Overloading of the intact foot as an indicator of the need for orthopedic support for patients after amputation of the lower limb


Ludmila M Smirnova, Grand PhD in Engineering sciences, leading researcher of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, Bestuzhevskaya Street, 50, 195067, Saint Petersburg, Russian Federation; Professor of Department of Biomedical Engineering, Saint Petersburg Electrotechnical University, Professora Popova Street, 5, 197376, Saint Petersburg, Russian Federation; e-mail: info@diaserv.ru; https://orcid.org/0000-0003-4373-9342.

In the heading: Original researches

Year: 2022 Volume: 4 Journal number: 4 

Pages: 34-43

Article type: scientific and practical

UDC: 615.1/.4; 617

DOI: 10.26211/2658-4522-2022-4-4-34-43


Introduction. Intact limb compensates for violations of the statodynamic function of the prosthetic limb and can experience significant overloads at walking with prosthetics what increases the risk of limb joint diseases and foot deformities. However, in prosthetics, proper attention is not paid to the need to reduce such overloads.
Aim. Attracting the attention of specialists to the need for orthopedic support for patients after unilateral amputation of the lower limb to reduce the risk of overload and prevent anatomical and functional disorders of the intact limb is the purpose of this work.
Materials and methods. A sample from the database with the results of biomechanical instrumental examinations and clinical examination of disabled people with different levels of amputation and the control group was studied to identify indicators of overload of the intact limb in patients after unilateral amputation of the lower limb. Biomechanical studies were performed using a hardware and software complex with matrix pressure sensors in the form of insoles. The relationship between the amputation level of the limb and the biomechanics of walking (bilateral asymmetry of walking parameters — duration of rolling through the feet, maximum load on the feet in the step cycle, conditional work of rolling through the feet, conditional rolling power through the feet; frontal and sagittal displacement of the center of pressure in the feet support contour) has been investigated.
Results. A direct relationship between the level of amputation and the degree of the intact foot overloading when walking on a prosthesis has been confirmed. The bilateral asymmetry of the duration of rolling through the foot and the bilateral asymmetry of the conditional work of rolling through over the foot turned out to be the most sensitive biomechanical indicators for detecting overloading of the intact foot. Hyperpression in the toe or lateral edge of the plantar surface due to pathological walking stereotypes caused by prosthetic errors is also a sign of overloading of the intact foot.
Discussion. The study confirmed the hypothesis of the intact limb overloading when patients walk on a prosthesis. The use of a certified instrument for obtaining initial biomechanical data, data processing using statistical methods adequate to the research task and high statistical significance are the basis for the reliability of the results obtained. Given that the level of limb amputation has an inverse relationship with the potential motor activity of amputees, but a direct relationship with the overload performance of the intact foot, orthopedic support to reduce these overloads is equally important at any level of amputation.
Conclusion. To detect overloading of the intact limb while walking on a prosthesis, it is reasonable to use coefficients of bilateral asymmetry of the duration of rolling through the feet and the conditional work of rolling through the feet. A decrease in these coefficients as compared to one due to an increase in the intact foot parameter (as compared to the artificial foot) corresponds to a more pronounced overload. Reducing the risk of overloading the intact limb is achieved by using an orthopedic insole, the timely and competent prescription of which requires continuity in the work of the prosthetic and orthopedic technicians.

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