This page gathers together the clinical evidence supporting Blatchford’s lower limb prosthetic products. Use the filter options on the left to find the information you are looking for. There is a downloadable PDF for every product, and most references include a one-page PDF summary.
Improvements in Clinical Outcomes using Avalon compared to non-hydraulic feet
Clinical Outcomes using the Avalon/Navigator keel design
1. | Barnett CT, Brown OH, Bisele M, et al. Individuals with Unilateral Transtibial Amputation and Lower Activity Levels Walk More Quickly when Using a Hydraulically Articulating Versus Rigidly Attached Prosthetic Ankle-Foot Device. JPO J Prosthet Orthot 2018; 30: 158–64. | |
2. | McGrath M, Moser D, Baier A. Anforderungen an eine geeignete Prosthesentechnologie für ältere, dysvaskuläre Amputierte - Requirements of a suitable prosthesis technology for elderly, dysvascular amputees. Orthop-Tech; 11. |
Download Overview |
3. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
4. | Moore R. Patient Evaluation of a Novel Prosthetic Foot with Hydraulic Ankle Aimed at Persons with Amputation with Lower Activity Levels. JPO J Prosthet Orthot 2017; 29: 44–47. |
Download Overview |
5. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. |
Improvements in Clinical Outcomes using Avalon compared to non-hydraulic feet
Improvements in Clinical Outcomes using EVS compared to other suspension types
Clinical Outcomes using the Avalon/Navigator keel design
Other Evidence
Vacuum levels generated:
When sensory control of the lower limb joints is lost, it is essential that the replacement behaves predictably. Consistency of performance is vital in providing prosthetic confidence. In terms of socket suspension method, this means providing the same good connection throughout a gait cycle, from one step to the next, and day-to-day, over the lifetime of the socket.
The difference between the vacuum levels generated by suction suspension, and that generated when using EVS, can be demonstrated by using a negative pressure gauge30. Figure 1 illustrates these measurements. Commonly, when the user bears weight on their prosthesis during stance phase, with suction suspension, the magnitude of the vacuum is low. When the leg is lifted into swing phase, the vacuum increases in magnitude, holding the socket to the residual limb. Comparatively, EVS retains a high level during stance phase – higher, in fact, than the peak swing phase vacuum with suction. Additionally, the difference between stance and swing phase is less pronounced, so that the vacuum level is more consistent throughout the gait cycle. For the amputee illustrated in the graph30, EVS gave an approximate 85% increase in peak vacuum magnitude and an approximate 67% reduction in the ‘amplitude’ of the vacuum measurement signal.
Figure 1: Negative pressure within the socket when walking using a one-way valve suction suspension (grey) and an elevated vacuum (EV) suspension. N.B. Data recorded with Echelon Vac system.
The difference in vacuum generated by the AvalonVAC, compared to that generated by the Echelon Vac, is shown in Figure 2. Despite differences in the method used (keel vs springs, different socket, different pressure gauge), when the same patient was asked to walk at ‘K2 walking speed’ (~2km/h, short steps), the trend of vacuum level to number of steps taken was comparable to when measured at ‘K3 walking speed’ (4-5km/h) with Echelon Vac.
Figure 2: Comparison of the EchelonVAC and AvalonVAC vacuum generation by number of steps (regardless of walking speed).
1. | Barnett CT, Brown OH, Bisele M, et al. Individuals with Unilateral Transtibial Amputation and Lower Activity Levels Walk More Quickly when Using a Hydraulically Articulating Versus Rigidly Attached Prosthetic Ankle-Foot Device. JPO J Prosthet Orthot 2018; 30: 158–64. | |
2. | McGrath M, Moser D, Baier A. Anforderungen an eine geeignete Prosthesentechnologie für ältere, dysvaskuläre Amputierte - Requirements of a suitable prosthesis technology for elderly, dysvascular amputees. Orthop-Tech; 11. |
Download Overview |
3. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
4. | Moore R. Patient Evaluation of a Novel Prosthetic Foot with Hydraulic Ankle Aimed at Persons with Amputation with Lower Activity Levels. JPO J Prosthet Orthot 2017; 29: 44–47. |
Download Overview |
5. | Rosenblatt NJ, Ehrhardt T, Fergus R, et al. Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life. JPO J Prosthet Orthot 2017; 29: 65–72. | |
6. | Samitier CB, Guirao L, Costea M, et al. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthet Orthot Int 2016; 40: 83–88. | |
7. | Ferraro C. Outcomes study of transtibial amputees using elevated vacuum suspension in comparison with pin suspension. JPO J Prosthet Orthot 2011; 23: 78–81. | |
8. | Gholizadeh H, Lemaire ED, Eshraghi A. The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback. Clin Biomech 2016; 37: 108–116. | |
9. | Xu H, Greenland K, Bloswick D, et al. Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension. Clin Biomech Bristol Avon 2017; 43: 95–101. | |
10. | Board WJ, Street GM, Caspers C. A comparison of trans-tibial amputee suction and vacuum socket conditions. Prosthet Orthot Int 2001; 25: 202–209. | |
11. | Xu H, Greenland K, Bloswick D, et al. Vacuum level effects on knee contact force for unilateral transtibial amputees with elevated vacuum suspension. J Biomech 2017; 57: 110–116. | |
12. | Gerschutz MJ, Hayne ML, Colvin JM, et al. Dynamic Effectiveness Evaluation of Elevated Vacuum Suspension. JPO J Prosthet Orthot 2015; 27: 161–165. | |
13. | Klute GK, Berge JS, Biggs W, et al. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume. Arch Phys Med Rehabil 2011; 92: 1570–1575. | |
14. | Darter BJ, Sinitski K, Wilken JM. Axial bone-socket displacement for persons with a traumatic transtibial amputation: The effect of elevated vacuum suspension at progressive body-weight loads. Prosthet Orthot Int 2016; 40: 552–557. | |
15. | Scott H, Hughes J. Investigating The Use Of Elevated Vacuum Suspension On The Adult PFFD Patient: A Case Study. ACPOC 2013; 19: 7–12. | |
16. | Youngblood RT, Brzostowski JT, Hafner BJ, et al. Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2020; Online first. | |
17. | Sanders JE, Harrison DS, Myers TR, et al. Effects of elevated vacuum on in-socket residual limb fluid volume: Case study results using bioimpedance analysis. J Rehabil Res Dev 2011; 48: 1231. | |
18. | Street G. Vacuum suspension and its effects on the limb. Orthopadie Tech 2006; 4: 1–7. | |
19. | Goswami J, Lynn R, Street G, et al. Walking in a vacuum-assisted socket shifts the stump fluid balance. Prosthet Orthot Int 2003; 27: 107–113. | |
20. | Rink C, Wernke MM, Powell HM, et al. Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial. J Rehabil Res Dev 2016; 53: 1121–1132. | |
21. | Beil TL, Street GM, Covey SJ. Interface pressures during ambulation using suction and vacuum-assisted prosthetic sockets. J Rehabil Res Dev 2002; 39: 693. | |
