The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees

Background: Achieving independent upright posture has known to be one of the main goals in rehabilitation following lower limb amputation. The purpose of this study was to compare postural steadiness of below knee amputees with visual alterations while wearing three different prosthetic feet. Methods: Ten male below-knee amputees were instructed to stand quietly on the Biodex((R)) balance platform while wearing solid ankle cushion heel (SACH), single axis ( SA) and energy storage and release (ESAR) prosthetic foot under different visual input conditions ( eyes-opened and eyes-closed). The overall stability index (OSI), anterior-posterior stability index (APSI), and medial-lateral stability index (MLSI) were computed. Perceived balance assessment of each foot was evaluated using Activities-specific Balance Confidence (ABC) score. Results: The findings highlights that SACH showed lowest overall stability index ( indicating less body sway) during eyes-opened ( OSI: SACH = 1.09, SA = 1.58, ESAR = 1.59) and SA showed lowest overall stability index during eyes-closed ( OSI: SACH = 2.52, SA = 2.30, ESAR = 2.76) condition. However, overall stability indexes between foot types did not differ significantly during eyes-opened or eyes-closed ( p = 0.651). There was a trend of instability which occurred more in medial-lateral compared to anterior-posterior direction for all foot types, with significant result in ESAR foot ( eyes-opened: MLSI = 1.59, APSI = 0.65, p = 0.034; eyes closed: MLSI = 2.76, APSI = 1.80, p = 0.017, respectively). When comparing between visual conditions, stability score was significantly higher during eyes-closed compared to eyes-opened situations for SACH and ESAR foot ( eyes-closed vs opened; SACH OSI: 3.43 vs 1.71, p = 0.018 and MLSI: 3.43 vs 1.71, p = 0.018; ESAR OSI: 3.58 vs 1.86, p = 0.043 and APSI: 1.80 vs 0.65, p = 0.027). Conclusions: The results of this study suggested postural steadiness in below-knee amputees was not affected by the types of prosthetic foot during quiet upright standing, but was significantly affected when visual cues was absent.