A systematic review of energy storing dynamic response foot for prosthetic rehabilitation

The purpose of this paper is to undertake a systematic review on various mechanical design considerations, simulation and optimization techniques as well as the clinical applications of energy storing and return (ESAR) prosthetic feet used in amputee rehabilitation. Methodological databases including PubMed, EMBASE, and SCOPUS were searched till July 2022, and the retrieved records were evaluated for relevance. The design, mechanism, materials used, mechanical and simulation techniques and clinical applications of ESAR foot used in developed and developing nations were reviewed. 61 articles met the inclusion criteria out of total 577 studies. A wide variety of design matrices for energy- storing feet was found, but the clinical relevance of its design parameters is uncommon. Definitive factors on technical and clinical characteristics were derived and included in the summary tables. To modify existing foot failure mechanisms, material selection and multiple experiments must be improved. Gait analysis and International Organization for Standardization (ISO) mechanical testing standards of energy-storing feet were the methods for integrating clinical experimentation with numerical results. To meet technological requirements, various frameworks simulate finite element models of the energy-storing foot, whereas clinical investigations involving gait analysis require proper insight. Analysis of structural behavior under varying loads and its effect on studies of functional gait are limited. For optimal functional performance, durability and affordability, more research and technological advancements are required to characterize materials and standardize prosthetic foot protocols.