22. | Hoskins RD, Sutton EE, Kinor D, et al. Using vacuum-assisted suspension to manage residual limb wounds in persons with transtibial amputation: a case series. Prosthet Orthot Int 2014; 38: 68–74. | |
23. | Traballesi M, Delussu AS, Fusco A, et al. Residual limb wounds or ulcers heal in transtibial amputees using an active suction socket system. A randomized controlled study. Eur J Phys Rehabil Med 2012; 48: 613–23. | |
24. | Traballesi M, Averna T, Delussu AS, et al. Trans-tibial prosthesization in large area of residual limb wound: Is it possible? A case report. Disabil Rehabil Assist Technol 2009; 4: 373–375. | |
25. | Brunelli S, Averna T, Delusso M, et al. Vacuum assisted socket system in transtibial amputees: Clinical report. Orthop-Tech Q Engl Ed; 2. | |
26. | Arndt B, Caldwell R, Fatone S. Use of a partial foot prosthesis with vacuum-assisted suspension: A case study. JPO J Prosthet Orthot 2011; 23: 82–88. | |
27. | Carvalho JA, Mongon MD, Belangero WD, et al. A case series featuring extremely short below-knee stumps. Prosthet Orthot Int 2012; 36: 236–238. | |
28. | Sutton E, Hoskins R, Fosnight T. Using elevated vacuum to improve functional outcomes: A case report. JPO J Prosthet Orthot 2011; 23: 184–189. | |
29. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
30. | McGrath M, Laszczak P, McCarthy J, et al. The biomechanical effects on gait of elevated vacuum suspension compared to suction suspension. Cape Town, South Africa, 2017. |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. | |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Improvements in Clinical Outcomes using four-bar, polycentric knees compared to monoaxial knees
1. | de Laat FA, van Kuijk AA, Geertzen JH, et al. Cosmetic effect of knee joint in a knee disarticulation prosthesis. J Rehabil Res Dev 2014; 51: 1545. | |
2. | Sensinger JW, Intawachirarat N, Gard SA. Contribution of prosthetic knee and ankle mechanisms to swing-phase foot clearance. IEEE Trans Neural Syst Rehabil Eng 2012; 21: 74–80. | |
3. | Andrysek J, Naumann S, Cleghorn WL. Design characteristics of pediatric prosthetic knees. IEEE Trans Neural Syst Rehabil Eng 2004; 12: 369–378. | |
4. | Gard SA, Childress DS, Uellendahl JE. The influence of four-bar linkage knees on prosthetic swing-phase floor clearance. JPO J Prosthet Orthot 1996; 8: 34–40. |
There are two published literature reviews that discuss different aspects of lower limb prosthetic liner technology1,2.
1. | Klute GK, Glaister BC, Berge JS. Prosthetic liners for lower limb amputees: a review of the literature. Prosthet Orthot Int 2010; 34: 146–153. | |
2. | Richardson A, Dillon MP. User experience of transtibial prosthetic liners: a systematic review. Prosthet Orthot Int 2017; 41: 6–18. | |
3. | Sanders JE, Greve JM, Mitchell SB, et al. Material properties of commonly-used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev 1998; 35: 161–176. | |
4. | Emrich R, Slater K. Comparative analysis of below-knee prosthetic socket liner materials. J Med Eng Technol 1998; 22: 94–98. | |
5. | Klute GK, Rowe GI, Mamishev AV, et al. The thermal conductivity of prosthetic sockets and liners. Prosthet Orthot Int 2007; 31: 292–299. | |
6. | Sonck WA, Cockrell JL, Koepke GH. Effect of liner materials on interface pressures in below-knee prostheses. Arch Phys Med Rehabil 1970; 51: 666. | |
7. | Lee WC, Zhang M, Mak AF. Regional differences in pain threshold and tolerance of the transtibial residual limb: including the effects of age and interface material. Arch Phys Med Rehabil 2005; 86: 641–649. |
Improvements in Clinical Outcomes using Echelon compared to ESR feet
1. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
2. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. |
Download Overview |
3. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. |
Download Overview |
4. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. |
Download Overview |
5. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. |
Download Overview |
6. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1. |
Download Overview |
7. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. |
Download Overview |
8. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
9. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. |
Download Overview |
10. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. |
Download Overview |
11. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. |
Download Overview |
12. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. | |
13. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. |
Download Overview |
14. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
15. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. |
Download Overview |
Improvements in Clinical Outcomes using Echelon compared to ESR feet
Improvements in Clinical Outcomes using EVS compared to other suspension types
Other Evidence
Vacuum levels generated:
When sensory control of the lower limb joints is lost, it is essential that the replacement behaves predictably. Consistency of performance is vital in providing prosthetic confidence. In terms of socket suspension method, this means providing the same good connection throughout a gait cycle, from one step to the next, and day-to-day, over the lifetime of the socket.
The difference between the vacuum levels generated by suction suspension, and that generated when using EVS, can be demonstrated by using a negative pressure gauge30. Figure 1 illustrates these measurements. Commonly, when the user bears weight on their prosthesis during stance phase, with suction suspension, the magnitude of the vacuum is low. When the leg is lifted into swing phase, the vacuum increases in magnitude, holding the socket to the residual limb. Comparatively, EVS retains a high level during stance phase – higher, in fact, than the peak swing phase vacuum with suction. Additionally, the difference between stance and swing phase is less pronounced, so that the vacuum level is more consistent throughout the gait cycle. For the amputee illustrated in the graph30, EVS gave an approximate 85% increase in peak vacuum magnitude and an approximate 67% reduction in the ‘amplitude’ of the vacuum measurement signal.
Figure 1: Negative pressure within the socket when walking using a one-way valve suction suspension (grey) and an elevated vacuum (EV) suspension. N.B. Data recorded with Echelon Vac system.
The difference in vacuum generated by the AvalonVAC, compared to that generated by the Echelon Vac, is shown in Figure 2. Despite differences in the method used (keel vs springs, different socket, different pressure gauge), when the same patient was asked to walk at ‘K2 walking speed’ (~2km/h, short steps), the trend of vacuum level to number of steps taken was comparable to when measured at ‘K3 walking speed’ (4-5km/h) with Echelon Vac.
Figure 2: Comparison of the EchelonVAC and AvalonVAC vacuum generation by number of steps (regardless of walking speed).
1. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
2. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. |
Download Overview |
3. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. |
Download Overview |
4. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. |
Download Overview |
5. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. |
Download Overview |
6. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic ’ankle’ damping. J Neuroengineering Rehabil 2013; 10: 1. |
Download Overview |
7. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. |
Download Overview |
8. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
9. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. |
Download Overview |
10. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. |
Download Overview |
11. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. |
Download Overview |
12. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. | |
13. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. |
Download Overview |
14. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
15. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. |
Download Overview |
16. | Rosenblatt NJ, Ehrhardt T. The effect of vacuum assisted socket suspension on prospective, community-based falls by users of lower limb prostheses. Gait Posture, http://www.sciencedirect.com/science/article/pii/S096663621730111X (2017, accessed 2 May 2017). | |
17. | Samitier CB, Guirao L, Costea M, et al. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthet Orthot Int 2016; 40: 83–88. | |
18. | Ferraro C. Outcomes study of transtibial amputees using elevated vacuum suspension in comparison with pin suspension. JPO J Prosthet Orthot 2011; 23: 78–81. | |
19. | Gholizadeh H, Lemaire ED, Eshraghi A. The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback. Clin Biomech 2016; 37: 108–116. | |
20. | Xu H, Greenland K, Bloswick D, et al. Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension. Clin Biomech Bristol Avon 2017; 43: 95–101. | |
21. | Board WJ, Street GM, Caspers C. A comparison of trans-tibial amputee suction and vacuum socket conditions. Prosthet Orthot Int 2001; 25: 202–209. | |
22. | Xu H, Greenland K, Bloswick D, et al. Vacuum level effects on knee contact force for unilateral transtibial amputees with elevated vacuum suspension. J Biomech 2017; 57: 110–116. | |
23. | Gerschutz MJ, Hayne ML, Colvin JM, et al. Dynamic Effectiveness Evaluation of Elevated Vacuum Suspension. JPO J Prosthet Orthot 2015; 27: 161–165. | |
24. | Klute GK, Berge JS, Biggs W, et al. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume. Arch Phys Med Rehabil 2011; 92: 1570–1575. | |
25. | Darter BJ, Sinitski K, Wilken JM. Axial bone-socket displacement for persons with a traumatic transtibial amputation: The effect of elevated vacuum suspension at progressive body-weight loads. Prosthet Orthot Int 2016; 40: 552–557. | |
26. | Scott H, Hughes J. Investigating The Use Of Elevated Vacuum Suspension On The Adult PFFD Patient: A Case Study. ACPOC 2013; 19: 7–12. | |
27. | Youngblood RT, Brzostowski JT, Hafner BJ, et al. Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2020; 0309364620909044. | |
28. | Sanders JE, Harrison DS, Myers TR, et al. Effects of elevated vacuum on in-socket residual limb fluid volume: Case study results using bioimpedance analysis. J Rehabil Res Dev 2011; 48: 1231. | |
29. | Street G. Vacuum and its effects on the limb. Orthopadie Tech 2006; 4: 1–7. Goswami J, Lynn R, Street G, et al. Walking in a vacuum-assisted socket shifts the stump fluid balance. Prosthet Orthot Int 2003; 27: 107–113. | |
30. | 30. Goswami J, Lynn R, Street G, et al. Walking in a vacuum-assisted socket shifts the stump fluid balance. Prosthet Orthot Int 2003; 27: 107–113. | |
31. | Rink C, Wernke MM, Powell HM, et al. Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial. J Rehabil Res Dev 2016; 53: 1121–1132. | |
32. | Beil TL, Street GM, Covey SJ. Interface pressures during ambulation using suction and vacuum-assisted prosthetic sockets. J Rehabil Res Dev 2002; 39: 693. | |
33. | Hoskins RD, Sutton EE, Kinor D, et al. Using vacuum-assisted suspension to manage residual limb wounds in persons with transtibial amputation: a case series. Prosthet Orthot Int 2014; 38: 68–74. | |
34. | Traballesi M, Delussu AS, Fusco A, et al. Residual limb wounds or ulcers heal in transtibial amputees using an active suction socket system. A randomized controlled study. Eur J Phys Rehabil Med 2012; 48: 613–23. | |
35. | Traballesi M, Averna T, Delussu AS, et al. Trans-tibial prosthesization in large area of residual limb wound: Is it possible? A case report. Disabil Rehabil Assist Technol 2009; 4: 373–375. | |
36. | Brunelli S, Averna T, Delusso M, et al. Vacuum assisted socket system in transtibial amputees: Clinical report. Orthop-Tech Q Engl Ed; 2. | |
37. | Arndt B, Caldwell R, Fatone S. Use of a partial foot prosthesis with vacuum-assisted suspension: A case study. JPO J Prosthet Orthot 2011; 23: 82–88. | |
38. | Rosenblatt NJ, Ehrhardt T, Fergus R, et al. Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life. JPO J Prosthet Orthot 2017; 29: 65–72. | |
39. | Carvalho JA, Mongon MD, Belangero WD, et al. A case series featuring extremely short below-knee stumps. Prosthet Orthot Int 2012; 36: 236–238. | |
40. | Sutton E, Hoskins R, Fosnight T. Using elevated vacuum to improve functional outcomes: A case report. JPO J Prosthet Orthot 2011; 23: 184–189. | |
41. | McGrath M, Laszczak P, McCarthy J, et al. The biomechanical effects on gait of elevated vacuum suspension compared to suction suspension. Cape Town, South Africa, 2017. |
Improvements in Clinical Outcomes using Echelon compared to ESR feet
Improvements in Clinical Outcomes using shock-absorbing pylon/torque absorber compared to rigid pylon
Reduced back pain during twisting movements e.g. golf swings16
1. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
2. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. |
Download Overview |
3. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. |
Download Overview |
4. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. |
Download Overview |
5. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. |
Download Overview |
6. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1. |
Download Overview |
7. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. |
Download Overview |
8. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
9. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. |
Download Overview |
10. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. |
Download Overview |
11. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. |
Download Overview |
12. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. | |
13. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. |
Download Overview |
14. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
15. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. |
Download Overview |
16. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
17. | Berge JS, Czerniecki JM, Klute GK. Efficacy of shock-absorbing versus rigid pylons for impact reduction in transtibial amputees based on laboratory, field, and outcome metrics. J Rehabil Res Dev 2005; 42: 795. | |
18. | Klute GK, Berge JS, Orendurff MS, et al. Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil 2006; 87: 717–722. | |
19. | Flick KC, Orendurff MS, Berge JS, et al. Comparison of human turning gait with the mechanical performance of lower limb prosthetic transverse rotation adapters. Prosthet Orthot Int 2005; 29: 73–81. | |
20. | Gard SA, Konz RJ. The effect of a shock-absorbing pylon on the gait of persons with unilateral transtibial amputation. J Rehabil Res Dev 2003; 40: 109–124. | |
21. | Boutwell E, Stine R, Gard S. Shock absorption during transtibial amputee gait: Does longitudinal prosthetic stiffness play a role? Prosthet Orthot Int 2017; 41: 178–185. | |
22. | Adderson JA, Parker KE, Macleod DA, et al. Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study. Prosthet Orthot Int 2007; 31: 384–393. |
Improvements in Clinical Outcomes using Elan compared to ESR feet
Improvements in Clinical Outcomes using Elan compared to non-microprocessor-control hydraulic ankle-feet
1. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
2. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. |
Download Overview |
3. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. |
Download Overview |
4. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. |
Download Overview |
5. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. |
Download Overview |
