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Ann Phys Rehabil Med 2020 May 22. Epub 2020 May 22.

Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.

Background: Previous work has highlighted the highly functional post-rehabilitation level of military individuals who sustained traumatic amputation. Understanding how these individuals walk with their prosthesis could be key to setting a precedent for what is realistically possible in the rehabilitation of individuals with amputations.

Objective: The aim of this paper is to answer how "normal" should the gait of an individual with an amputation(s) be and can we aspire to mimic able-bodied gait with the most advanced prosthetics in highly functioning individuals?

Methods: This was a cross-sectional study comparing the gait of severely injured and highly functional UK trans-tibial (n=10), trans-femoral (n=10) and bilateral trans-femoral (n=10) military amputees after completion of their rehabilitation programme to that of able-bodied controls (n=10). Read More

Mil Med 2020 01;185(Suppl 1):480-489

Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD 20817.

Introduction: The objective was to determine if the Mobile Device Outcomes-based Rehabilitation Program (MDORP) improved strength, mobility, and gait quality in service members (SMs) and Veterans with lower limb amputation (LLA).

Methods: Seven SMs and 10 Veterans with LLA enrolled and were trained to use a mobile sensor system, called Rehabilitative Lower Limb Orthopedic Analysis Device (ReLOAD). ReLOAD provided participants with real-time assessment of gait deviations, subsequent corrective audio feedback, and exercise prescription for normalizing gait at home and in the community. Read More

Conf Proc IEEE Eng Med Biol Soc 2019 07;2019:5382-5385

People with a transtibial amputation worldwide rely on their prosthetic socket to regain their mobility. Patient comfort is largely affected by the weight and strength of these prosthetic sockets. The use of additive manufacturing could give the prosthetist a range of new design possibilities when designing a prosthetic socket. Read More

Injury 2019 Nov 11. Epub 2019 Nov 11.

Institute for Biomechanics, BG Klinikum Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.

Movement or gait analysis has become a viable assessment tool not only used in sports science or basic biomechanical research, but has also expanded to be a very valuable instrument in clinical diagnostics, monitoring functional recovery and musculoskeletal rehabilitation. In this context, this method has long been an integral part solely in neurological disorders such as cerebral palsy. However, in the meantime the benefits have also become apparent in other medical areas, such as foot surgery, orthopaedic technology, or in patients after lower limb amputation. Read More

J Neuroeng Rehabil 2019 11 6;16(1):132. Epub 2019 Nov 6.

Department of Engineering, University Roma TRE, Roma, Italy.

Background: The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects. Read More

J Orthop Case Rep 2019 ;9(3):75-78

Department of Orthopaedic Surgery, Biomedical and Health Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan.

Introduction: An extensor digitorum brevis (EDB) flap can be used to cover a small soft-tissue defect and has been widely used as pedicled flap to cover defects around the ankle and foot. However, its post-operative functional recovery is unknown. Few reports have evaluated gait after foot flap surgeries, although gait assessment is considered to be necessary for functional evaluation after foot reconstruction. Read More

J Orthop Surg Res 2019 Sep 2;14(1):287. Epub 2019 Sep 2.

Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.

Background: The thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction.

Methods: From January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. Read More

Med Hypotheses 2019 Aug 23;129:109238. Epub 2019 May 23.

University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, Po Box 30.001, 9700 RB Groningen, the Netherlands. Electronic address:

In the Netherlands, 34% of all major lower limb amputations are at the trans-femoral level. Information and consensus is lacking on the optimal length of the residual length of the femur following the amputation. HYPOTHESIS: We hypothesize that femur length should be kept as long as possible considering construction of the knee unit beneath the socket. Read More

JB JS Open Access 2019 Apr-Jun;4(2):e0053. Epub 2019 Apr 5.

Texas Scottish Rite Hospital for Children, Dallas, Texas.

Background: Fibular hemimelia, a congenital disorder characterized by the partial or complete absence of the fibula, tibial growth inhibition, and foot and ankle deformity and deficiency, is the most common deficiency of long bones. The purpose of the present study of children with congenital fibular hemimelia was to examine the functional and psychosocial outcomes at a minimum of 2 years after treatment either with amputation and a prosthesis or with reconstruction and lengthening.

