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J Reconstr Microsurg 2021 Mar 31. Epub 2021 Mar 31.

Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.

Background:  Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. Read More

Arthroplast Today 2021 Apr 26;8:46-52. Epub 2021 Feb 26.

Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Background: Extensor mechanism disruption (EMD) combined with periprosthetic joint infection (PJI) after total knee arthroplasty are life-changing complications. The literature suggests many eventually receive above-knee amputation and lose ambulatory function. An alternative is modular knee fusion (KF), but little is known about its outcomes and biomechanical function. Read More

Gait Posture 2021 Feb 19. Epub 2021 Feb 19.

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

Background: Trunk postural control (TPC) is critical in maintaining balance following perturbations (i.e., avoiding falls), and impaired among persons with lower extremity trauma, contributing to elevated fall risk. Read More

J Neuroeng Rehabil 2021 01 19;18(1). Epub 2021 Jan 19.

Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355, Wroclaw, Poland.

Background: Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). Read More

J Long Term Eff Med Implants 2020 ;30(4):267-273

P.N. Soukakos Orthopaedic Research and Education Center, Sylvia Ioannou Biomechanics and Gait Analysis Laboratory, Attikon University Hospital, First Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Open calcaneal fractures with extensive bone loss and severe soft tissues injuries are very rare. There is no treatment protocol for these severe injuries. The incidence of infection, osteomyelitis, and amputation is high compared to closed calcaneal fractures. Read More

J Neuroeng Rehabil 2020 10 8;17(1):134. Epub 2020 Oct 8.

Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, (898) P.O. Box 9101, NL-6500 HB, Nijmegen, The Netherlands.

Background: After transfemoral amputation, many hours of practice are needed to re-learn walking with a prosthesis. The long adaptation process that consolidates a novel gait pattern seems to depend on cerebellar function for reinforcement of specific gait modifications, but the precise, step-by-step gait modifications (e.g. Read More

Clin Biomech (Bristol, Avon) 2020 12 7;80:105102. Epub 2020 Jul 7.

University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America. Electronic address:

Background: Movement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown.

Methods: Kinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Read More

Clin Biomech (Bristol, Avon) 2020 12 31;80:105141. Epub 2020 Jul 31.

Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA. Electronic address:

Background: Prosthetic feet are available in a range of stiffness categories, however, there is limited evidence to guide optimal selection during prosthetic foot prescription. The aim of this study was to determine the effect of commercial prosthetic foot stiffness category on foot-ankle biomechanics, gait symmetry, community ambulation, and relative foot stiffness perception.

Methods: Participants were fit in randomized order with three consecutive stiffness categories of a commonly-prescribed prosthetic foot. Read More

Am J Phys Med Rehabil 2020 11;99(11):1067-1071

From the Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada (GC, HO, EM, CF, SWH); Department of Physical Medicine & Rehabilitation, Parkwood Institute, London, Ontario, Canada (RV, MWP); Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada (RV, MWP, SWH); and School of Physical Therapy, University of Western Ontario, London, Ontario, Canada (SWH).

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Read More

Gait Posture 2020 07 31;80:162-167. Epub 2020 May 31.

Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States. Electronic address:

Background: Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. Read More

Ann Phys Rehabil Med 2021 Jan 26;64(1):101395. Epub 2020 Aug 26.

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

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;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 2020 May 11;51 Suppl 2:S90-S96. 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

Mil Med 2019 12;184(11-12):e907-e913

Leidos, San Diego, CA, USA.

Introduction: Military service members with limb loss have unrestricted access to physical therapy (PT) services. Identifying PT interventions used based on clinical rationale and patient needs/goals can provide insight towards developing best practice guidelines. The purpose of this study was to identify preferred PT practice patterns for military service members with lower limb loss. 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