Individuals with unilateral transtibial amputation and lower activity levels walk more quickly when using a hydraulically articulating versus rigidly attached prosthetic ankle-foot device

Introduction: Prosthetic ankle-foot devices incorporating a hydraulic articulation between the pylon and prosthetic foot have been shown to be beneficial to the gait of more active individuals with unilateral transtibial amputation (UTA). However, the functional benefits of using hydraulic ankle-foot devices to less active individuals with UTA are yet to be determined. The aim of the current study was to investigate the effects on gait performance of using a non-ESR foot with a hydraulic attachment, compared to an identical, rigidly attached foot during overground walking in less active individuals with UTA. Materials and Methods: Kinematic and kinetic data were recorded while five individuals with UTA, deemed K2 activity level by their prescribing physician, performed two-minute walk tests (2MWT) and ten overground gait trials, in two conditions; using a hydraulically articulating ankle foot device (HYD) and using a rigidly attached ankle foot device (RIG). Results: Walking speed during the 2MWT was increased by 6.5% on average, in the HYD (1.07 m/s) condition, compared to the RIG (1.01 m/s) condition (Cohen’s d = 0.4). Participants displayed more symmetrical inter-limb loading (d = 0.8), increased minimum forward centre of pressure velocity (d = 0.8), increased peak shank rotational velocity (d = 1.0) and decreased prosthetic energy efficiency (d = 0.7) when using the HYD compared to RIG device. Conclusions: Individuals with lower activity levels walk faster and therefore further when, using a foot with a hydraulically articulating attachment, in comparison to a rigid attachment. A reduced braking effect in early stance phase, as a result of the action of the hydraulic component present in the articulating attachment, partially explains the improvement in walking performance.