Une orthèse crurosurale prolongée d’une coque talonnière ou une orthèse cruropédieuse permettent de mettre en décharge un compartiment fémorotibial arthrosique. Pour garantir l’efficacité de l’appareillage, il faut réunir plusieurs conditions: un certain degré de mobilité frontale, un moulage en contrainte, une orthèse rigide dans le plan frontal, des appuis bien placés et confortables.

Quand le sacrifice du genou s’impose chez des patients jeunes ayant subi une amputation transtibiale (TT) d’origine traumatique, les objectifs de performances fonctionnelles doivent guider le choix du niveau et de la technique d’amputation. Les résultats et le type d’appareillage diffèrent selon que sont réalisées une désarticulation tibiofémorale, une intervention de Gritti ou une amputation de cuisse proprement dite. Après rappel des avantages et inconvénients de ces techniques, cinq cas cliniques sont présentés.

Unloading of an arthritic tibiofemoral compart- ment of the knee joint may be effected by a knee brace exten- ded by a heel cup, or by a long leg brace terminating beyond the ankle joint. Several conditions must be satisfied to ensure effectiveness of the appliance. These include a certain degree of anterior mobility, moulding of the brace with the joint under stress, rigidity of the brace in the anterior aspect and well-placed and comfortable supports.

This paper reports on a functional evaluation of prosthetic feet based on gait analysis. The aim is to analyse prosthetic feet behaviour under loads applied during gait in order to quantify user benefits for each foot. Ten traumatic amputees (six trans-tibial and four trans-femoral) were tested using their own prosthetic foot. An original protocol is presented to calculate the forefoot kinematics together with the overall body kinematics and ground reaction forces during gait. In this work, sagittal motion of the prosthetic ankle and the forefoot, time-distance parameters and ground reaction forces were examined. It is shown that an analysis of not only trans-tibial but also trans-femoral amputees provides an insight in the performance of prosthetic feet. Symmetry and prosthetic propulsive force were proved to be mainly dependant on amputation level. In contrast, the flexion of the prosthetic forefoot and several time-distance parameters are highly influenced by foot design. Correlations show influential of foot and ankle kinematics on other parameters. These results suggest that prosthetic foot efficiency depends simultaneously on foot design and gait style. The evaluation, proposed in this article, associated to clinical examination should help to achieve the best prosthetic foot match to a patient.