Outcomes of prosthetic and orthotic use in individuals with a minor lower extremity amputation: A scoping review

Restoring independent daily activity is crucial for patients with a lower extremity amputation. Amputations at or distal to the midtarsal level pose unique challenges, necessitating specialized prosthetic and orthotic interventions to improve functionality, wellness, and quality of life. The objective of this scoping review was to examine the impact of prosthetic and orthotic use on clinical and health care outcomes in adults with a minor lower extremity amputation. Following Arksey and O'Malley's framework and the updated Joanna Briggs Institute's methodology, a systematic search of MEDLINE, CINAHL, SPORTDiscus, APA PsycInfo, Scopus, and the Cochrane Database of Systematic Reviews, was conducted. Fifty-nine relevant studies, primarily originating from the United States of America and Australia, were included. Trauma (47.5%) and diabetes (35.6%) were the leading causes of amputation. The most reported biomechanical outcomes were gait alterations (49.2%), revealing deficits and improvements in spatiotemporal parameters (33.9%), and plantar pressure distribution (22.0%). Custom-made devices insertable into the shoe, such as toe fillers and foot orthoses, enhanced walking speed and plantar pressure distribution, whereas above-ankle devices were more effective than foot orthoses in more proximal amputations. Well-fitted devices increased satisfaction and quality of life, but economic impacts were less frequently addressed. Despite most of the included studies being case reports (23.7%), which have a higher risk of bias, the review underscores the essential role of prosthetic and orthotic prescriptions based on tailored patient-centered care. The findings highlight the need for higher-quality research considering cost, and a broader range of patient-related outcomes and experiences measures, including psycho-social aspects.