Effect of trans-tibial prosthesis pylon flexibility on ground reaction forces during gait

This study explored the effects of trans-tibial prosthesis pylon flexibility on ground reaction forces (GRFs) associated with walking and step-down. Four (4) active subjects with unilateral trans-tibial amputation and pylon lengths ranging from 4.9 cm to 25.9 cm were studied wearing an aluminium (rigid) pylon and a nylon (more flexible) pylon. Ground reaction forces were collected for the amputated limb during walking at pre-measured self-selected velocity and when stepping down from a 20 cm box. Pylon material significantly affected the magnitudes and patterns of GRFs in both tests. During walking, the most notable differences were seen in the anteroposterior (AP) direction. With the flexible pylon, the AP propulsive peak was greater (p=0.031), and the irregularities in the AP force curve were reduced. Additionally, when walking with the flexible pylon, the vertical peak associated with weight acceptance occurred earlier (p=0.010), the vertical terminal stance peak occurred later (p=0.012), and stance time was longer (p=0.010). During step-down, the vertical loading rate (p=0.010) and the peak vertical force (p=0.010) were greater with the more flexible pylon. Subjective feedback indicated that subjects could distinguish between the two pylons and felt that the nylon component was more comfortable, more flexible, and would enable them to walk more quickly. These results suggest that the pylon may be an influential component of the prosthesis with respect to gait and comfort, and that some degree of flexibility is desirable.