Influence of gait training and prosthetic foot category on external work symmetry during unilateral transtibial amputee gait

Background: 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.