Prosthetic forefoot and heel stiffness across consecutive foot stiffness categories and sizes

PLoS One. 2022 May 10;17(5):e0268136. doi: 10.1371/journal.pone.0268136. eCollection 2022.

Abstract

Prosthetic foot stiffness plays a key role in the functional mobility of lower limb prosthesis users. However, limited objective data exists to guide selection of the optimal prosthetic foot stiffness category for a given individual. Clinicians often must rely solely on manufacturer recommendations, which are typically based on the intended user's weight and general activity level. Availability of comparable forefoot and heel stiffness data would allow for a better understanding of differences between different commercial prosthetic feet, and also between feet of different stiffness categories and foot sizes. Therefore, this study compared forefoot and heel linear stiffness properties across manufacturer-designated stiffness categories and foot sizes. Mechanical testing was completed for five types of commercial prosthetic feet across a range of stiffness categories and three foot-sizes. Data were collected for 56 prosthetic feet, in total. Testing at two discrete angles was conducted to isolate loading of the heel and forefoot components, respectively. Each prosthetic foot was loaded for six cycles while force and displacement data were collected. Forefoot and heel measured stiffness were both significantly associated with stiffness category (p = .001). There was no evidence that the relationships between stiffness category and measured stiffness differed by foot size (stiffness category by size interaction p = .80). However, there were inconsistencies between the expected and measured stiffness changes across stiffness categories (i.e., magnitude of stiffness changes varied substantially between consecutive stiffness categories of the same feet). While statistical results support that, on average, measured stiffness is positively correlated with stiffness category, force-displacement data suggest substantial variation in measured stiffness across consecutive categories. Published objective mechanical property data for commercial prosthetic feet would likely therefore be helpful to clinicians during prescription.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Artificial Limbs*
  • Biomechanical Phenomena
  • Foot
  • Gait*
  • Prosthesis Design

Grants and funding

This research is a project of the Seattle Institute for Biomedical and Clinical Research (https://www.sibcr.org/) supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Orthotics and Prosthetics Outcomes Research Program (https://cdmrp.army.mil/oporp/default) under Award No. W81XWH-16-1-0569 (PI: D.C.M.). Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. This material is the result of work supported with resources and the use of facilities at the VA Puget Sound Health Care System, Seattle, Washington (https://www.pugetsound.va.gov/). The contents do not represent the views of the United States Department of Veterans Affairs or the United States Government. This study was not funded or sponsored by any commercial companies. Co-authors J.M.C. and C.S.C. are employed by Human Motion Technologies LLC d/b/a Humotech at no cost to the study. Humotech does not have any competing interests for the data presented in this manuscript. The study sponsor (the Office of the Assistant Secretary of Defense for Health Affairs, through the Orthotics and Prosthetics Outcomes Research Program under Award No. W81XWH-16-1-0569), provided support in the form of salaries for authors [D.C.M., E.G.H., A.T.T., B.J.H]. However, the funder did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.