6. | De Asha AR, Barnett CT, Struchkov V, et al. Which Prosthetic Foot to Prescribe?: Biomechanical Differences Found during a Single-Session Comparison of Different Foot Types Hold True 1 Year Later. JPO J Prosthet Orthot 2017; 29: 39–43. |
Download Overview |
7. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. | |
8. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1. |
Download Overview |
9. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. |
Download Overview |
10. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. |
Download Overview |
11. | Alexander N, Strutzenberger G, Kroell J, et al. Joint Moments During Downhill and Uphill Walking of a Person with Transfemoral Amputation with a Hydraulic Articulating and a Rigid Prosthetic Ankle—A Case Study. JPO J Prosthet Orthot 2018; 30: 46–54. |
Download Overview |
12. | Struchkov V, Buckley JG. Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle–foot mechanisms. Clin Biomech 2016; 32: 164–170. |
Download Overview |
13. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. |
Download Overview |
14. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. |
Download Overview |
15. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. |
Download Overview |
16. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
17. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. |
Download Overview |
18. | McGrath M, Laszczak P, Zahedi S, et al. The influence of a microprocessor-controlled hydraulic ankle on the kinetic symmetry of trans-tibial amputees during ramp walking: a case series. J Rehabil Assist Technol Eng 2018; 5: 2055668318790650. |
Download Overview |
Improvements in Clinical Outcomes using Elan compared to ESR feet
Improvements in Clinical Outcomes using Elan compared to non-microprocessor-control hydraulic ankle-feet
Reduced residual knee flexion at loading response12
1. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
2. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. |
Download Overview |
3. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. |
Download Overview |
4. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. |
Download Overview |
5. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. |
Download Overview |
6. | De Asha AR, Barnett CT, Struchkov V, et al. Which Prosthetic Foot to Prescribe?: Biomechanical Differences Found during a Single-Session Comparison of Different Foot Types Hold True 1 Year Later. JPO J Prosthet Orthot 2017; 29: 39–43. |
Download Overview |
7. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. | |
8. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1. |
Download Overview |
9. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. |
Download Overview |
10. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. |
Download Overview |
11. | Alexander N, Strutzenberger G, Kroell J, et al. Joint Moments During Downhill and Uphill Walking of a Person with Transfemoral Amputation with a Hydraulic Articulating and a Rigid Prosthetic Ankle—A Case Study. JPO J Prosthet Orthot 2018; 30: 46–54. |
Download Overview |
12. | Struchkov V, Buckley JG. Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle–foot mechanisms. Clin Biomech 2016; 32: 164–170. |
Download Overview |
13. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. |
Download Overview |
14. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. |
Download Overview |
15. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. |
Download Overview |
16. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. |
Download Overview |
17. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. |
Download Overview |
18. | McGrath M, Laszczak P, Zahedi S, et al. The influence of a microprocessor-controlled hydraulic ankle on the kinetic symmetry of trans-tibial amputees during ramp walking: a case series. J Rehabil Assist Technol Eng 2018; 5: 2055668318790650. |
Download Overview |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Clinical Outcomes using e-carbon feet
Improvements in Clinical Outcomes using shock-absorbing pylon/torque absorber compared to rigid pylon
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. | |
9. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
10. | Berge JS, Czerniecki JM, Klute GK. Efficacy of shock-absorbing versus rigid pylons for impact reduction in transtibial amputees based on laboratory, field, and outcome metrics. J Rehabil Res Dev 2005; 42: 795. | |
11. | Klute GK, Berge JS, Orendurff MS, et al. Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil 2006; 87: 717–722. | |
12. | Flick KC, Orendurff MS, Berge JS, et al. Comparison of human turning gait with the mechanical performance of lower limb prosthetic transverse rotation adapters. Prosthet Orthot Int 2005; 29: 73–81. | |
13. | Gard SA, Konz RJ. The effect of a shock-absorbing pylon on the gait of persons with unilateral transtibial amputation. J Rehabil Res Dev 2003; 40: 109–124. | |
14. | Boutwell E, Stine R, Gard S. Shock absorption during transtibial amputee gait: Does longitudinal prosthetic stiffness play a role? Prosthet Orthot Int 2017; 41: 178–185. | |
15. | Adderson JA, Parker KE, Macleod DA, et al. Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study. Prosthet Orthot Int 2007; 31: 384–393. |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Clinical Outcomes using e-carbon feet
Improvements in Clinical Outcomes using shock-absorbing pylon/torque absorber compared to rigid pylon
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. | |
9. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
10. | Berge JS, Czerniecki JM, Klute GK. Efficacy of shock-absorbing versus rigid pylons for impact reduction in transtibial amputees based on laboratory, field, and outcome metrics. J Rehabil Res Dev 2005; 42: 795. | |
11. | Klute GK, Berge JS, Orendurff MS, et al. Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil 2006; 87: 717–722. | |
12. | Flick KC, Orendurff MS, Berge JS, et al. Comparison of human turning gait with the mechanical performance of lower limb prosthetic transverse rotation adapters. Prosthet Orthot Int 2005; 29: 73–81. | |
13. | Gard SA, Konz RJ. The effect of a shock-absorbing pylon on the gait of persons with unilateral transtibial amputation. J Rehabil Res Dev 2003; 40: 109–124. | |
14. | Boutwell E, Stine R, Gard S. Shock absorption during transtibial amputee gait: Does longitudinal prosthetic stiffness play a role? Prosthet Orthot Int 2017; 41: 178–185. | |
15. | Adderson JA, Parker KE, Macleod DA, et al. Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study. Prosthet Orthot Int 2007; 31: 384–393. |
Clinical Outcomes using e-carbon feet
Clinical Outcomes using Multiflex-style ankles
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
Multiflex was the “habitual” foot for all or majority of participants in 13 different studies9-21
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
Download Overview |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. | |
9. | Moore R. Patient Evaluation of a Novel Prosthetic Foot with Hydraulic Ankle Aimed at Persons with Amputation with Lower Activity Levels. JPO J Prosthet Orthot 2017; 29: 44–47. | |
10. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. | |
11. | Buckley JG, De Asha AR, Johnson L, et al. Understanding adaptive gait in lower-limb amputees: insights from multivariate analyses. J Neuroengineering Rehabil 2013; 10: 98. | |
12. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. | |
13. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
14. | Kobayashi T, Orendurff MS, Boone DA. Dynamic alignment of transtibial prostheses through visualization of socket reaction moments. Prosthet Orthot Int 2015; 39: 512–516. | |
15. | Wright D, Marks L, Payne R. A comparative study of the physiological costs of walking in ten bilateral amputees. Prosthet Orthot Int 2008; 32: 57–67. | |
16. | Vanicek N, Strike SC, Polman R. Kinematic differences exist between transtibial amputee fallers and non-fallers during downwards step transitioning. Prosthet Orthot Int 2015; 39: 322–332. | |
17. | Barnett C, Vanicek N, Polman R, et al. Kinematic gait adaptations in unilateral transtibial amputees during rehabilitation. Prosthet Orthot Int 2009; 33: 135–147. | |
18. | Emmelot C, Spauwen P, Hol W, et al. Case study: Trans tibial amputation for reflex sympathetic dystrophy: Postoperative management. Prosthet Orthot Int 2000; 24: 79–82. | |
19. | Boonstra A, Fidler V, Eisma W. Walking speed of normal subjects and amputees: aspects of validity of gait analysis. Prosthet Orthot Int 1993; 17: 78–82. | |
20. | Datta D, Harris I, Heller B, et al. Gait, cost and time implications for changing from PTB to ICEX® sockets. Prosthet Orthot Int 2004; 28: 115–120. | |
