The Chopart amputation does not replace distal ..
The comprehensiveness of the evidence base is limited because investigators have tended to describe isolated aspects of gait dealing with specific hypotheses. More comprehensive gait analyses including kinematic and kinetic patterns at the knee and hip joints  or the contralateral lower limb  are scarce and poorly understood. As such, the purpose of this observational study was to more completely describe the gait patterns of a broad cohort of partial foot amputees with a view to better understanding the underlying mechanical adaptations to PFA and prosthetic fitting.
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Subjects with amputation were recruited through either the Queensland Amputee Limb Service (QALS) or prosthetic/orthotic service providers in Queensland, Australia. Of the 56 individuals identified through these avenues, data could be collected on 7 persons with PFA. Minimal exclusion criteria were applied to the sample with amputation because of the limited number of potential participants; as such, the amputee cohort was quite variable in cause of amputation, amputation level, years since amputation, number of limbs affected, and types of prosthetic fitting (). Subjects were excluded if they ambulated with the use of any gait aids, had concomitant health problems such as ulceration, or had neuromuscular/musculoskeletal conditions that might affect their gait. Diabetes or peripheral vascular disease were not considered criteria for exclusion, although none of the subjects with amputation had these systemic illnesses. The reported incidences of gangrene could be traced back to nonvascular causes, such as frostbite or burns.
We interviewed participants to obtain a detailed initial assessment that included details about their amputation, past medical history, and prosthetic management. A qualified prosthetist assessed each participant's residual foot to determine the amputation level, and where possible, this level was verified through X-ray, surgical reports, or comparison of the residual and sound foot lengths . Details about the type and construction of the prosthesis were also noted (). A qualified prosthetist evaluated the quality of prosthetic fit and function to ensure it was appropriate.
Orthotic and prosthetic devices in partial foot amputations
Abstract — Our understanding of the gait mechanics of persons with partial foot amputation and the influence of prosthetic intervention has been limited by the reporting of isolated gait parameters in specific amputation levels and limited interpretation and discussion of results. This observational study aimed to more completely describe the gait patterns of persons with partial foot amputation wearing their existing prosthesis and footwear in comparison with a nonamputee control group. Major adaptations occurred once the metatarsal heads were compromised. Persons with transmetatarsal and Lisfranc amputation who were wearing insoles and slipper sockets maintained the center of pressure behind the end of the residuum until after contralateral heel contact. This gait pattern may be a useful adaptation to protect the residuum, moderate the requirement of the calf musculature, or compensate for the compliance of the forefoot. Power generation across the affected ankle was virtually negligible, necessitating increased power generation across the hip joints. The clamshell devices fitted to the persons with Chopart amputation restored their effective foot length and normalized many aspects of gait. These persons' ability to adopt this gait pattern may be the result of the broad anterior shell of the socket, a relatively stiff forefoot, and immobilization of the ankle. The hip joints still contributed significantly to the power generation required to walk.
Prosthetic management of a Chopart amputation ..
Amputation did not influence the horizontal GRF patterns observed in the sound limb (). The horizontal GRF patterns observed on the affected limb(s) during loading response were quite variable, with timing of the first peak delayed and the magnitude of the peak reduced more commonly, but not exclusively, in those with bilateral Chopart amputation (). During terminal stance, consistent reductions in the magnitude of the horizontal GRF were observed, along with premature timing of the peak, in the subjects with TMT and Lisfranc amputation (). These same characteristics were not evident in the subjects with metatarsophalangeal (MTP) or Chopart amputation ().
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