Biomechanics of ambulation after partial foot amputation: A systematic literature review

The purpose of this systematic review was to establish what is known about gait and prosthetic/orthotic intervention in persons with partial foot amputation (PFA) and to identify what needs to be known to optimize gait and prosthetic/orthotic intervention. A systematic search of the literature identified 437 citations, with 28 publications selected for review based on inclusion criteria. Studies analyzing the gait of PFA were generally published in the last two decades in a myriad of journals spanning many disciplines. Publications that met the inclusion criteria were predominantly classified as case-control or cross-sectional studies and were reviewed based on various aspects of the biomechanics of gait, including temporospatial, ground reaction force (GRF), center of pressure (CoP) excursion, kinematics, kinetics, plantar pressure, electromyography, and energy expenditure. Studies reporting results for each variable were described, methodological issues identified and discussed, and the results summarized. The quality of the evidence was then rated as high, moderate, low, or insufficient for a number of outcome statements based on the various aspects of the biomechanics of gait. Overall, there was a high level of evidence that PFA generally affects temporospatial, GRF, ankle kinetics, and plantar pressures during gait, but there was less confidence in the evidence regarding more detailed statements about exactly how these aspects of gait are affected by PFA. This is reflective of the small and heterogenous populations included in the reviewed literature. Because the studies were largely observational, there is insufficient evidence regarding the efficacy of specific prosthetic and orthotic interventions, although generally there was low to moderate evidence that prosthetic and orthotic interventions affect ankle kinematics and moments and may moderate CoP progression. There remains the need to further our understanding of the biomechanics of PFA gait and establish hypotheses regarding prosthetic and orthotic requirements for improved ambulation/function and protection of the residuum.