21. | de Castro MP, Soares D, Mendes E, et al. Center of pressure analysis during gait of elderly adult transfemoral amputees. JPO J Prosthet Orthot 2013; 25: 68–75. | |
22. | Major MJ, Scham J, Orendurff M. The effects of common footwear on stance-phase mechanical properties of the prosthetic foot-shoe system. Prosthet Orthot Int 2018; 42: 198–207. | |
23. | McNealy LL, A. Gard S. Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations. Prosthet Orthot Int 2008; 32: 111–126. | |
24. | Su P-F, Gard SA, Lipschutz RD, et al. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev 2007; 44: 491–502. | |
25. | Boonstra A, Fidler V, Spits G, et al. Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees. Prosthet Orthot Int 1993; 17: 90–94. | |
26. | Gard SA, Su P-F, Lipschutz RD, et al. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations. J Rehabil Res Dev 2011; 48: 1037. | |
27. | Major MJ, Stine RL, Gard SA. The effects of walking speed and prosthetic ankle adapters on upper extremity dynamics and stability-related parameters in bilateral transtibial amputee gait. Gait Posture 2013; 38: 858–863. | |
28. | Van der Linden M, Solomonidis S, Spence W, et al. A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait. J Biomech 1999; 32: 877–889. | |
29. | Graham LE, Datta D, Heller B, et al. A comparative study of conventional and energy-storing prosthetic feet in high-functioning transfemoral amputees. Arch Phys Med Rehabil 2007; 88: 801–806. | |
30. | Graham LE, Datta D, Heller B, et al. A comparative study of oxygen consumption for conventional and energy-storing prosthetic feet in transfemoral amputees. Clin Rehabil 2008; 22: 896–901. | |
31. | Mizuno N, Aoyama T, Nakajima A, et al. Functional evaluation by gait analysis of various ankle-foot assemblies used by below-knee amputees. Prosthet Orthot Int 1992; 16: 174–182. |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. |
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6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. | |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Improvements in Clinical Outcomes using four-bar, polycentric knees compared to monoaxial knees
1. | de Laat FA, van Kuijk AA, Geertzen JH, et al. Cosmetic effect of knee joint in a knee disarticulation prosthesis. J Rehabil Res Dev 2014; 51: 1545. | |
2. | Sensinger JW, Intawachirarat N, Gard SA. Contribution of prosthetic knee and ankle mechanisms to swing-phase foot clearance. IEEE Trans Neural Syst Rehabil Eng 2012; 21: 74–80. | |
3. | Andrysek J, Naumann S, Cleghorn WL. Design characteristics of pediatric prosthetic knees. IEEE Trans Neural Syst Rehabil Eng 2004; 12: 369–378. | |
4. | Gard SA, Childress DS, Uellendahl JE. The influence of four-bar linkage knees on prosthetic swing-phase floor clearance. JPO J Prosthet Orthot 1996; 8: 34–40. |
Improvements in Clinical Outcomes using Linx compared to mechanical knees
Improvements in Clinical Outcomes using Linx compared to ESR feet
Improvements in Clinical Outcomes using Linx compared to non-microprocessor-control hydraulic ankle-feet
1. | Kaufman KR, Bernhardt KA, Symms K. Functional assessment and satisfaction of transfemoral amputees with low mobility (FASTK2): A clinical trial of microprocessor-controlled vs. non-microprocessor-controlled knees. Clin Biomech 2018; 58: 116–122. | |
2. | Campbell JH, Stevens PM, Wurdeman SR. OASIS 1: Retrospective analysis of four different microprocessor knee types. Journal of Rehabilitation and Assistive Technologies Engineering. 2020 Nov;7:2055668320968476. | |
3. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with ‘standing support’ and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. | |
4. | Heller BW, Datta D, Howitt J. A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees. Clin Rehabil 2000; 14: 518–522. | |
5. | Chin T, Maeda Y, Sawamura S, et al. Successful prosthetic fitting of elderly trans-femoral amputees with Intelligent Prosthesis (IP): a clinical pilot study. Prosthet Orthot Int 2007; 31: 271–276. | |
6. | Datta D, Howitt J. Conventional versus microchip controlled pneumatic swing phase control for trans-femoral amputees: user’s verdict. Prosthet Orthot Int 1998; 22: 129–135. | |
7. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of amputees (MAAT 3): Matching individuals based on comorbid health reveals improved function for above-knee prosthesis users with microprocessor knee technology. Assist Technol 2018; 1–7. | |
8. | Saglam Y, Gulenc B, Birisik F, et al. The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees. Acta Orthop Traumatol Turc 2017; 51: 466e469. | |
9. | Chin T, Sawamura S, Shiba R, et al. Energy expenditure during walking in amputees after disarticulation of the hip: a microprocessor-controlled swing-phase control knee versus a mechanical-controlled stance-phase control knee. J Bone Joint Surg Br 2005; 87: 117–119. | |
10. | Datta D, Heller B, Howitt J. A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control. Clin Rehabil 2005; 19: 398–403. | |
11. | Buckley JG, Spence WD, Solomonidis SE. Energy cost of walking: comparison of “intelligent prosthesis” with conventional mechanism. Arch Phys Med Rehabil 1997; 78: 330–333. | |
12. | Taylor MB, Clark E, Offord EA, et al. A comparison of energy expenditure by a high level trans-femoral amputee using the Intelligent Prosthesis and conventionally damped prosthetic limbs. Prosthet Orthot Int 1996; 20: 116–121. | |
13. | Kirker S, Keymer S, Talbot J, et al. An assessment of the intelligent knee prosthesis. Clin Rehabil 1996; 10: 267–273. | |
14. | Chin T, Machida K, Sawamura S, et al. Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg. Prosthet Orthot Int 2006; 30: 73–80. | |
15. | Chin T, Sawamura S, Shiba R, et al. Effect of an Intelligent Prosthesis (IP) on the walking ability of young transfemoral amputees: comparison of IP users with able-bodied people. Am J Phys Med Rehabil 2003; 82: 447–451. | |
16. | Abdulhasan ZM, Scally AJ, Buckley JG. Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system. Clin Biomech Bristol Avon 2018; 57: 35–41. | |
17. | Chen C, Hanson M, Chaturvedi R, et al. Economic benefits of microprocessor controlled prosthetic knees: a modeling study. J Neuroengineering Rehabil 2018; 15: 62. | |
18. | Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P. Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8. | |
19. | Johnson L, De Asha AR, Munjal R, et al. Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429. | |
20. | Bai X, Ewins D, Crocombe AD, et al. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093. | |
21. | Askew GN, McFarlane LA, Minetti AE, et al. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39. | |
22. | De Asha AR, Barnett CT, Struchkov V, et al. Which Prosthetic Foot to Prescribe?: Biomechanical Differences Found during a Single-Session Comparison of Different Foot Types Hold True 1 Year Later. JPO J Prosthet Orthot 2017; 29: 39–43. | |
23. | De Asha AR, Munjal R, Kulkarni J, et al. Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734. | |
24. | De Asha AR, Munjal R, Kulkarni J, et al. Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic ’ankle’ damping. J Neuroengineering Rehabil 2013; 10: 1. | |
25. | De Asha AR, Johnson L, Munjal R, et al. Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224. | |
26. | Bai X, Ewins D, Crocombe AD, et al. Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836. | |
27. | Alexander N, Strutzenberger G, Kroell J, et al. Joint Moments During Downhill and Uphill Walking of a Person with Transfemoral Amputation with a Hydraulic Articulating and a Rigid Prosthetic Ankle—A Case Study. JPO J Prosthet Orthot 2018; 30: 46–54. | |
28. | Struchkov V, Buckley JG. Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle–foot mechanisms. Clin Biomech 2016; 32: 164–170. | |
29. | Portnoy S, Kristal A, Gefen A, et al. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125. | |
30. | McGrath M, Davies KC, Laszczak P, et al. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2. | |
31. | Moore R. Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70. | |
32. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. | |
33. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. | |
34. | McGrath M, Laszczak P, Zahedi S, et al. The influence of a microprocessor-controlled hydraulic ankle on the kinetic symmetry of trans-tibial amputees during ramp walking: a case series. J Rehabil Assist Technol Eng 2018; 5: 2055668318790650. |
Clinical Outcomes using e-carbon feet
Much research confirms the substantial equivalency of all energy-storing and return feet, including Blatchford e-carbon feet1.
