Background: Energy storage and return (ESR) prosthetic feet are the standard of care for individuals with Medicare Functional Classification Level K3 or K4, particularly in developed healthcare systems. While conventional ESR feet with J- or C-shaped carbon blades offer effective energy return, they often require high build heights and offer limited adjustability, which may restrict their use in specific patient populations. Objective: The aim of the study was to evaluate the biomechanical and functional performance of a novel low-profile ESR prosthetic foot, featuring a unique load transmission system and adjustable heel components, in comparison to participants' established ESR feet (everyday foot, EF). Study Design: Different prosthetic feet were evaluated using a cross-sectional study design based on biomechanical tests and patient-reported evaluations. Methods: Twelve experienced prosthesis users (6 transtibial [TTA], 6 transfemoral [TFA], K3-K4) completed a minimum 9-week accommodation period using the study foot (SF). Comparative assessments included instrumented gait analysis, Six-Minute Walk Test (6MWT), and patient-reported outcomes (PLUS-M, ABC scale, foot preference rating). Kinetic and kinematic data were collected via motion capture and force plates. Differences between SF and EF were analyzed using paired t tests and Wilcoxon signed-rank tests (alpha = 0.05). Results: Biomechanical results revealed significantly greater anterior-posterior ground reaction force peaks (TFA: +14%, P = 0.028; TTA: +13%, P = 0.046), increased ankle power (All: +21%, P = 0.010) and ankle ROM (all: +14%, P < 0.001). Heel compression increased by 24% (P = 0.030), indicating enhanced shock absorption. No differences were found in contralateral knee loading. The average 6MWT distance increased by 6% (P = 0.004). ABC scale and PLUS-M scores revealed no clinically relevant differences. Nine participants (75%, P = 0.021) preferred the SF over their EF. Conclusions: The SF demonstrated comparable or superior performance in key biomechanical and functional outcomes. It offers a valuable option for users requiring low build height, increased shock absorption, or terrain adaptability. Clinical Relevance Statement: This study highlights the potential of a novel ESR foot design to enhance gait dynamics, comfort, and user satisfaction, especially for transfemoral amputees and individuals with limited clearance needs.

Background Accurate motion analysis of prosthetic knee joints is essential for optimizing component design, improving gait restoration, and evaluating clinical performance. Sagittal knee angles and moments are key biomechanical parameters for assessing joint function. This study determined these parameters using various gait models and validated the results against sensor data from the prosthetic knee, supporting more reliable gait analysis and potential improvements in patient outcomes. Methods Nineteen above-knee amputees walked at three self-selected speeds while gait was analyzed using optoelectronic cameras and force plates. Sagittal prosthetic knee moment and angle were calculated with four different models: Plug-in Gait, adapted Clinical Cleveland, 2D-model and a new 3D-model developed for analysis of transfemoral amputees. Simultaneously, prosthetic knee sensor angle and moment data were recorded. Findings The mean sagittal knee angle and moment waveforms from all models closely match the sensor data, reflected by low root mean square errors, with the new developed model showing the smallest values. The most precise (most often lowest reproducibility coefficient) sagittal knee angle and moment is shown with the new model. For the sagittal knee angle the highest accuracy (most often lowest mean deviation) is also determined with this model. For the knee moment, the new model, the 2D-model and Plug-in Gait equally frequently show the smallest mean deviation. Interpretation Relevant parameters of prosthetic knee joints can be determined using gait analysis, but not all models have the level of accuracy and precision required for evaluating prosthetic knee joints. The new model shows the most reliable data.

