Postural control imbalance in individuals with a minor lower extremity amputation: A scoping review

Minor lower extremity amputations (LEA) compromise postural control and increase the risk of falls. This issue is exacerbated by conditions such as diabetes, which affect proprioception and sensorimotor mechanisms. While orthopedic devices, including prostheses and orthoses, are frequently prescribed, their specific role in restoring postural control remains underexplored. This scoping review aimed to synthesize current research on postural control in individuals with a minor LEA and to evaluate the interventions that may improve balance.

A systematic search was conducted across databases (MEDLINE, CINAHL, SPORTDiscus, Cochrane) and grey literature, targeting studies employing biomechanics (e.g., kinetics, kinematics), functional tests (e.g., Functional Reach Test, Timed Up and Go) and self-reported assessments of balance confidence, fall risk, and physical performance.

Fifteen articles involving 288 individuals with various levels of minor LEA were included. Increased risk of falling were evidenced by lower scores on functional balance tests, with postural deficits confirmed by biomechanical measurements in both static and dynamic conditions. Custom orthotic devices improved functional performance and biomechanical outcomes, suggesting their effectiveness in restoring balance. Prosthetic devices, such as custom prosthetic shoes, enhanced postural stability and facilitated smoother weight transitions during tasks. However, small sample sizes and inconsistent evaluation protocols, complicate understanding of their effectiveness in rehabilitation.

This scoping review highlights the underestimated postural challenges experienced by individuals with a minor LEA and supports the role of orthotic and prosthetic interventions in restoring balance. High-quality research to guide clinical decision-making in this population is needed.