Effects of footwear on the gait kinematics of women with unilateral transtibial amputation: an observational case series

Prosthesis geometry and behaviour limit the footwear options available to women. Using a commercially available prosthetic foot that permits user-alignment to accommodate shoes with different heel heights, we investigated the effect of footwear on gait kinematics, with and without adjustment for differences in heel-forefoot differential. Three women with transtibial amputation walked at a self-selected pace, first in an athletic shoe (prosthetist-aligned; baseline condition), then (i) in a flatter shoe without realigning the prosthesis, and (ii) in flat and heeled shoes following user re-alignment. Kinematics in each condition were compared to baseline. Baseline gait patterns were highly variable across participants. Gait was slower in comparison to baseline in all conditions, but movement compensations varied across participants. An increased lower limb extension tendency was evident with the misaligned prosthesis. With user re-alignment to accommodate the shoe there were fewer deviations from baseline, however kinematic differences remained in both the flat and heeled shoes. The user-alignment feature of the prosthetic foot reduced the effect of a change in footwear on kinematics, and permitted walking in heeled shoes when it might otherwise not be possible. Persistence of some deviations suggests differences in walking task demand remained despite adjustment.Implications for rehabilitationPermitting prosthesis users to don footwear of choice may improve body image, well-being and quality of life following amputation.Prosthetic feet that permit user ankle adjustment can reduce gait deviations associated with a change in footwear heel height, although kinematic adaptations are individual. Permitting prosthesis users to don footwear of choice may improve body image, well-being and quality of life following amputation. Prosthetic feet that permit user ankle adjustment can reduce gait deviations associated with a change in footwear heel height, although kinematic adaptations are individual.

假肢的几何形态与运动特性限制了女性截肢者可选择的鞋履种类。本研究采用一款支持使用者自行调节对准以适配不同鞋跟高度的商用假肢脚板，探究了鞋履对步态运动学的影响，并分别考量了是否调整足跟-前足高度差两种情形。本研究招募3名经胫骨截肢的女性受试者，令其以自择步速行走，实验条件依次为：① 穿着运动鞋（由假肢技师完成对准，为基线对照条件）；② 穿着平底鞋但未重新调节假肢对准状态；③ 经使用者重新对准假肢后，分别穿着平底鞋与高跟鞋。将各实验条件下的运动学数据与基线条件进行对比。受试者间的基线步态模式存在显著个体差异。所有非基线条件下的步态速度均慢于基线，但受试者的运动代偿模式存在个体差异。当假肢未对准状态下，受试者下肢伸展趋势明显增强。经使用者调整假肢对准以适配鞋履后，步态与基线的偏差有所减少，但无论平底鞋还是高跟鞋，其运动学差异仍存在。该假肢脚板的使用者自主对准功能，可削弱鞋履变化对运动学参数的影响，并使受试者能够穿着高跟鞋行走——这在未具备该功能时难以实现。仍存在部分偏差的现象表明，即便完成对准调节，行走任务的需求差异仍未完全消除。康复启示：允许假肢使用者自主选择鞋履，可改善截肢后患者的身体意象、心理健康与生活质量。支持使用者进行踝关节调节的假肢脚板，可减少因鞋履跟高变化引发的步态偏差，不过运动学代偿仍存在个体差异。允许假肢使用者自主选择鞋履，可改善截肢后患者的身体意象、心理健康与生活质量。支持使用者进行踝关节调节的假肢脚板，可减少因鞋履跟高变化引发的步态偏差，不过运动学代偿仍存在个体差异。