Introduction Weakness of plantarflexor and dorsiflexor muscles is a complex individual condition and can result in pathological gait, such as crouch gait or knee hyperextension. Affected patients can be supported with ankle-foot orthoses (AFOs) to improve gait and safety. Objective This study aims to compare three orthotic ankle joint designs in AFOs for patients with muscle weakness in the plantarflexors and/or dorsiflexors: a conventional hinged ankle joint with rigid stops (CAJ), a jointless orthosis (JLO), and a reactive-dynamic ankle joint with adjustable spring modules (RDA). Study Design Seven patients with plantarflexor and/or dorsiflexor muscle weakness tested three orthosis configurations in randomized order during a single session. Methods Biomechanical gait analysis was performed during standing and walking on level ground and up and down 10 degrees slopes. The main outcomes were ground reaction forces, joint angles, moments, and power at the ankle, knee, and hip joints. Mean values of outcome measures for patients and values of an able-bodied control group were compared with nonparametric analyses of variance and pairwise post hoc tests. Results Throughout all motion tasks, statistically significant differences (P < 0.05) were predominantly found in ankle and knee joint kinematics between RDA and CAJ, as well as between JLO and CAJ, whereas only few differences were found between RDA and JLO. Conclusions For this patient group, RDA enabled the most physiological gait, with outcomes measure values closest to those of the able-bodied control group, and the best perception of support for an active lifestyle and physically demanding activities. In less physically demanding situations, such as short walking distances and even surfaces, JLO also showed sufficient support for physiological gait and may be an adequate orthosis for patients living with supportive infrastructure or a more sedentary lifestyle. CAJ restricted physiological movements, showed the highest deviations from the values of the able-bodied controls in most activities, and provides the least comfort for patients in the tested situations.

BACKGROUND:Prosthetic fittings for persons with a transfemoral amputation should provide adequate ground clearance (GC) during prosthetic side swing to minimize the risk of stumbling or falling. Insufficient ground clearance often leads to compensatory movements that consequently influence gait biomechanics negatively. RESEARCH QUESTION:How do different prosthetic components and alignment of a transfemoral prosthesis affect prosthetic side GC and compensatory strategies during level walking? METHODS:Eight persons with transfemoral amputation were enrolled. Three different knee joints (one monocentric and two polycentric) as well as two prosthetic feet (with and without passive dorsiflexion) were investigated. For prosthetic alignment, ap-position of the knee and foot as well as prosthesis length were varied. Kinematic and kinetic parameters were recorded with a 12-camera optoelectronic system and two force plates embedded in a 12-m walkway. The measurements were performed during level walking with self-selected slow, mid and fast gait speed. RESULTS:Several consistent effects were observed. GC increased with higher prosthetic swing knee flexion angle, a more anterior knee position and more posterior foot position. The individual swing phase control of the investigated knee joints showed a higher impact on GC than by geometric shortening effects of the polycentric knee joints. Passive ankle dorsiflexion enhanced GC, but the more anterior position of the foot (recommended by the manufacturer) eliminates this effect. Shortening of the prosthesis did not affect GC consistently but resulted in negative impact on the pelvis and trunk. To compensate for a lack of GC, vaulting was primarily observed. SIGNIFICANCE:The findings provide experts with a comprehensive overview of relevant factors influencing ground clearance. The importance of prosthetic alignment and prosthetic knee swing phase control was particularly evident. This can help to optimize the prosthetic fitting to the needs of the user and to reduce unnatural compensatory strategies.

