Low-cost prosthetic feet for underserved populations: A comparison of gait analysis and mechanical stiffness.

ABSTRACT

BACKGROUND: Lower-limb loss is an ongoing cause of disability throughout the world. Despite advancements in prosthetic technologies, there are numerous underserved populations in need of effective low-cost prosthetic foot options. OBJECTIVE: To evaluate the biomechanical performance of several low-cost prosthetic feet, using a combination of instrumented gait analysis and mechanical stiffness testing. STUDY DESIGN: Randomized crossover with additional case study. METHODS: We compared the solid-ankle-cushioned-heel (SACH), Jaipur, and Niagara feet with carbon fiber feet. Mechanical stiffness was evaluated using a cantilever-style bending test at 2 angles that was designed to mimic late stance gait loading. Eight below-knee amputees participated in the gait analysis, which focused on foot and ankle motion and energetics. RESULTS: Metric analysis showed significant differences among feet in ankle motion and power as well as distal-to-shank power, with SACH showing reduced ankle motion and positive work compared with the other feet. Waveform analysis additionally revealed a compensatory knee flexion moment in SACH and a knee extension moment in Niagara and Jaipur during midstance. In mechanical stiffness testing, SACH had the highest stiffness, with Niagara and carbon fiber roughly similar, and Jaipur the most compliant with the greatest hysteresis. CONCLUSIONS: There may be an optimal stiffness range for future prosthesis designs that maximizes propulsive energy. This may be achieved by combining some characteristics of Jaipur and Niagara feet in new designs. Ultimately, optimizing stiffness and energetics for gait biomimicry while maintaining cost, availability, and versatility across cultures will alleviate the effects of limb loss among underserved populations.