Ground reaction forces sensitive to small gait changes in patients with poor fitting prostheses

BROOMFIELD, Colo. — Pediatric patients with an inappropriate fitting prosthesis demonstrated an increased sensitivity of ground forces to small changes in gait, according to study results presented at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting, here.

“The purpose of this study was … to assess ground reaction forces and temporal-spatial parameters to differentiate between an inappropriate fitting and an appropriate fitting prosthesis for children with unilateral below knee amputations,” Hank White, PT, PhD, of Shriners Hospital for Children in Lexington, Ky., said.

Hank White

Hank White


White and colleagues studied 31 patients between ages 4 years and 20 years with unilateral amputation who were able to walk independently without an assistive device while wearing a prosthesis. White said the goal of prosthetic gait is a symmetrical gait pattern, but inappropriate fit of a prosthesis leads to an asymmetrical gait, pain and decreased efficiency.

All patients wore the same type of walking shoe. The researchers used a Motion Analysis Corporation data collection system to collect motion and kinetic data.

Results showed patients with inappropriate fitting prostheses had delayed timing of propulsion force during late stance on the involved side and delayed timing of peak medial force on the uninvolved side during weight acceptance.

“After being evaluated, 18 [participants] were found to have an incorrect fitting prosthesis,” White said. “There were no significant differences between correct and incorrect fitting prostheses in temporal-spatial data. However, there was a trend that for the incorrect fitting prosthesis, the involved side had a longer step length.”

The researchers also separately studied the patients who used patellar tendon weight bearing prostheses and found significant differences in stride length and in the amount of time spent in the stance phase between patients wearing correct fitting and incorrect fitting prostheses.

“We did find differences for all of our patients based on the ground reaction forces. However, the temporal-spatial factors did not hold up for the subjects with end-bearing prostheses,” White said.

He added prosthetists with resources should consider documenting information on stance and swing phases for all patients to ensure patients’ prostheses fit correctly and record progression of gait over time.

“We would like to look at changes over time for this population,” White said. – by Amanda Alexander 


White H, et al. Comparison of ground reaction forces between correct fitting and incorrect fitting prosthesis for children with unilateral below knee amputations. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; April 13, 16, 2016; Broomfield, Colo.

Disclosure: White reports no relevant financial disclosures.

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