1. | Crimin A, McGarry A, Harris EJ, et al. The effect that energy storage and return feet have on the propulsion of the body: A pilot study. Proc Inst Mech Eng [H] 2014; 228: 908–915. | |
2. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
3. | Strike SC, Arcone D, Orendurff M. Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees. Gait Posture 2018; 62: 327–332. | |
4. | Ray SF, Wurdeman SR, Takahashi KZ. Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device. J Neuroengineering Rehabil 2018; 15: 6. | |
5. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784. | |
6. | Haber CK, Ritchie LJ, Strike SC. Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task. Hum Mov Sci 2018; 58: 337–346. | |
7. | Rock CG, Wurdeman SR, Stergiou N, Takahashi KZ. Stride-to-stride fluctuations in transtibial amputees are not affected by changes in push-off mechanics from using different prostheses. PloS one. 2018;13(10). | |
8. | Highsmith MJ, Kahle JT, Miro RM, et al. Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial. Mil Med 2016; 181: 45–54. |
Clinical Outcomes using Multiflex feet
Multiflex was the “habitual” foot for all or majority of participants in 13 different studies1-13.
1. | Moore R. Patient Evaluation of a Novel Prosthetic Foot with Hydraulic Ankle Aimed at Persons with Amputation with Lower Activity Levels. JPO J Prosthet Orthot 2017; 29: 44–47. | |
2. | Moore R. Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48. | |
3. | Buckley JG, De Asha AR, Johnson L, et al. Understanding adaptive gait in lower-limb amputees: insights from multivariate analyses. J Neuroengineering Rehabil 2013; 10: 98. | |
4. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. | |
5. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
6. | Kobayashi T, Orendurff MS, Boone DA. Dynamic alignment of transtibial prostheses through visualization of socket reaction moments. Prosthet Orthot Int 2015; 39: 512–516. | |
7. | Wright D, Marks L, Payne R. A comparative study of the physiological costs of walking in ten bilateral amputees. Prosthet Orthot Int 2008; 32: 57–67. | |
8. | Vanicek N, Strike SC, Polman R. Kinematic differences exist between transtibial amputee fallers and non-fallers during downwards step transitioning. Prosthet Orthot Int 2015; 39: 322–332. | |
9. | Barnett C, Vanicek N, Polman R, et al. Kinematic gait adaptations in unilateral transtibial amputees during rehabilitation. Prosthet Orthot Int 2009; 33: 135–147. | |
10. | Emmelot C, Spauwen P, Hol W, et al. Case study: Trans tibial amputation for reflex sympathetic dystrophy: Postoperative management. Prosthet Orthot Int 2000; 24: 79–82. | |
11. | Boonstra A, Fidler V, Eisma W. Walking speed of normal subjects and amputees: aspects of validity of gait analysis. Prosthet Orthot Int 1993; 17: 78–82. | |
12. | Datta D, Harris I, Heller B, et al. Gait, cost and time implications for changing from PTB to ICEX® sockets. Prosthet Orthot Int 2004; 28: 115–120. | |
13. | de Castro MP, Soares D, Mendes E, et al. Center of pressure analysis during gait of elderly adult transfemoral amputees. JPO J Prosthet Orthot 2013; 25: 68–75. | |
14. | Major MJ, Scham J, Orendurff M. The effects of common footwear on stance-phase mechanical properties of the prosthetic foot-shoe system. Prosthet Orthot Int 2018; 42: 198–207. | |
15. | McNealy LL, A. Gard S. Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations. Prosthet Orthot Int 2008; 32: 111–126. | |
16. | Su P-F, Gard SA, Lipschutz RD, et al. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev 2007; 44: 491–502. | |
17. | Boonstra A, Fidler V, Spits G, et al. Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees. Prosthet Orthot Int 1993; 17: 90–94. | |
18. | Gard SA, Su P-F, Lipschutz RD, et al. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations. J Rehabil Res Dev 2011; 48: 1037. | |
19. | Major MJ, Stine RL, Gard SA. The effects of walking speed and prosthetic ankle adapters on upper extremity dynamics and stability-related parameters in bilateral transtibial amputee gait. Gait Posture 2013; 38: 858–863. | |
20. | Van der Linden M, Solomonidis S, Spence W, et al. A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait. J Biomech 1999; 32: 877–889. | |
21. | Graham LE, Datta D, Heller B, et al. A comparative study of conventional and energy-storing prosthetic feet in high-functioning transfemoral amputees. Arch Phys Med Rehabil 2007; 88: 801–806. | |
22. | Mizuno N, Aoyama T, Nakajima A, et al. Functional evaluation by gait analysis of various ankle-foot assemblies used by below-knee amputees. Prosthet Orthot Int 1992; 16: 174–182. |
Clinical Outcomes using Navigator
Clinical Outcomes using Multiflex-style ankles
Majority of users rate Multiflex as either “good” or “acceptable”23 and prefer Multiflex to fixed ankle/foot17
Multiflex was the “habitual” foot for all or majority of participants in 13 different studies2-14.
