Effects of prosthetic mass distribution on metabolic costs and walking symmetry

Unilateral, transtibial amputees exhibit walking asymmetries and higher metabolic costs of walking than nonamputees walking at similar speeds. Using lightweight prostheses has previously been suggested as a contributing factor to walking asymmetries. The purpose was to investigate the effects of prosthesis mass and mass distribution on metabolic costs and walking asymmetries among six unilateral, transtibial amputees. Kinematic and temporal symmetry did not improve when mass was added at different locations on the limb. Stance and swing time asymmetries increased by 3.4% and 7.2%, respectively, with loads positioned distally on the limb. Maximum knee angular velocity asymmetries increased by 6% with mass added to the thigh, whereas maximum thigh angular velocity asymmetries increased by approximately 10% with mass positioned near the prosthetic ankle. Adding 100% of the estimated mass difference between intact and prosthetic legs to the ankle of the prosthesis increased energy costs of walking by 12%; adding the same mass to the prosthesis center of mass or thigh center of mass increased metabolic cost by approximately 7% and 5%, respectively. Unless other benefits are gained by increasing prosthesis mass, this should not be considered as a possible alternative to current lightweight prosthesis designs currently being prescribed to unilateral amputees.