Methods: Twenty children who were managed with primary amputation were compared with 22 children who were managed with staged limb reconstruction. Read More

Gait Posture 2019 09 27;73:8-13. Epub 2019 Jun 27.

Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address:

Background: To assist with forward progression during gait, persons with unilateral lower-limb amputation typically perform more work within the unaffected versus affected limb. However, prior cross-sectional (>2years post-amputation) studies cannot necessarily elucidate the origin or evolution of these compensatory mechanics.

Research Question: Do lower limb joint kinetics change during the initial stages of independent ambulation among persons with lower-limb amputation?

Methods: Nine males with unilateral lower-limb amputation (6 transtibial; 3 transfemoral) completed instrumented gait analyses (speed = 1. Read More

Gait Posture 2019 09 1;73:1-7. Epub 2019 Jul 1.

Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany. Electronic address:

Background: In subjects with Chopart amputation the foot lever is clearly diminished. Usually high or low profile prostheses are routinely utilized to re-establish the lost forefoot lever.

Research Question: The aim of this study was to investigate to what extent the proposed prostheses were able to replace the forefoot lever in chopart-amputees. Read More

Prosthet Orthot Int 2019 Aug 30;43(4):447-452. Epub 2019 May 30.

1 DoD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, San Diego, CA, USA.

Background And Purpose: Passive dynamic ankle-foot orthoses have potential to facilitate return to running after a lower limb trauma. However, transitioning patients to new movement patterns that enhance passive dynamic ankle-foot orthoses benefits can pose a challenge. The purpose of this case study was to report biomechanical and functional outcomes for a patient utilizing a passive dynamic ankle-foot orthoses following completion of a session-based, midfoot strike run training program. Read More

Int J Artif Organs 2019 Nov 24;42(11):645-657. Epub 2019 May 24.

Department of Mechanical and Industrial Engineering, College of Engineering, Majmaah University, Al-Majmaah, Saudi Arabia.

The production of customized prostheses for the foot and ankle still relies on slow and laborious steps of the traditional plaster molding fabrication techniques. Additive manufacturing techniques where three-dimensional objects can be constructed directly based on the object's computer-aided-design data in a layerwise manner has opened the door to new opportunities for manufacturing of novel and personalized medical devices. The purpose of the present study was to develop a new methodology for design and manufacturing of a customized silicone partial foot prosthesis via an indirect additive manufacturing process. Read More

Clin Orthop Relat Res 2019 04;477(4):821-825

D. J. Schuett, US Naval Hospital, Okinawa, Japan M. P. Wyatt, T. Kingsbury, N. Thesing, K. M. Kuhn, Naval Medical Center San Diego, San Diego, CA, USA D. M. Dromsky, Orthopedics Department, Conroe Regional Medical Center, Conroe, TX, USA.

Background: Through-knee amputation is a common amputation level after battlefield injuries during the medical evacuation process. However, there are limited data comparing through-knee amputation with transfemoral amputation as a definitive amputation level in terms of gait parameters.

Questions/purposes: (1) Does through-knee amputation result in improved gait velocity when compared with matched transfemoral amputees? (2) Do through-knee amputees have a faster gait cadence than matched transfemoral amputees? (3) Do through-knee amputees have a different stride length or stride width than matched transfemoral amputees? (4) Does through-knee amputation result in decreased work of ambulation when compared with matched transfemoral amputees?

Methods: Between January 2008 and December 2012, six male active-duty military patients who had undergone unilateral through-knee amputations as a result of trauma underwent gait studies at our institution. Read More

Clin Orthop Relat Res 2019 04;477(4):829-835

K. Spahn, Department of Orthopedics, Naval Medical Center San Diego, San Diego, CA, USA M. P. Wyatt, J. M. Stewart, C5 Gait Analysis Laboratory, Naval Medical Center San Diego, San Diego, CA, USA B. N. Mazzone, A. J. Yoder, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA; and Naval Medical Center San Diego, San Diego CA, USA K. M. Kuhn, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA.