1. | Curtze C, Hof AL, van Keeken HG, et al. Comparative roll-over analysis of prosthetic feet. J Biomech 2009; 42: 1746–1753. | |
2. | Moore R. Patient Evaluation of a Novel Prosthetic Foot with Hydraulic Ankle Aimed at Persons with Amputation with Lower Activity Levels. JPO J Prosthet Orthot 2017; 29: 44–47. | |
3. | Moore R. Effect on stance phase timing asymmetry in individuals with amputation using hydraulic ankle units. JPO J Prosthet Orthot 2016; 28: 44–48. | |
4. | Buckley JG, De Asha AR, Johnson L, et al. Understanding adaptive gait in lower-limb amputees: insights from multivariate analyses. J Neuroengineering Rehabil 2013; 10: 98. | |
5. | Sedki I, Moore R. Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254. | |
6. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right‐sided trans‐tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
7. | Kobayashi T, Orendurff MS, Boone DA. Dynamic alignment of transtibial prostheses through visualization of socket reaction moments. Prosthet Orthot Int 2015; 39: 512–516. | |
8. | Wright DA, Marks L, Payne RC. A comparative study of the physiological costs of walking in ten bilateral amputees. Prosthet Orthot Int 2008; 32: 57–67. | |
9. | Vanicek N, Strike SC, Polman R. Kinematic differences exist between transtibial amputee fallers and non-fallers during downwards step transitioning - Natalie Vanicek, Siobhán C Strike, Remco Polman, 2015. Prosthet Orthot Int 2015; 39: 322–332. | |
10. | Barnett CT, Vanicek N, Polman R, et al. Kinematic gait adaptations in unilateral transtibial amputees during rehabilitation: Prosthetics and Orthotics International: Vol 33, No 2. Prosthet Orthot Int 2009; 33: 135–147. | |
11. | Emmelot CH, Spauwen PHM, Hol W, et al. Case study: Trans‐tibial amputation for reflex sympathetic dystrophy: Postoperative management. Prosthet Orthot Int 2000; 24: 79–82. | |
12. | Boonstra AM, Fidler V, Eisma WH. Walking speed of normal subjects and amputees: Aspects of validity of gait analysis. Prosthet Orthot Int 1993; 17: 78–82. | |
13. | Datta DD, Harris I, Heller B, et al. Gait, cost and time implications for changing from PTB to ICEX® sockets. Prosthet Orthot Int 2004; 28: 115–120. | |
14. | Castro M de, Soares D, Mendes E, et al. Center of Pressure Analysis During Gait of Elderly Adult Transfemoral Amputees. J Prosthet Orthot 2013; 25: 68–75. | |
15. | Major MJ, Scham J, Orendurff M. The effects of common footwear on stance-phase mechanical properties of the prosthetic foot-shoe system. Prosthet Orthot Int 2018; 42: 198–207. | |
16. | McNealy LL, Gard SA. Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations. Prosthet Orthot Int 2008; 32: 111–126. | |
17. | Su P-F, Gard SA, Lipschutz RD, et al. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev 2007; 44: 491–502. | |
18. | Boonstra A, Fidler V, Spits G, et al. Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees. Prosthet Orthot Int 1993; 17: 90–94. | |
19. | Gard SA, Su P-F, Lipschutz RD, et al. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations. J Rehabil Res Dev 2011; 48: 1037. | |
20. | Major MJ, Stine RL, Gard SA. The effects of walking speed and prosthetic ankle adapters on upper extremity dynamics and stability-related parameters in bilateral transtibial amputee gait. Gait Posture 2013; 38: 858–863. | |
21. | Van der Linden ML, Solomonidis SE, Spence WD, et al. A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait. J Biomech 1999; 32: 877–889. | |
22. | Graham LE, Datta D, Heller B, et al. A comparative study of conventional and energy-storing prosthetic feet in high-functioning transfemoral amputees. Arch Phys Med Rehabil 2007; 88: 801–806. | |
23. | Mizuno N, Aoyama T, Nakajima A, et al. Functional evaluation by gait analysis of various ankle-foot assemblies used by below-knee amputees. Prosthet Orthot Int 1992; 16: 174–182. |
Improvements in Clinical Outcomes using microprocessor-controlled prosthetic knees
1. | Kaufman KR, Bernhardt KA, Symms K. Functional assessment and satisfaction of transfemoral amputees with low mobility (FASTK2): A clinical trial of microprocessor-controlled vs. non-microprocessor-controlled knees. Clin Biomech 2018; 58: 116–122. | |
2. | Campbell JH, Stevens PM, Wurdeman SR. OASIS 1: Retrospective analysis of four different microprocessor knee types. Journal of Rehabilitation and Assistive Technologies Engineering. 2020;7:2055668320968476. | |
3. | McGrath M, Laszczak P, Zahedi S, et al. Microprocessor knees with ‘standing support’ and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396. | |
4. | Heller BW, Datta D, Howitt J. A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees. Clin Rehabil 2000; 14: 518–522. | |
5. | Chin T, Maeda Y, Sawamura S, et al. Successful prosthetic fitting of elderly trans-femoral amputees with Intelligent Prosthesis (IP): a clinical pilot study. Prosthet Orthot Int 2007; 31: 271–276. | |
6. | Datta D, Howitt J. Conventional versus microchip controlled pneumatic swing phase control for trans-femoral amputees: user’s verdict. Prosthet Orthot Int 1998; 22: 129–135. | |
7. | Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of amputees (MAAT 3): Matching individuals based on comorbid health reveals improved function for above-knee prosthesis users with microprocessor knee technology. Assist Technol 2018; 1–7. | |
8. | Saglam Y, Gulenc B, Birisik F, et al. The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees. Acta Orthop Traumatol Turc 2017; 51: 466e469. | |
9. | Chin T, Sawamura S, Shiba R, et al. Energy expenditure during walking in amputees after disarticulation of the hip: a microprocessor-controlled swing-phase control knee versus a mechanical-controlled stance-phase control knee. J Bone Joint Surg Br 2005; 87: 117–119. | |
10. | Datta D, Heller B, Howitt J. A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control. Clin Rehabil 2005; 19: 398–403. | |
11. | Buckley JG, Spence WD, Solomonidis SE. Energy cost of walking: comparison of “intelligent prosthesis” with conventional mechanism. Arch Phys Med Rehabil 1997; 78: 330–333. | |
12. | Taylor MB, Clark E, Offord EA, et al. A comparison of energy expenditure by a high level trans-femoral amputee using the Intelligent Prosthesis and conventionally damped prosthetic limbs. Prosthet Orthot Int 1996; 20: 116–121. | |
13. | Kirker S, Keymer S, Talbot J, et al. An assessment of the intelligent knee prosthesis. Clin Rehabil 1996; 10: 267–273. | |
14. | Chin T, Machida K, Sawamura S, et al. Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg. Prosthet Orthot Int 2006; 30: 73–80. | |
15. | Chin T, Sawamura S, Shiba R, et al. Effect of an Intelligent Prosthesis (IP) on the walking ability of young transfemoral amputees: comparison of IP users with able-bodied people. Am J Phys Med Rehabil 2003; 82: 447–451. | |
16. | Chen C, Hanson M, Chaturvedi R, et al. Economic benefits of microprocessor controlled prosthetic knees: a modeling study. J Neuroengineering Rehabil 2018; 15: 62. |
Clinical Outcomes using Senior feet
Low stiffness at weight acceptance leads to early foot-flat and greater stability for lower mobility patients1
1. | Turcot K, Sagawa Jr Y, Lacraz A, et al. Comparison of the International Committee of the Red Cross foot with the solid ankle cushion heel foot during gait: a randomized double-blind study. Arch Phys Med Rehabil 2013; 94: 1490–1497. | |
2. | Dudkiewicz I, Pisarenko B, Herman A, et al. Satisfaction rates amongst elderly amputees provided with a static prosthetic foot. Disabil Rehabil 2011; 33: 1963–1967. | |
3. | Sasaki K, Pinitlertsakun J, Rattanakoch J, et al. The development and testing of a modified natural rubber CR solid ankle–cushion heel prosthetic foot for developing countries. J Rehabil Assist Technol Eng 2017; 4: 2055668317712978. |
Clinical Outcomes using Sweat Management liners
There are two published literature reviews that discuss different aspects of lower limb prosthetic liner technology5,6.
