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Abstract-Lower-limb amputees have identified comfort and mobility as the two most important characteristics of a prosthesis. While these in turn depend on a multitude of factors, they are strongly influenced by the biomechanical performance of the prosthesis and the loading it imparts to the residual limb. Recent years have seen improvements in several prosthetic components that are designed to improve patient comfort and mobility. In this paper, we discuss two of these: VSAP and prosthetic foot-ankle systems; specifically, their mechanical properties and impact on amputee gait are presented.
Key words: amputation, artificial limbs, biomechanics, pain, rehabilitation, residual limbs.
INTRODUCTION
The primary goal of rehabilitation of the individual who has undergone lower-limb amputation is the optimum restoration of function. Although many aspects of the rehabilitation plan-beginning with the surgical care, physical therapy, occupational therapy, and psychological support-can influence the rehabilitation outcome, one of the most important determinants is the quality of the prosthetic restoration. This depends primarily upon the fit of the prosthetic socket and the choice of prosthetic components. The physician and prosthetist who formulate a prosthetic prescription must integrate marketing and scientific data to make important, cost-effective decisions. Unfortunately, the marketing strategy of most prosthetic manufacturers is to persuade providers and patients to choose the most expensive components, and the scientific evaluation of these components is frequently quite limited. As we formulate a prosthetic prescription, we must be simultaneously aware of the prosthetic characteristics that are most important to the amputee and of the characteristics that will most strongly influence their functional status.
Patient comfort is one of the most important factors that influence the functional status a patient ultimately achieves. In a survey of veterans and nonveterans with lower-limb amputations, Legro et al. (1) found that the fit and comfort of the prosthesis, and the avoidance of blisters or sores on the residual limb, were the most important functional characteristics of the prosthesis. Similarly.,
Postema et al. (2) found that amputees rate "absence of stump pain" and "no fatigue during walking" as the most important subjective aspects of a prosthesis. Although its negative impact on function is widely appreciated, residual-limb pain continues to be a pervasive problem for the amputee. In a survey of 255 amputees, Ehde et al. (3) found that...