Background: Surgical attempts at lower limb preservation after trauma may be complicated by pain and gait disturbances, which can impact the activity level of a military service member. It is unclear how later transtibial amputation (TTA) might affect patients who elect this option after attempts at limb preservation.

Questions/purposes: The purposes of the study were to compare preamputation and postamputation (1) the numeric rating scale for pain and pain medication use; (2) self-reported activity level, Four Square Step Test (FSST) results, and assistive device use; and (3) spatiotemporal variables measured with instrumented gait analysis in individuals who elected TTA after multiple attempts at limb preservation. Read More

Clin Orthop Relat Res 2019 04;477(4):838-847

M. Quacinella, E. Bernstein, K. M. Kuhn, Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA B. Mazzone, Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, San Diego, CA, USA M. Wyatt, Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA.

Background: Pilon fractures are high-energy fractures about the ankle observed commonly in both civilian and military trauma populations. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries. Read More

Disabil Rehabil Assist Technol 2020 04 27;15(3):350-356. Epub 2019 Feb 27.

Department of Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada.

Experimental study. Research is lacking on the Unity suspension system's effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF). Read More

J Prosthet Orthot 2019 Jan 9;31(1):2-8. Epub 2018 Nov 9.

PHILLIP M. STEVENS MEd, CPO, is affiliated with the Hanger Clinic, Salt Lake City, Utah.

Introduction: This guideline was developed to present the evidence and provide clinical recommendations on prosthetic knee selection for unilateral amputation at the knee disarticulation or transfemoral level.

Methods: The guideline is based upon the best available evidence as it relates to prosthetic knee selection after unilateral knee disarticulation or transfemoral amputation. Recommendations are drawn from systematic review, meta-analysis, and additional published practice guidelines. Read More

PLoS One 2018 28;13(12):e0209783. Epub 2018 Dec 28.

Clinic for Ruminants, Vetsuisse-Faculty, University of Berne, Berne, Switzerland.

Assessment of lameness in cattle after foot surgery is important to monitor the recovery period, to improve the long-term success and the cows` welfare. This longitudinal multicenter retrospective study was carried out to evaluate the usefulness of automated tools of weight bearing and gait analysis following foot surgery to support the clinician to monitor lameness in cattle. For this purpose, the effect of involvement of different anatomical structures and the use of different surgery methods on gait parameters of post-operative recovery was assessed. Read More

Gait Posture 2019 02 30;68:44-49. Epub 2018 Oct 30.

DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA. Electronic address:

Background: Long duration walking, a commonly recommended treatment option for knee osteoarthritis (OA), may lead to increased knee joint loading.

Research Question: To evaluate the effects of prolonged walking on dynamic knee joint stiffness and contralateral knee joint contact forces (KCFs) in individuals with unilateral symptomatic knee OA.

Methods: Twenty-six older adults with knee OA completed a 45-minute bout of walking on a treadmill. Read More

Prosthet Orthot Int 2019 Apr 16;43(2):180-187. Epub 2018 Aug 16.

2 International Prosthetics and Orthotics, Bohemia, NY, USA.

Background:: Wellness activities can benefit health, yet committed adherence is challenging.

Objectives:: Identify factors associated with committed participation in an amputee wellness-walking program and determine benefits of committed participation.

Study Design:: Prospective longitudinal cohort. Read More

Gait Posture 2018 06 16;63:260-267. Epub 2018 May 16.

Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomedical Signals and Systems, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.

Background: Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics. Read More

PM R 2018 Oct 5;10(10):1012-1019. Epub 2018 Apr 5.

Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada; School of Physical Therapy, University of Western Ontario, London, ON, Canada; Room 1588, Elborn College, 1201 Western Road, London, Ontario N6G 1H1, Canada.

Background: Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. Read More

J Neuroeng Rehabil 2018 01 27;15(1). Epub 2018 Jan 27.

Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.

Background: There are many studies that have investigated biomechanical differences among prosthetic feet, but not changes due to adaptation over time. There is a need for objective measures to quantify the process of adaptation for individuals with a transtibial amputation. Mechanical power and work profiles are a primary focus for modern energy-storage-and-return type prostheses, which strive to increase energy return from the prosthesis. Read More

J Foot Ankle Surg 2018 Jan - Feb;57(1):44-51

Research Head, Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy.

