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Background: Individuals with trans-tibial amputation show a greater peak prosthetic ankle power (push- off) when using energy storing and returning (ESAR) prosthetic feet as compared to solid-ankle cushion-heel feet. ESAR feet further contribute to the users' body support and thus limit prosthetic ankle motion. To improve ankle motion, articulating prosthetic feet have been introduced. However, articulating feet may diminish push-off.Research Question: Does a novel prosthetic foot, with a serial layout of carbon fibre leaf springs, connected by a multi-centre joint construction, have advantages in kinematics and kinetics over a conventional ESAR prosthetic foot?> METHODS: Eleven individuals with unilateral trans-tibial amputation were fitted with the novel foot (NF) and a conventional ESAR Foot (CF) and underwent 3D gait analysis. As an additional power estimate of the prosthetic ankle, a unified, deformable, segment model approach was applied. Eleven matched individuals without impairments served as a reference.Results: The NF shows an effective prosthetic ankle range of motion that is closer to a physiologic ankle range of motion, at 31.6° as compared to 15.2° with CF (CF vs. NF p = 0.003/NF vs. Reference p = 0.171) without reducing the maximum prosthetic ankle joint moment. Furthermore, the NF showed a great increase in prosthetic ankle power (NF 2.89 W/kg vs. CF 1.48 W/kg CF vs. NF p = <0.001) and a reduction of 19% in the peak knee varus moment and 13% in vertical ground reaction forces on the sound side for NF in comparison to CF.Significance: The NF shows that serial carbon fibre leaf springs, connected by a multi-centre joint construction gives a larger ankle joint range of motion and higher ankle power than a conventional carbon fibre structure alone. Consequently load is taken off the contralateral limb, as measured by the decrease in vertical ground reaction forces and peak knee varus moment. [ABSTRACT FROM AUTHOR]

Recent reports have shown that timing of genu recurvatum (GR) might be caused by different underlying factors and that equinus leads to GR especially during early stance. The purpose of this study was to investigate the reduction of GR after surgical correction of equinus in children with bilateral spastic cerebral palsy and whether the children with early and late type GR show differences in reduction of knee hyperextension after a surgery. In 24 limbs (mean age 10.3 years, GMFCS I-III) showing equinus and GR the kinematics of the knee and ankle as well as the kinetics of the knee were evaluated before and one year (mean follow up period: 12.8 months) after surgical correction of equinus. The study was approved by the local ethical committee. Limbs with early type GR showed a reduction by 11.1° (p<0.001) and those with late type GR by 6.0° (p<0.049) in GR after surgery. Before surgery limbs with early type GR showed increased external extending moments, which decreased significantly after surgery. In contrast limbs with late GR did not show a significant reduction of those moments. The findings of this study underline the influence of equinus on early GR as an underlying factor. As equinus is attributed to early knee hyperextension and proximal factors are more important as underlying factors in late type GR, a classification into early and late onset GR is useful to identify underlying factors and to choose adequate treatment. [ABSTRACT FROM AUTHOR]

Background: Despite of many attempts to determine or correct hip and knee joint parameters via non-invasive techniques such as regression or functional methods, in conventional gait models the position of the ankle joint center still is assumed at the center point between malleoli.Research Question: The aim of this study was to estimate the ankle joint parameters using a functional approach.Methods: To this aim, we used data of 23 typically developed adults performing two different calibration motions. Subsequently, we applied functional approaches to determine the functional joint center and axis.Results: The results show significant differences for ankle joint parameters in all directions for both calibration motions applied with respect to the malleoli line. Most prominently, we find a shift of the ankle joint center of 7 % of the foot length anteriorly to the malleoli mid-point when applying functional calibration.Conclusion: These significant alterations of the ankle joint center and axis indicate the importance of accurate determination of ankle joint parameters and consequently their influence on the clinical outcome. [ABSTRACT FROM AUTHOR]

The incidence of knee and hip joint osteoarthritis in subjects with below knee amputation (BK) appears significantly higher compared to unimpaired subjects, especially in the intact side. However, it is controversial if constant higher loads on the sound side are one of the major factors for an increased osteoarthritis (OA) incidence in subjects with BK, beside other risk factors, e.g. with respect to metabolism. The aim wasto investigate joint contact forces (JCF) calculated by a musculoskeletal model in the intact side and to compare it with those of unimpaired subjects and to further elucidate in how far increased knee JCF are associated with increased frontal plane knee moments. A group of seven subjects with BK amputation and a group of ten unimpaired subjects were recruited for this study. Gait data were measured by 3D motion capture and force plates. OpenSim software was applied to calculate JCF. Maximum joint angles, ground reaction forces, and moments as well as time distance parameters were determined and compared between groups showing no significant differences, with some JCF components of knee and hip even being slightly smaller in subjects with BK compared to the reference group. This positive finding may be due to the selected ESAR foot. However, other beneficial factors may also have influenced this positive result such as the general good health status of the subjects or the thorough and proper fitting and alignment of the prosthesis. [ABSTRACT FROM AUTHOR]