New standard of functional requirements for prosthetic foot for patients with osseointegration: need for development and prospects for practical application

Authors:

Prof. Pitkin, M.R. Dr. Tech. Sci. Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail: mpitkin@tuftsmedicalcenter.org

Annotation:

Introduction. Osseointegrated implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved: early loosening, mechanical failure of percutaneous and medullar parts of implant, periprosthetic issues, and infections. Unit now, there are no objective criterion for prescribing prosthetic feet, which could prevent the overloading of the abutment.

Aim. To evaluate an index of anthropomorphicity of the feet design being introduced for a traditional socket attachment of leg prostheses in a gait analysis study in amputees with osseointegration and normal subjects as a control.

Materials and methods. We discuss a gait study being conducted in Australia and USA in three amputees wearing their own prostheses: RUSH foot (RUSH), Trias-1C30 (Otto Bock), и Triton-Vertical shock 1C6 (Otto Bock) with initially unknown index of anthropomorphicity and the Free-Flow Foot (Ohio Willow Wood), which positive index was been measured in the prior studies. Further, we compare these indices with those obtained in the early gait analysis study with normal subjects.

Results. It was found that the least bending moment applied to the abutment was generated by the prosthetic foot with greatest index of anthropomorphicity.

Discussion. The consequences of severe trauma, vascular disease, diabetes, or malignancy make the stump skin more vulnerable to destruction, inflammation, infection, and other malignancies [K. E. Buikema et al., 2014], which leads to a reduction in the time of using the prosthesis, reducing the walking distance [H. E. Meulenbelt et al., 2011] and in General, the deterioration of the quality of life. Progress towards solving the problem of skin complications in the traditional attachment of the prosthesis to the sleeve is the development of new designs of sleeves and unloading covers [E. Kos, 2008; T. Pohjolainen et al., 1999]. The remaining high level of skin complications indicates that these efforts are insufficient. New approaches are needed to improve the functionality and safety of prosthetics. One of them, which consists in quantifying the anthropomorphism of prosthetic feet, was presented in this article.

Conclusion. We suggest to use the index of anthropomorphicity in the development of a new standard of functionality regulating design of prosthetic feet prescribed for amputees with osseointegration.

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