1. | McGrath M, McCarthy J, Gallego A, et al. The influence of perforated prosthetic liners on residual limb wound healing: a case report. Can Prosthet Orthot J 2019; 2(1) | |
2. | Davies KC, McGrath M, Stenson A, Savage Z, Moser D, Zahedi S. Using perforated liners to combat the detrimental effects of excessive sweating in lower limb prosthesis users. Can Prosthet Orthot J. 2020;3(2). | |
3. | Williams RJ, Washington ED, Miodownik M, et al. The effect of liner design and materials selection on prosthesis interface heat dissipation. Prosthet Orthot Int 2018; 42: 275–279. | |
4. | Caldwell R, Fatone S. Technique for perforating a prosthetic liner to expel sweat. JPO J Prosthet Orthot 2017; 29: 145–147. | |
5. | Klute GK, Glaister BC, Berge JS. Prosthetic liners for lower limb amputees: a review of the literature. Prosthet Orthot Int 2010; 34: 146–153. | |
6. | Richardson A, Dillon MP. User experience of transtibial prosthetic liners: a systematic review. Prosthet Orthot Int 2017; 41: 6–18. | |
7. | Sanders JE, Greve JM, Mitchell SB, et al. Material properties of commonly-used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev 1998; 35: 161–176. | |
8. | Emrich R, Slater K. Comparative analysis of below-knee prosthetic socket liner materials. J Med Eng Technol 1998; 22: 94–98. | |
9. | Klute GK, Rowe GI, Mamishev AV, et al. The thermal conductivity of prosthetic sockets and liners. Prosthet Orthot Int 2007; 31: 292–299. | |
10. | Sonck WA, Cockrell JL, Koepke GH. Effect of liner materials on interface pressures in below-knee prostheses. Arch Phys Med Rehabil 1970; 51: 666. | |
11. | Lee WC, Zhang M, Mak AF. Regional differences in pain threshold and tolerance of the transtibial residual limb: including the effects of age and interface material. Arch Phys Med Rehabil 2005; 86: 641–649. |
Clinical Outcomes using Sweat Management liners
There are two published literature reviews that discuss different aspects of lower limb prosthetic liner technology5,6.
1. | McGrath M, McCarthy J, Gallego A, et al. The influence of perforated prosthetic liners on residual limb wound healing: a case report. Can Prosthet Orthot J 2019; 2(1) | |
2. | Davies KC, McGrath M, Stenson A, Savage Z, Moser D, Zahedi S. Using perforated liners to combat the detrimental effects of excessive sweating in lower limb prosthesis users. Can Prosthet Orthot J. 2020;3(2). | |
3. | Williams RJ, Washington ED, Miodownik M, et al. The effect of liner design and materials selection on prosthesis interface heat dissipation. Prosthet Orthot Int 2018; 42: 275–279. | |
4. | Caldwell R, Fatone S. Technique for perforating a prosthetic liner to expel sweat. JPO J Prosthet Orthot 2017; 29: 145–147. | |
5. | Klute GK, Glaister BC, Berge JS. Prosthetic liners for lower limb amputees: a review of the literature. Prosthet Orthot Int 2010; 34: 146–153. | |
6. | Richardson A, Dillon MP. User experience of transtibial prosthetic liners: a systematic review. Prosthet Orthot Int 2017; 41: 6–18. | |
7. | Sanders JE, Greve JM, Mitchell SB, et al. Material properties of commonly-used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev 1998; 35: 161–176. | |
8. | Emrich R, Slater K. Comparative analysis of below-knee prosthetic socket liner materials. J Med Eng Technol 1998; 22: 94–98. | |
9. | Klute GK, Rowe GI, Mamishev AV, et al. The thermal conductivity of prosthetic sockets and liners. Prosthet Orthot Int 2007; 31: 292–299. | |
10. | Sonck WA, Cockrell JL, Koepke GH. Effect of liner materials on interface pressures in below-knee prostheses. Arch Phys Med Rehabil 1970; 51: 666. | |
11. | Lee WC, Zhang M, Mak AF. Regional differences in pain threshold and tolerance of the transtibial residual limb: including the effects of age and interface material. Arch Phys Med Rehabil 2005; 86: 641–649. |
Improvements in Clinical Outcomes using prosthetic knees with microprocessor-controlled swing phase
1. | Heller BW, Datta D, Howitt J. A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees. Clin Rehabil 2000; 14: 518–522. | |
2. | Chin T, Maeda Y, Sawamura S, et al. Successful prosthetic fitting of elderly trans-femoral amputees with Intelligent Prosthesis (IP): a clinical pilot study. Prosthet Orthot Int 2007; 31: 271–276. | |
3. | Datta D, Heller B, Howitt J. A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control. Clin Rehabil 2005; 19: 398–403. | |
4. | Datta D, Howitt J. Conventional versus microchip controlled pneumatic swing phase control for trans-femoral amputees: user’s verdict. Prosthet Orthot Int 1998; 22: 129–135. | |
5. | Buckley JG, Spence WD, Solomonidis SE. Energy cost of walking: comparison of “intelligent prosthesis” with conventional mechanism. Arch Phys Med Rehabil 1997; 78: 330–333. | |
6. | Kirker S, Keymer S, Talbot J, et al. An assessment of the intelligent knee prosthesis. Clin Rehabil 1996; 10: 267–273. | |
7. | Chin T, Sawamura S, Shiba R, et al. Energy expenditure during walking in amputees after disarticulation of the hip: a microprocessor-controlled swing-phase control knee versus a mechanical-controlled stance-phase control knee. J Bone Joint Surg Br 2005; 87: 117–119. | |
8. | Taylor MB, Clark E, Offord EA, et al. A comparison of energy expenditure by a high level trans-femoral amputee using the Intelligent Prosthesis and conventionally damped prosthetic limbs. Prosthet Orthot Int 1996; 20: 116–121. | |
9. | Chin T, Machida K, Sawamura S, et al. Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg. Prosthet Orthot Int 2006; 30: 73–80. | |
10. | Chin T, Sawamura S, Shiba R, et al. Effect of an Intelligent Prosthesis (IP) on the walking ability of young transfemoral amputees: comparison of IP users with able-bodied people. Am J Phys Med Rehabil 2003; 82: 447–451. |
Clinical Outcomes using SACH feet
1. | Turcot K, Sagawa Jr Y, Lacraz A, et al. Comparison of the International Committee of the Red Cross foot with the solid ankle cushion heel foot during gait: a randomized double-blind study. Arch Phys Med Rehabil 2013; 94: 1490–1497. | |
2. | Dudkiewicz I, Pisarenko B, Herman A, et al. Satisfaction rates amongst elderly amputees provided with a static prosthetic foot. Disabil Rehabil 2011; 33: 1963–1967. | |
3. | Sasaki K, Pinitlertsakun J, Rattanakoch J, et al. The development and testing of a modified natural rubber CR solid ankle–cushion heel prosthetic foot for developing countries. J Rehabil Assist Technol Eng 2017; 4: 2055668317712978. |
Improvements in Clinical Outcomes using shock-absorbing pylon/torque absorber compared to rigid pylon
1. | Rogers JP, Strike SC, Wallace ES. The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee. Prosthet Orthot Int 2004; 28: 121–131. | |
2. | Berge JS, Czerniecki JM, Klute GK. Efficacy of shock-absorbing versus rigid pylons for impact reduction in transtibial amputees based on laboratory, field, and outcome metrics. J Rehabil Res Dev 2005; 42: 795. | |
3. | Klute GK, Berge JS, Orendurff MS, et al. Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil 2006; 87: 717–722. | |
4. | Flick KC, Orendurff MS, Berge JS, et al. Comparison of human turning gait with the mechanical performance of lower limb prosthetic transverse rotation adapters. Prosthet Orthot Int 2005; 29: 73–81. | |
5. | Gard SA, Konz RJ. The effect of a shock-absorbing pylon on the gait of persons with unilateral transtibial amputation. J Rehabil Res Dev 2003; 40: 109–124. | |
6. | Boutwell E, Stine R, Gard S. Shock absorption during transtibial amputee gait: Does longitudinal prosthetic stiffness play a role? Prosthet Orthot Int 2017; 41: 178–185. | |
7. | Adderson JA, Parker KE, Macleod DA, et al. Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study. Prosthet Orthot Int 2007; 31: 384–393. |