It has recently been suggested that first ray amputation in diabetic patients with serious foot complications can prolong bipedal ambulatory status, and reduce morbidity and mortality. However, no data are available on gait analysis and quality of life after this procedure. In the present case-control study (6 amputee and 6 nonamputee diabetics, 6 healthy non-diabetic), a sample of amputee diabetic patients were evaluated and compared with a sample of nonamputee diabetic patients and a group of age-matched healthy subjects. Read More

Disabil Rehabil Assist Technol 2018 May 3;13(4):388-393. Epub 2017 Oct 3.

a Centre of Movement Science, Faculty of Medicine , University of Iceland , Reykjavık , Iceland.

Following a transfemoral amputation (TFA), numerous changes in movement patterns during gait can occur. Frontal plane hip and pelvis compensatory strategies are recognized among individuals with a TFA, some thought to aid in safe foot clearance during the swing phase of gait. The aim of this case study was to evaluate the effect of an active ankle dorsiflexion provided by a microprocessor-controlled prosthetic foot, as well as the effect of individualized training on these parameters. Read More

Gait Posture 2017 10 25;58:103-107. Epub 2017 Jul 25.

University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620, USA; Extremity Trauma & Amputation Center of Excellence, US Department of Veterans Affairs, Tampa, FL, USA; US Army Reserves, 319th Minimal Care Detachment, Pinellas Park, FL, USA.

This study was a randomized crossover of stair ambulation of Transfemoral Amputees (TFAs) using the Genium and C-Leg prosthetic knees. TFAs typically have difficulty ascending and descending stairs, limiting community mobility. The objective of this study was to determine the relative efficacy of the Genium and C-Leg prostheses for stair ascent and descent, and their absolute efficacy relative to non-amputees. Read More

Gait Posture 2017 06 30;55:15-22. Epub 2017 Mar 30.

Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomedical Signals and Systems, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.

Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. Read More

Gait Posture 2017 05 21;54:167-173. Epub 2017 Feb 21.

Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, United States; Extremity Trauma and Amputation Center of Excellence, United States. Electronic address:

Background: Surgical advances have substantially improved outcomes for individuals sustaining traumatic lower extremity injury. Injuries once requiring lower limb amputation are now routinely managed with limb reconstruction surgery. However, comparisons of functional outcomes between the procedures are inconclusive. Read More

Prosthet Orthot Int 2017 Oct 9;41(5):446-454. Epub 2017 Jan 9.

2 University of North Georgia, Dahlonega, GA, USA.

Background: Many individuals with lower limb loss report concern with walking ability after completing structured traditional rehabilitation.

Objectives: The purpose of this study was to explore the impact of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation.

Study Design: Repeated measures. Read More

Technol Innov 2016 Sep;18(2-3):193-201

Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.

The hill assessment index (HAI) and stair assessment index (SAI) were developed to objectively evaluate ramp and stair gait. This study's purpose was to determine the validity and reliability of these tests in a sample of persons with unilateral transfemoral amputation (TFA) using microprocessor prosthetic knee systems. All subjects were fit with a microprocessor knee system. Read More

J Orthop Trauma 2016 Dec;30(12):e390-e395

*Department of Orthopaedic Surgery, Naval Hospital Oak Harbor, Oak Harbor, WA; †Gait Analysis Laboratory, Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA; ‡BADER Consortium, University of Delaware, Newark, DE; and §Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA.

Objectives: To determine if there is a difference in functional gait outcomes between patients with limb injuries treated with either transtibial amputation or limb preservation with the Intrepid Dynamic Exoskeletal Orthosis.

Design: Retrospective prognostic study.

Setting: Tertiary referral military hospital. Read More

Springerplus 2016 19;5(1):1819. Epub 2016 Oct 19.

Department of Statistics, Manipal University, Manipal, India.

Background: Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Therefore they are prone to develop frequent and often foot problems with a relative high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. Read More

J Vasc Surg 2017 09 29;66(3):891-901. Epub 2016 Sep 29.