IntroductionFor patients with a complex lower-limb muscle weakness including the knee and/or hip extensors, a knee-ankle-foot orthosis (KAFO), available with different knee mechanisms, is required to guarantee safety while providing the highest possible degree of functionality. For planning the configuration of a KAFO, the orthotic ankle joint appears to be a secondary consideration. An advanced generation of orthotic ankle joints (reactive-dynamic ankle [RDA]) enables, compared with conventional components (CAJ), increased range of motion with adjustable motion resistances. However, currently, it is an open question whether the new orthotic ankle joint generation leads to additional benefits for KAFO users.ObjectivesThe aim of the present study was to investigate the complex interactions between two different KAFO knee joint mechanisms (microprocessor-controlled CBrace orthosis and EMAG-Active stance-controlled orthosis) and ankle joint mechanisms representing both RDA and CAJ based on biomechanical tests and patient-reported evaluations. This comparison should help answer the question if the new ankle joint mechanism increases the patient benefits of a KAFO fitting.Study DesignThe different orthotic configurations were evaluated using a cross-sectional study design based on biomechanical tests and patient-reported evaluations.MethodsFive patients were enrolled in the present study. All of them had been users of the microprocessor-controlled C-Brace and had experience with the stance control orthosis from previous fittings. The modular concept of the ankle joint representing the new mechanism allows for testing both RDA and CAJ functionality. Therefore, four KAFO configurations were tested in randomized order using motion analysis during level walking with normal speed, level walking with given short steps, ascending and descending ramps, and standing on level ground as well as 10-degree incline and decline. After finishing the biomechanical tests, patients were asked in a questionnaire for their subjective evaluation of the benefits of the respective orthosis.ResultsWith C-Brace, the reliability of switching from stance to swing was close to 100% in all cases independent of the orthotic ankle joint condition. The reliability of switching from stance to swing with EMAG-Active was clearly enhanced with RDA for short-step level walking and ascending ramps, and high for level walking with both ankles. During level walking and ascending ramps with RDA, the mean maximum dorsiflexion was significantly increased for both KAFOs between 7 degrees and 12 degrees.This was accompanied by a significant reduction of the peak external sagittal knee extension moment between 0.1 and 0.13 Nm/kg, enabling an improved swing phase initiation. During descending ramps, the C-Brace enabled a nearly natural knee flexion during stance, whereas the EMAG-Active remained in the locked state; both characteristics were not significantly influenced by either ankle joint. In the subjective evaluation with RDA, higher mean usefulness scores were found compared with CAJ for both KAFOs.ResultsWith C-Brace, the reliability of switching from stance to swing was close to 100% in all cases independent of the orthotic ankle joint condition. The reliability of switching from stance to swing with EMAG-Active was clearly enhanced with RDA for short-step level walking and ascending ramps, and high for level walking with both ankles. During level walking and ascending ramps with RDA, the mean maximum dorsiflexion was significantly increased for both KAFOs between 7 degrees and 12 degrees. This was accompanied by a significant reduction of the peak external sagittal knee extension moment between 0.1 and 0.13 Nm/kg, enabling an improved swing phase initiation. During descending ramps, the C-Brace enabled a nearly natural knee flexion during stance, whereas the EMAG-Active remained in the locked state; both characteristics were not significantly influenced by either ankle joint. In the subjective evaluation with RDA, higher mean usefulness scores were found compared with CAJ for both KAFOs.ConclusionsIt can be concluded that the novel RDA joint represents an additional and beneficial option for the individual optimization of KAFOs, in particular for patients who must master varying terrains and walking conditions frequently in their daily lives.Clinical RelevanceThe use of the RDA new orthotic ankle mechanism tested in the present study results in relevant benefits, especially in gait situations in nonlevel conditions for KAFOs with different orthotic knee joint mechanisms. Therefore, this mechanism represents an additional option to optimize patient fittings with a KAFO.

BACKGROUND: Previous studies show that during level walking, the load on the contralateral side increases with more proximal amputation levels. Furthermore, a typical compensation mechanism, vaulting on the contralateral side, may also influence the load. However, no study has compared the load applied to the contralateral side across more than two different amputation levels. OBJECTIVE: The objectives of this study were to analyze the biomechanical impact of different lower limb amputation levels and vaulting on the load applied to the locomotor system. METHODOLOGY: Gait data from 82 individuals with different amputation levels (44 transtibial (TT), 30 transfemoral (TF), and 8 hip disarticulation (HD)) were retrospectively analyzed in this study. Peak knee adduction, flexion and extension moments, vertical ground reaction force peaks, and force rates were statistically analyzed between different amputation levels and between two groups “TF with vaulting” and “TF without vaulting”. FINDINGS: As the level of amputation increases, walking speed decreases and asymmetry of stance duration increases. TF individuals with vaulting tend to walk faster than those without vaulting. The first peak of vertical ground reaction forces, the peak knee adduction and extension moments increase, and the peak knee flexion moments decrease with higher amputation level. The higher the amputation level, the curve of the vertical ground reaction force becomes significantly steeper during the first 5% of the gait cycle (GC). The first peak of ground reaction forces, the knee flexion, extension and adduction moments tend to be higher in TF individuals with vaulting. CONCLUSION: In summary, a higher lower limb amputation level can increase loading on the contralateral limb and contribute to a higher incidence of vaulting during gait. The effect of vaulting as a compensation pattern leads to an additional increase in contralateral limb loading. Layman's Abstract Gait characteristics in people using lower limb prostheses deviate from normal gait patterns in individuals without amputation. Furthermore, some people with amputation rise onto the toes of their intact side (a movement known as vaulting) as a compensatory mechanism during walking, which helps them clear the ground on the prosthetic side. In people with lower limb amputation, the load applied to the intact side during level walking is higher compared to able-bodied individuals, and it increases as the level of amputation progresses from below the knee to hip disarticulation. No previous study has compared the load applied to the intact side across more than two different amputation levels. The aims of the present study were to analyze the influence of the amputation level and of vaulting on the load applied to the lower limb. Therefore, we analyzed previously collected gait data from 82 individuals with amputation (44 transtibial, 30 transfemoral, and 8 with hip disarticulation). As the level of amputation increases, walking speed decreases and individuals tend to spend more time on the intact side than the prosthetic side during each gait cycle. Individuals with transfemoral amputation who use vaulting as a compensatory movement tend to walk faster than those who do not use this strategy and experience higher forces on the intact limb. As the level of amputation increases, most of the forces applied to the body during level walking also increase. Furthermore, vaulting is more common in individuals with higher amputation levels. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44416/33698 How To Cite: Pröbsting E, Schmalz T, Bellmann M. Impact of amputation level and vaulting on loading parameters during level ground walking. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 2. Https://doi.org/10.33137/cpoj.v8i1.44416 Corresponding Author: Eva Pröbsting, Dipl.-Ing (FH) Affiliation: Clinical Research and Services, Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany. E-Mail: Eva.Proebsting@ottobock.de ORCID ID: https://orcid.org/0000-0002-6349-2992

