Acta Univ. Palacki. Olomuc., Gymn. 2007 37(4): 55-60

Temporal symmetry of sound and prosthetic limbs during transtibial amputee gait with various prosthetic alignment

Zdeněk Svoboda, Miroslav Janura

Faculty of Physical Culture, Palacky University, Olomouc

The term "gait" refers to fundamental locomotion by means of which the individual moves him/herself from one place to another. For people afflicted by some involvement of the lower limbs, this activity is partially or completely reduced. In the course of the biomechanical investigation of gait in subjects with various afflictions, the symmetry of lower limb loading is also the object of research. A certain number of biomechanical studies are focussed on the kinematic and dynamic variables of the gait cycle in subjects with transtibial amputation (Bateni & Olney, 2002; Thomas et al., 2000; Perry, 2004). An interesting problem is the evaluation of gait symmetry between a transtibial amputee and groups of healthy persons (Winter & Sienko, 1988; Dingwell, Davis, & Frazier, 1996). Miff et al. (2005) compared temporal symmetries in a healthy group with the values in a transtibial amputee group during gait initiation and termination. Nolan et al. (2003) took an interest in changes in gait symmetry influenced by gait speed in transtibial and transfemoral amputees in comparison with a healthy group. The interlimb gait symmetry of transtibial amputees wearing two different prosthetic feet in the early rehabilitation stage was investigated by Marinakis (2004). Full symmetry in one's gait is not always desirable. The human system, with its major structural asymmetries in the neuromuscular skeletal system (one limb has been amputated) cannot perform optimally when the gait is symmetrical (Winter & Sienko, 1988). Non symmetrical gait performance, with constraints of its residual system and the mechanics of its prosthesis, is better in this case. For persons who have undergone amputation, asymmetrical gait may be the instrument which protects the stump of the disabled limb. We can say that gait asymmetry would be a relevant measure for investigating the gait characteristics of amputees and establishing their propensity for future joint pain and degeneration (Nolan et al., 2003). For amputee gait, the choice of a suitable prosthesis is very important. The influence of a prosthetic foot on gait variables in a group of these subjects was observed by Gitter et al. (1991). Efficiency of performance of the gait cycle is also markedly influenced by a prosthesis or prosthetic foot alignment. Rehabilitation of an amputee can be considered to be successful only when the amputee finds the prosthesis aesthetic and comfortable during walking. Prosthesis alignment has to correspond to the demands of the prosthetist (Fridman, Ona, & Isakov, 2003). When the prosthetic foot is not aligned optimally, this fact can show up in different levels of gait cycle performance. During gait analysis, the prosthesis is intentionally "not optimally" aligned in order to elicit the implied implications. Fridman, Ona and Isakov (2003) observed the influence of a prosthetic foot positioned in external rotation. Schmalz, Blumentritt and Jarasch (2002) used sagittal shifting of the foot to both anterior and posterior directions and foot alignment to both plantar a dorsal flexion. Blumentritt et al. (1999) focussed on the effects of sagittal plane prosthetic alignment to the magnitude of knee joint loads on a standing transtibial amputee. The objectives of prosthetic alignment in persons with lower limb amputation are the enhancement of the remaining limb's comfort and to maximize the individual's walking capabilities. In biomechanical gait analysis, it is important to investigate not only the relationship between prosthetic foot alignment and the prosthetic limb, but also the relationship between this alignment and activity of the contralateral, sound limb (Pinzur et al., 1995). An accent on the sound limb appears in other studies (Nolan & Lees, 2000; Hurley et al., 1990), but there the question of various prosthetic alignments is not considered. This relationship between the sound and the prosthetic limb can be quantitative, measured by the symmetry or asymmetry of the measured variables.

Keywords: Transtibial amputation, alignment, gait, temporal variables

Prepublished online: January 31, 2009; Published: September 1, 2007  Show citation