Department of Surgery, Emory University School of Medicine, Atlanta, Ga; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, Ga. Electronic address:

Objective: Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Read More

PLoS One 2016 8;11(7):e0158980. Epub 2016 Jul 8.

Department of Biochemistry and Tissue Biology (DBBT)-Institute of Biology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.

Myotoxins present in Bothrops venom disrupt the sarcolemma of muscle fibers leading to the release of sarcoplasmic proteins and loss of muscle homeostasis. Myonecrosis and tissue anoxia induced by vascularization impairment can lead to amputation or motor functional deficit. The objective of this study was to investigate the dynamic behavior of motor function in mice subjected to injection of Bothrops jararacussu venom (Bjssu) and exposed to low-level laser therapy (LLLT). Read More

Clin Rehabil 2017 Jun 7;31(6):798-808. Epub 2016 Jul 7.

1 Roessingh Research and Development, Enschede, The Netherlands.

Objective: (1) To study the effects of providing ankle-foot orthoses in subjects with (sub)acute stroke; and (2) to study whether the point in time at which an ankle-foot orthosis is provided post-stroke (early or delayed) influences these effects.

Design: Randomized controlled trial.

Setting: Rehabilitation centre. Read More

Am J Phys Med Rehabil 2017 Feb;96(2):116-119

From the Departments of Orthopedic Surgery (BTS, MTH, TCS, FHS) and Physical Medicine and Rehabilitation (KLA, MT), Mayo Clinic, Rochester, Minnesota.

Background: The immediate postoperative prosthesis has been purported to allow early mobilization with potential physical and psychologic benefits to patients. This study used accelerometers and validated questionnaires to prospectively examine activity level and quality of life data for patients receiving an immediate postoperative prosthesis after transtibial amputation.

Methods: A total of 10 patients were included in the study. Read More

Clin Biomech (Bristol, Avon) 2016 08 10;37:13-21. Epub 2016 May 10.

Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712, USA. Electronic address:

Background: Passive-dynamic ankle-foot orthoses are commonly prescribed to augment impaired ankle muscle function, however their design and prescription are largely qualitative. One design includes a footplate and cuff, and flexible strut connecting the two. During gait, deflection occurs along the strut, with the greatest deflection at a central bending axis. Read More

J Orthop Surg Res 2016 Apr 28;11(1):54. Epub 2016 Apr 28.

Department of Orthopedic Oncology, Podkarpacie Oncology Centre, Specialist Hospital in Brzozów, Bielawskiego 18, 36-200, Brzozów, Polska.

Background: Metastatic lesions localized in the periacetabular area cause troublesome pain and reduced mobility of the patients. Radiotherapy effectively decreases pain, yet it does not restore the ability to load the joint. Surgical treatment involving resection of metastatic lesions and joint reconstruction using bone grafts is burdened with a high rate of complications. Read More

Clin Orthop Relat Res 2016 Apr 11;474(4):995-1004. Epub 2016 Jan 11.

Orthopaedic and Traumatologic Clinic for Musculoskeletal Tumors, Rizzoli Orthopedic Institute, Bologna, Italy.

Background: Rotationplasty may be indicated for some children with osteosarcoma in the distal femur or proximal tibia; in properly selected patients, it may offer functional advantages over transfemoral amputation and more durable results than a prosthesis. The clinical and functional outcomes reported for this procedure generally have been limited to studies with a mean followup of approximately 8 years in terms of Musculoskeletal Tumor Society Score (MSTS), physical examination, and gait analysis. However, the effects of residual thigh-shank length on gait have not been explored to our knowledge. Read More

Int Orthop 2016 Mar 10;40(3):561-7. Epub 2015 Nov 10.

Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.

Purpose: Limb-sparing resection of malignant pelvic tumours provides the opportunity for patients to obtain better post-operative mobility. However, because few studies have examined in detail the gait function of patients following pelvic tumour resection, the factors affecting gait performance remain to be clarified. Here, with the laboratory-based computer-assisted gait analysis, we evaluated these patients' gait objectively and the impact of a hip-stabilising supporter on gait improvement was simultaneously examined. Read More

Front Hum Neurosci 2015 19;9:276. Epub 2015 May 19.

Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University Adelaide, SA, Australia.

Reorganization of primary motor cortex (M1) is well-described in long-term lower limb amputees. In contrast cortical reorganization during the rehabilitation period after amputation is poorly understood. Thirteen transtibial amputees and 13 gender matched control participants of similar age were recruited. Read More

Orthopade 2015 Jun;44(6):419-25

Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.

Background And Objective: Rehabilitation of patients having undergone limb amputation is difficult due to problems related to poor socket fit, which often deteriorates comfort, gait and the ability to take part in everyday life and work. The endo-exo prosthesis has been an alternative provision for people having undergone lower limb amputation for reasons other than diabetes or peripheral vascular disease for more than 10 years. The system consists of an intramedullar, osseointegrated and skin perforating prosthesis, which is implanted in the remaining bone and has an abutment to allow the attachment of the external prosthetic part including the knee joint in the case of a trans-femoral amputation. Read More

J Biomech 2015 Apr 7;48(6):984-9. Epub 2015 Feb 7.

Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, United States. Electronic address:

The step-to-step transition of walking requires significant mechanical and metabolic energy to redirect the center of mass. Inter-limb mechanical asymmetries during the step-to-step transition may increase overall energy demands and require compensation during single-support. The purpose of this study was to compare individual limb mechanical gait asymmetries during the step-to-step transitions, single-support and over a complete stride between two groups of individuals following stroke stratified by gait speed (≥0. Read More

J Rehabil Res Dev 2014 ;51(8):1229-42

Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL;

People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC) that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. Read More

J Bone Joint Surg Am 2014 Oct;96(19):1641-7

117 Coronado Drive #1113, Denton, TX 76209.

Background: Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes.

Methods: Sixty-four patients (age range, 4. Read More

Arch Phys Med Rehabil 2015 Jan 4;96(1):154-7. Epub 2014 Aug 4.

Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD; Department of Defense and Veterans Affairs, Extremity Trauma and Amputation Center of Excellence, Bethesda, MD.

Objective: To analyze mediolateral joint powers at the low back during gait among persons with and without unilateral transfemoral amputation to better understand the functional contributions of tissues in and around the low back to altered lateral trunk movements in this population.

Design: Retrospective analysis of biomechanical gait data.

Setting: Gait laboratory. Read More

Am J Clin Oncol 2016 12;39(6):600-603

Departments of *Radiation Oncology ‡Orthopaedics,University of Florida College of Medicine, Gainesville †University of Florida Proton Therapy Institute, Jacksonville, FL.

Objective: To evaluate outcomes after conservative resection and radiotherapy (RT) for soft-tissue sarcoma (STS) of the distal extremity, with assessment of functional quality of life using the validated Toronto Extremity Salvage Score (TESS) questionnaire and Common Terminology Criteria for Adverse Events (CTCAE), v4.0.

Methods: Thirty-three patients with STS involving the hand/wrist (N=18) or foot/ankle (N=15) complex received adjuvant RT with conservative resection and were evaluated for local tumor control, survival, toxicities, and preservation of objective functional ability. Read More

IEEE Trans Biomed Eng 2014 Dec 1;61(12):2911-20. Epub 2014 Jul 1.

This paper presents a noncontact capacitive sensing system (C-Sens) for locomotion mode recognition of transtibial amputees. C-Sens detects changes in physical distance between the residual limb and the prosthesis. The sensing front ends are built into the prosthetic socket without contacting the skin. Read More

Vet J 2014 Sep 13;201(3):307-15. Epub 2014 May 13.

Friedrich-Schiller-University, Institute of Systematic Zoology and Evolutionary Biology, Jena, Germany. Electronic address:

To gain insight into the adaptive mechanisms to tripedal locomotion and increase understanding of the biomechanical consequences of limb amputation, this study investigated kinetic and temporal gait parameters in dogs before and after the loss of a hindlimb was simulated. Nine clinically sound Beagle dogs trotted on an instrumented treadmill and the ground reaction forces as well as the footfall patterns were compared between quadrupedal and tripedal locomotion. Stride and stance durations decreased significantly in all limbs when the dogs ambulated tripedally, while relative stance duration increased. Read More