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Clinical Rehabilitation, Vol. 17, No. 7, 787-796 (2003)
DOI: 10.1191/0269215503cr678oa

Effects of prosthesis alignment on pressure distribution at the stump/socket interface in transtibial amputees during unsupported stance and gait

H A M Seelen

Rehabilitation Foundation Limburg and Institute for Rehabilitation Research, Hoensbroek

S Anemaat

Department of Movement Sciences, Maastricht University, Maastricht

H M H Janssen

J H M Deckers

Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands

Objective: To assess the effects of antero-posterior realignment of the prosthesis on pressure distribution at the stump/socket interface in unilateral transtibial amputees during unsupported stance and gait.

Design: Cross-sectional group study.

Setting: Outpatient rehabilitation clinic.

Subjects: Seventeen unilateral transtibial amputees.

Intervention: Antero-posterior prosthesis realignment using 0.5 cm heel or forefoot wedging.

Measures: Pressure distribution changes at several sites at the stump/socket interface, expressed as peak pressure, peak pressure time, sustained submaximal load (MP80+) and time period of MP80+ (TP80+).

Results: During stance, heel wedging led to a 30.4% decrease in mean pressure near the patella tendon and a 40.0% increase near the distal tibia site, whereas forefoot wedging led to a 30.0% decrease in pressure in the tibial end region. Antero-posterior ankle realignment did not lead to significant changes near the fibular head. During gait only heel wedging led to a 11.5% increase in peak pressure in the tibia end region. Mean peak pressure time increased 22.7% using heel wedging and decreased 8.8% using forefoot wedging. MP80+ increased 23.8% in the tibia end region during heel wedging and 17.0% in the subpatellar region during forefoot wedging.

Conclusions: Antero-posterior realignment of the ankle joint led to an inverse loading and unloading of the subpatellar region versus tibial end region. However, results indicate that stump/socket interface pressure during stance seems not to be highly predictive as to pressure behaviour during gait. Ankle joint realignment led to significant differences in temporal sequences of tissue (un-)loading in the subpatellar area during gait.


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