Article

Individuals with transtibial amputation are at increase risk of
falling. The absence of an ankle joint and the associated musculature in these
individuals can reduce clearance between the prosthetic foot and ground during
the swing phase of gait, which may increase the risk of stumbling and in turn
falling. OBJECTIVES: To associate minimum toe clearance during gait in the
laboratory with community-based, trip-related stumbles by individuals with
transtibial amputation using conventional feet. STUDY DESIGN: Prospective cohort
design; following quantitative gait analysis, participants completed electronic
surveys to prospectively report stumbles and falls for 1 year thereafter.
METHODS: General community with gait analysis conducted within a motion analysis
laboratory and prospective tracking of stumbles occurring in the community. A
volunteer sample of eight unilateral, transtibial amputees that were K3 or K4
level ambulators and current patients at a local prosthetic clinic. All
participants completed the entire 1-year follow-up study. Prosthetic-side minimum
toe clearance while walking on a level treadmill at self-selected speed and
self-reported trip-related stumbles in the community. Minimum toe clearance was
defined as a local minimum of the vertical displacement of the toe from toe-off
to heelstrike relative to its position during midstance. RESULTS: Prosthetic-side
minimum toe clearance was more than 50% lower for participants who reported one
or more trip-related stumbles on that side compared with participants who
reported zero trip-related stumbles on the prosthetic side (minimum toe clearance
= 12.3 +/- 0.8 mm vs 25.6 +/- 5.4 mm, respectively; p = 0.036). CONCLUSION: This
is the first study relating laboratory-based measures to prospective stumbles by
prosthesis users. The results suggest that prosthesis users with low minimum toe
clearance may be at increased risk of experiencing a trip-related stumble in the
community. Given that frequent stumbling increases the risk of falling, future
work is warranted on the effectiveness of interventions focused on minimum toe
clearance on reducing fall risk. Clinical relevance Interventions to increase
minimum toes clearance, which could include prescription of active dorsiflexing
prostheses or gait training, may help reduce the risk of trip-related falls for
individuals who report a history of trip-related stumbles.

Langue : ANGLAIS