of 19% in the peak knee varus moment and 13% in vertical ground reaction forces on the sound side for NF in comparison to CF. Significance: The NF shows that serial carbon fibre leaf springs, connected by a multi-centre joint construction gives a larger ankle joint range of motion and higher ankle power than a conventional carbon fibre structure alone. Consequently load is taken off the contralateral limb, as measured by the decrease in vertical ground reaction forces and peak knee varus moment.