Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle–foot mechanisms

AbstractBackgroundWalking down slopes and/or over uneven terrain is problematic for unilateral trans-tibial amputees. Accordingly, ‘ankle’ devices have been added to some dynamic-response feet. This study determined whether use of a microprocessor controlled passive-articulating hydraulic ankle–foot device improved the gait biomechanics of ramp descent in comparison to conventional ankle–foot mechanisms.MethodsNine active unilateral trans-tibial amputees repeatedly walked down a 5° ramp, using a hydraulic ankle–foot with microprocessor active or inactive or using a comparable foot with rubber ball-joint (elastic) ‘ankle’ device. When inactive the hydraulic unit's resistances were those deemed to be optimum for level-ground walking, and when active, the plantar- and dorsi-flexion resistances switched to a ramp-descent mode. Residual limb kinematics, joints moments/powers and prosthetic foot power absorption/return were compared across ankle types using ANOVA.FindingsFoot-flat was attained fastest with the elastic foot and second fastest with the active hydraulic foot (P<0.001). Prosthetic shank single-support mean rotation velocity (p =0.006), and the flexion (P<0.001) and negative work done at the residual knee (P=0.08) were reduced, and negative work done by the ankle–foot increased (P