Article

Prosthetic foot prescription guidelines lack scientific evidence and
are concurrent with an amputee's concurrent with an amputee's Medicare Functional
Classification Level (K-Level) and categorization of prosthetic feet. Objective:
To evaluate the influence of gait training and four categories of prosthetic feet
(K1, K2, K3, and microprocessor ankle/foot) on Symmetry in External Work for
K-Level-2 and K-Level-3 unilateral transtibial amputees. Design: Randomized
repeated-measures trial. Methods: Five K-Level-2 and five K-Level-3 subjects were
tested in their existing prosthesis during Session 1 and again in Session 2,
following 2 weeks of standardized gait training. In Sessions 3-6, subjects were
tested using a study socket and one of four randomized test feet. There was an
accommodation period of 10-14 days with each foot. Symmetry in External Work for
positive and negative work was calculated at each session to determine symmetry
of gait dynamics between limbs at self-selected walking speeds. Results:
K-Level-2 subjects had significantly higher negative work symmetry with the K3
foot, compared to K1/K2 feet. For both subject groups, gait training had a
greater impact on positive work symmetry than test feet. Conclusion: Higher work
symmetry is possible for K-Level-2 amputees who are trained to take advantage of
K3 prosthetic feet designs. There exists a need for an objective determinant for
categorizing and prescribing prosthetic feet. Clinical relevance Findings that
gait training can influence symmetry of gait dynamics and that K-Level-2 amputees
can achieve greater work symmetry with a K3 foot having a "J-shaped" ankle and
heel-to-toe footplate could potentially impact prosthetic care and foot
prescription by clinicians and reimbursement guidelines by third-party
health-care payers.

Langue : ANGLAIS