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. 2004;2004(1):CD003978.
doi: 10.1002/14651858.CD003978.pub2.

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation

C Hofstad  1 , H Linde, J Limbeek, K Postema
Affiliations

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation

C Hofstad et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic ankle-foot mechanisms. There seems to be no clear clinical consensus on the precise prescription criteria for the various prosthetic ankle-foot mechanisms related to the functional abilities of amputees.

Objectives: To obtain information about aspects of prosthetic ankle-foot mechanisms and daily functioning of amputees with a prosthesis, for appropriate prosthetic prescription criteria.

Search strategy: We searched the Cochrane Musculoskeletal Injuries Group specialised register of trials (April 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (1966 to April 2003), EMBASE (1983 to April 2003), CINAHL (1982 to April 2003) and reference lists of articles. No language restrictions were applied.

Selection criteria: All randomised controlled trials and quasi-randomised controlled trials comparing different prosthetic devices for lower limb amputation in adults. No language restrictions were applied.

Data collection and analysis: Two reviewers independently identified potential articles from the literature search. Methodological quality was assessed using a checklist comprising 13 criteria. The reviewers extracted data using pre-defined extraction forms.

Main results: Twenty-three trials were included, with a total of 217 participants. The methodological quality was moderate. Only one study was of high quality. No classical RCT's were identified, yet, all included studies used cross-over designs allowing sufficient control for confounding. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds.

Reviewer's conclusions: There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle-foot mechanism. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. In prescribing prosthetic-ankle foot mechanisms for lower-limb amputees, practitioners should take into account availability, patient functional needs, and cost.

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Conflict of interest statement

None known.

Update of

References

References to studies included in this review

Barth 1992 {published data only}
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Boonstra 1993 {published data only}
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Casillas 1995 {published data only}
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Cortes 1997 {published data only}
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Culham 1984 {published data only}
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Doane 1983 {published data only}
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Goh 1984 {published data only}
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Hsu 1999 {published data only}
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    1. Hsu MJ, Nielsen DH, Yack J, Shurr DG, Lin SJ. Physiological comparisons of physically active persons with transtibial amputation using static and dynamic prostheses versus persons with nonpathological gait during multiple‐speed walking. JPO: Journal of Prosthetics and Orthotics 2000;12(2):60‐9.
Hsu 2006 {published data only}
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Huang 2000 {published data only}
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Lehmann 1993a {published data only}
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Lehmann 1993b {published data only}
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MacFarlane 1991 {published data only}
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MacFarlane 1997 {published data only}
    1. MacFarlane PA, Nielsen DH, Shurr DG. Mechanical gait analysis of transfemoral amputees: SACH‐foot versus the Flex‐foot. Journal of Prosthetics and Orthotics: JPO 1997;9(4):144‐51.
    1. MacFarlane PA, Nielsen DH, Shurr DG, Meier K, Clark R, Kerns J, et al. Transfemoral amputee physiological requirements: comparisons between SACH foot walking and FLEX‐FOOT walking. Journal of Prosthetics and Orthotics: JPO 1997;9(4):138‐43.
Marinakis 2004 {published data only}
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Menard 1992 {published data only}
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Nielsen 1988 {published data only}
    1. Nielsen DH, Shurr DG, Golden JC, Meier K. Comparison of energy cost and gait efficiency during ambulation in below‐knee amputees using different prosthetic feet. Journal of Prosthetics and Orthotics: JPO 1988;1:24‐31.
Perry 1997 {published data only}
    1. Perry J, Boyd LA, Rao SS, Mulroy SJ. Prosthetic weight acceptance mechanics in transtibial amputees wearing the Single Axis, Seattle Lite, and Flex Foot. IEEE Transactions on Rehabilitation Engineering 1997;5(4):283‐9. - PubMed
Postema 1994 {published data only}
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Powers 1994 {published data only}
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Rao 1998 {published data only}
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Schmalz 2002 {published data only}
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Snyder 1995 {published data only}
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Torburn 1990 {published data only}
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Torburn 1995 {published data only}
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Underwood 2004 {published data only}
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References to studies excluded from this review

Alaranta 1991 {published data only}
    1. Alaranta H, Kinnunen A, Karkkainen M, Pohjalainen T, Heliovaara M. Practical benefits of Flex‐Foot in below‐knee amputees. Journal of Prosthetics and Orthotics: JPO 1991;3(4):179‐81.
Arya 1995 {published data only}
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Hayden 2000 {published data only}
    1. Hayden S, Evans R, McPoil TG, Cornwall MW, Pipinich L. The effect of four prosthetic feet on reducing plantar pressures in diabetic amputees. JPO: Journal of Prosthetics and Orthotics 2000;12(3):92‐6.
James 1986 {published data only}
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Mizuno 1992 {published data only}
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Nyska 2002 {published data only}
    1. Nyska M, Shabat S, Arya A, McCabe C, Linge K, Klenerman L. A comparative study of different below‐knee prostheses by dynamic foot pressure analysis.. International Journal of Rehabilitation Research 2002;25(4):341‐4. - PubMed
Torburn 1994 {published data only}
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vd Water 1998 {published data only}
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Wagner 1987 {published data only}
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Wirta 1991 {published data only}
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Yack 1999 {published data only}
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