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

Abstract

Purpose

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.

Materials and methods

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.

Results

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.

Conclusions

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 rehabilitation

• 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.

Keywords:

• Gait
• footwear
• transtibial amputation
• prostheses
• women's health
• amputation
• walking

Acknowledgements

The authors would like to thank Julia Quinlan, PhD and Clare Severe for their assistance in data processing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by a Shaw Family Pioneer Award, sponsored by the Northwestern University Women’s Health Research Institute, and Advanced Rehabilitation Research Training Program Award [#90AR5031] from the National Institute on Disability, Independent Living, and Rehabilitation Research.