BACKGROUND:The alignment of the axis in ankle-foot orthoses is essential for ensuring optimal biomechanical function and comfort for the user. Correct alignment reduces orthosis displacement, minimizes skin irritation and joint stress, and improves overall performance. This study explores the effects of varying joint axis positions on ankle-foot orthoses functionality and shaft-to-leg movement. METHODS:Six healthy adult males (mean age: 35 ± 12 years) participated, walking with bilateral ankle foot orthoses configured in five joint axis positions and a shod condition. A 3D motion analysis system captured kinematic and kinetic data, examining the effects of anterior, posterior, proximal, and distal axis shifts on range of motion, joint moments, energy, and shaft-to-leg relative movement (pistoning). FINDINGS:Anterior-posterior axis shifts significantly affected joint mechanics. Anterior alignment produced the highest dorsiflexion moments and reduced pistoning during dorsiflexion. Range of motion was reduced in all orthotic conditions compared to the shod condition. Proximal-distal shifts had minimal biomechanical impact but increased pistoning. Contrary to expectations, neutral alignment due to the recommendations of the manufacturer did not consistently minimize pistoning or preserve motion. INTERPRETATION:This study underscores the importance of anterior-posterior alignment in optimizing ankle joint function with orthotics. Specifically, anterior alignment reduced pistoning more effectively than the manufacturer-recommended neutral position, particularly during dorsiflexion. These findings highlight the clinical relevance of aligning the orthotic axis with natural joint mechanics, which can reduce motion restrictions, improve gait efficiency, and prevent harmful pressures that may cause discomfort, bruising, and inflammation around the ankle.

Dank technisch hochentwickelter Prothesenkomponenten kann beinamputierten Menschen eine näherungsweise natürliche Fortbewegung im Alltag ermöglicht werden. Diese Prothesensysteme eignen sich jedoch nicht für den breitensportlichen Laufsport und den paralympischen Hochleistungssport. Hierfür wurden in den letzten Jahren spezifische Prothesenkniegelenke und -füße entwickelt. Diese ermöglichen es beispielsweise, ein breitensportliches Lauftraining aufzunehmen oder betroffenen Kindern die Teilhabe am Schulsport zu ermöglichen. Im Leistungssport gelingt es mit diesen Prothesensystemen, im 100-m-Sprint Zeiten unter 12 s und beim Weitsprung Weiten über der 7-m-Marke zu erreichen. Eine gegenwärtige Einschränkung der verwendeten Prothesenkniegelenke besteht darin, dass keine Knieflexionsbewegungen unter Belastung möglich sind. Die dadurch notwendige Modifikation der Bewegungsmotorik ist von interessierten Anwendern innerhalb einer kurzen Trainingsphase ohne Probleme erlernbar. Gegenwärtige Forschungs- und Entwicklungsaktivitäten sind darauf ausgerichtet, diese Einschränkung durch weiterentwickelte technische Lösungen zu eliminieren.

ABSTRACT Introduction A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs.

OCCUPATIONAL APPLICATIONSGlobalization and eCommerce continue to fuel unprecedented growth in the logistics and warehousing markets. Simultaneously, the biggest bottleneck for these industries is their human capital. Where automation and robotic solutions fail to deliver a return on investment, humans frequently take over handling tasks that place harmful loads and strains on the body. Occupational exoskeletons can reduce fatigue and strain by supporting the lower spine and are designed to prevent work-related musculoskeletal disorders and other injuries. They are a mid- to long-term investment for industries to improve ergonomic conditions in workplaces, with the potential for reducing absences from work, sick days logged, and workers compensation claims. To examine the effectiveness of the newly introduced Paexo Back exoskeleton, a study was completed with 10 participants who completed manual load handling tasks with and without the exoskeleton. Key findings include significant reductions in metabolic effort and low back loading when the exoskeleton is worn.

