Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

Pilot Study: Application of Roll-over Shape toward Evaluation and Design of Partial Foot Prostheses

Trans-metatarsal level, partial foot amputation

Principal Investigators: Dudley S. Childress, PhD and Steven A. Gard, PhD

Project Director: Andrew H. Hansen, PhD

Co-Investigators: Stefania Fatone, PhD, BPO(Hons); Rebecca L. Stine, MS; and Kerice A. Tucker, BS,
Northwestern University
Robert D. Lipschutz, CP, Rehabilitation Institute of Chicago
Michael Dillon, PhD, La Trobe University, Australia
Scheck and Siress Prosthetics, Orthotics and Pedorthics

Student Investigator: Pinata H. Sessoms, MS

Funded by: National Institute on Disability and Rehabilitation Research (NIDRR)

Status: Completed

Purpose

Partial Foot Types
Different types of partial footamputations: a) Lisfranc, b) transmetatarsal, and c) meta-tarsalphalangeal.

A partial foot (PF) amputation, in theory, should be superior to a transtibial or Symes amputation because the physiologic ankle joint is preserved. Persons with PF amputations should generally be able to walk without their prosthesis, if only to walk to and from the toilet during the night. The remaining ankle and subtalar joints in cases of toe and transmetatarsal amputations (TMAs), should allow these persons to more readily adapt to different terrains compared to more proximal amputations (e.g. Lisfranc and Chopart), where the ankle and subtalar joints are lost or compromised. The decision to mechanically limit ankle joint motion may be based on many factors including the need to reduce forces acting on the distal end of the residuum, inability to transfer the remaining ankle motion to the device in a short PF amputation, or to insure suspension of the device. In cases of short PF amputations such as Chopart, the ankle joint may be surgically fused to provide stability for the remaining foot bones. While in theory a PF amputation should be more advantageous than a transtibial amputation, the walking performance on level ground of persons with PF prostheses is often reduced in comparison with the performance of persons using transtibial prostheses. This is due in part to problems with the tolerance of the residual foot to weight-bearing forces and difficulties with the fitting and performance of P&O devices. We believe that roll-over shape principles, which we have established from our examination of non-disabled walking, can be used to enhance the understanding of a range of currently utilized PF prostheses-orthoses. We also believe that roll-over shape can be used to design highly functional devices for persons with PF loss.

Related Presentations and Publications

Dillon MP, Fatone S, Hansen AH. Effect of prosthetic design on center of pressure excursion in partial foot prostheses. J Rehabil Res Dev. 2011;48(2):161-78. Epub 2011/04/12.

Dillon M, Fatone S, Hansen A, editors. Effect of prosthetic design on centre of pressure excursion in partial foot prostheses. Annual Scientific Meeting of the International Society for Prosthetics and Orthotics, Australian National Member Society; 2011 November 3-5; Dockside, Cockle Bay Wharf, Sydney, Australia.

Dillon, M., Hansen, A. and Fatone, S. (2008). Influence of marker models on ankle kinematics in persons with partial foot amputation: an investigation using a mechanical model. Journal of Rehabilitation Research & Development, 45(4): 567-576.

Dillon, M., Hansen, A. and Fatone, S. (2008). Influence of marker models on ankle kinematics in persons with partial foot amputation: an investigation using a mechanical model. Journal of Rehabilitation Research & Development, 45(4): 567-576.

Hansen A.H., Dillon, M.P. and Fatone, S. (2008) Model Simulations of Partial Foot Amputation Gait While Wearing Shoes or Below-Ankle Devices with Respect to Marker Placement and Increased Dorsiflexion. Capabilities, 16(2):1-4. Northwestern University, Chicago, IL.

Fatone, S. (2007). Studies of the Biomechanics of Gait of Persons with Partial Foot Amputation. Capabilities, 15(4):3-4. Northwestern University, Chicago, IL.

Hansen, A., Dillon, M. and Fatone, S. (2008). Source of Increased Dorsiflexion During Gait of Persons with Partial Foot Amputations when Shod or in 'Below-Ankle' Devices. Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists, February 27 - March 1, Orlando, FL.

Sessoms, P., Fatone, S. and Hansen, A. (2008). Case Study: Gait Analyses of Persons with Partial Foot Amputation Walking Barefoot and With Dorsiflexion Stop Ankle Foot Orthoses. Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists, February 27 - March 1, Orlando, FL.

Fatone, S. (2008). Biomechanics of Ambulation after Partial Foot Amputation: A Systematic Literature Review. Invited Speaker in: Hafner B and Fatone S. Evidence Reports: Findings from the SSC on Biomechanics of Ambulation after Partial Foot Amputation (Instructional Course). Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists, February 27 - March 1, Orlando, FL.

Dillon, M., Fatone, S., Hodge, M. (2007). Biomechanics of Ambulation after Partial Foot Amputation: Systematic Review. In: Symposium―Management of the Partial Foot Amputee. Invited Speaker, 12th World Congress of the International Society for Prosthetics and Orthotics, July 29 to August 30, Vancouver, BC, Canada.

Dillon, M., Fatone, S., and Hodge, MC. (2007). Biomechanics of Ambulation after Partial Foot Amputation. Journal of Prosthetics and Orthotics, 19:(8 Proceedings):P2-P61.