Plantar pressures and ground reaction forces during walking of individuals with unilateral transfemoral amputation

摘要

Objective: To describe and compare the plantar pressures, temporal foot roll-over, and ground reaction forces (GRFs) between both limbs of subjects with unilateral transfemoral amputation and with those of able-bodied participants during walking. We also verify the relevance of a force plate and a pressure plate to discriminate changes in gait parameters of subjects with limb loss. Design: Cross-sectional study. Setting: Biomechanics laboratory. Subjects: A total of 14 subjects with unilateral transfemoral amputation and 21 able-bodied participants. Methods: We used a force plate and a pressure plate to assess biomechanical gait parameters while the participants were walking at their self-selected gait speed. Main Outcome Measurements: We measured plantar pressure peaks in 6 foot regions and the instant of their occurrence (temporal foot roll-over); and GRF peaks and impulses of anterior-posterior (braking and propulsive phases), medial-lateral, and vertical (load acceptance and thrust phases) components. Results: The thrust, braking, and propulsive peaks, and the braking and propulsive impulses, were statistically significantly lower in the amputated limb than in the sound limb (P< .05) and in able-bodied participants (P< .05). In the amputated limb, we observed higher pressure peaks in the lateral rearfoot and medial and lateral midfoot, and lower values in the forefoot regions compared to those in the other groups (P< .05). The temporal foot roll-over showed statistically significant differences among the groups (P<.05). Conclusions: The plantar pressures, temporal foot roll-over, and GRFs in subjects with unilateral transfemoral amputation showed an asymmetric gait pattern, and different values were observed in both of their lower limbs as compared with those of able-bodied subjects during walking. The force plate and pressure plate were able to determine differences between participants in gait pattern, suggesting that both plantar pressure and GRF analyses are useful tools for gait assessment in individuals with unilateral transfemoral amputation. Because of the convenience of pressure plates, their use in the clinical context for prosthetic management appears relevant to guide the rehabilitation of subjects with lower limb amputation.