Background Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.

BACKGROUND:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side. OBJECTIVE:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters. STUDY DESIGN:Interventional cross sectional study. METHODS:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used. RESULTS:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity. CONCLUSIONS:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.

BACKGROUND: Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The uneven ground and the resulting functional leg length discrepancy in this situation requires adaptability of both user and prosthesis. OBJECTIVE(S): This study investigated the effects of a novel prosthetic foot that offers adaptability on cross-slope surfaces, using instrumented gait analysis and patient-reported outcomes. Moreover, the results were compared with two common prosthetic feet. METHODOLOGY: Twelve individuals with unilateral transtibial amputation and ten able-bodied control subjects participated in this randomized cross-over study. Participants walked on level ground and ±10° inclined cross-slopes at a self-selected walking speed. There were three prosthetic foot interventions: Triton Side Flex (TSF), Triton LP and Pro-Flex LP. The accommodation time for each foot was at least 4 weeks. The main outcome measures were as follows: frontal plane adaptation of shoe and prosthetic foot keel, mediolateral course of the center of pressure, ground reaction force in vertical and mediolateral direction, external knee adduction moment, gait speed, stance phase duration, step length and step width. Patient-reported outcomes assessed were the Activities Specific Balanced Confidence (ABC) scale, Prosthetic Limb Users Survey of Mobility (PLUS M) and Activities of Daily Living Questionnaire (ADL-Q). FINDINGS: The TSF prosthetic foot adapted both faster and to a greater extent to the cross-slope conditions compared to the Triton LP and Pro-Flex LP. The graphs for the mediolateral center of pressure course and mediolateral ground reaction force showed a distinct grouping for level ground and ±10° cross-slopes, similar to control subjects. In the ADL-Q, participants reported a higher level of perceived safety and comfort when using the TSF on cross-slopes. Eight out of twelve participants preferred the TSF over the reference. CONCLUSION: The frontal plane adaptation characteristics of the TSF prosthetic foot appear to be beneficial to the user and thus may enhance locomotion on uneven ground – specifically on cross-slopes. Layman's Abstract Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The adaptability of prostheses is limited. Users alter gait strategies to cope with uneven ground. The prosthetic foot is a central component of a lower limb prosthesis. This study investigated if a novel prosthetic foot with greater adaptability is beneficial on cross-slopes. Twelve individuals with transtibial amputation (ITTAs) took part in the study. In addition, ten abled-bodied persons were measured as controls. The ITTAs were fitted with the novel foot and a reference foot. The accommodation time for each foot was four weeks at least. Afterwards gait data and patient-reported outcomes were assessed. The analyzed gait data showed clear differences in terrain compliance for the measured feet. The novel foot adapts both faster and to a greater extent to the cross-slope conditions. The self-reported outcome measures revealed better comfort and perceived safety when using the adaptive foot concept in comparison to the commercial reference. These results suggest that the adaptation characteristics of the novel foot concept are beneficial to the user. Thus, it may enhance locomotion on uneven ground such as cross-slopes. Article PDF Link: How To Cite: Altenburg B, Ernst M, Maciejasz P, Schmalz T, Braatz F, Gerke H, Bellmann M. Effects of a prosthetic foot with increased coronal adaptability on cross-slope walking. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.7. https://doi.org/10.33137/cpoj.v4i1.35206 Corresponding Author: Björn Altenburg,Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany.E-Mail: Bjoern.altenburg@ottobock.comORCID ID: https://orcid.org/0000-0002-3484-4346

Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0 degrees, 3 degrees, 6 degrees, 9 degrees). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 +/- 1 degrees for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.

We welcome the global community of professionals involved in the care of persons in need of prosthetic, orthotic, mobility and assistive devices to the ISPO 18th World Congress! [View Programme Overview in Oxford Abstracts](https://virtual.oxfordabstracts.com/#/e/ispo2021/program) I [View the Abstract Book](https://journals.lww.com/poijournal/toc/2021/12001) | [HowToTreat ISPO Edition](https://360-ot.de/howtotreat/)