Prosthetic alignment effects on gait symmetry: a case study

The loss of a significant portion of a lower extremity causes changes in the usual pattern of human ambulation. These changes have been documented kinematically, kinetically and metabolically, giving insight into the costs of limb amputation relative to ambulatory efforts. The role of the prosthetist is to provide a limb substitute to achieve the best gait performance, while assuring maximum comfort for the patient. This case study examined the effects of antero-posterior alignment of a below-knee prosthesis on sagittal plane gait kinematics by comparing the anatomical side with the prosthetic side. The greatest changes due to variations of alignment were found during the prosthetic stance phase; knee angles showed the greatest asymmetry between anatomical and prosthetic sides. The stance phase on the prosthetic side was reduced with anterior socket displacement due to early knee flexion and toe-off. Posterior socket displacement caused a greater maximum centre of gravity height, but anterior socket displacement caused greater knee flexion which decreased the maximum centre of gravity height. Asymmetries in temporal and other kinematic parameters were not always minimal at the optimal alignment subjectively selected by a certified prosthetist. Comparisons of asymmetry ratios with prosthetic side data revealed the subclinical sensitivity of this amputee to antero-posterior alignment discrepancies.