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

- Walking down/descending slopes is problematic for unilateral trans-tibial amputees.
- We compare ramp descent using microprocessor-controlled foot with conventional feet.
- Negative 'ankle' work during descent increased using microprocessor-controlled foot.
- Residual-knee flexion and negative work decreased with microprocessor-controlled foot.
- Use of a microprocessor-controlled foot should make descending slopes less problematic.

BackgroundWalking 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 < 0.001) when using the active hydraulic compared to the other two ankle types.InterpretationThe greater negative 'ankle' work done when using the active hydraulic compared to other two ankle types, explains why there was a corresponding reduction in flexion and negative work at the residual knee. These findings suggest that use of a microprocessor controlled hydraulic foot will reduce the biomechanical compensations used to walk down slopes.