Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review

Autoři: Roy Müller aff001;  Lisa Tronicke aff003;  Rainer Abel aff001;  Knut Lechler aff003
Působiště autorů: Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany aff001;  Institute of Sport Sciences, Friedrich Schiller University Jena, Jena, Germany aff002;  R&D Össur, Reykjavik, Iceland aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225032



Unilateral trans-tibial amputation signifies a challenge to locomotion. Prosthetic ankle-foot units are developed to mimic the missing biological system which adapts push-off power to walking speed in some new prosthetic ankle-foot designs. The first systematic review including the two factors aims to investigate push-off power differences among Solid Ankle Cushion Heel (SACH), Energy Storage And Return (ESAR) and Powered ankle-foot units (PWR) and their relation to walking speed.

Data sources

A literature search was undertaken in the Web of Science, PubMed, IEEE xplore, and Google Scholar databases. The search term included: ampu* AND prosth* AND ankle-power AND push-off AND walking.

Study appraisal and synthesis methods

Studies were included if they met the following criteria: unilateral trans-tibial amputees, lower limb prosthesis, reported analysis of ankle power during walking. Data extracted from the included studies were clinical population, type of the prosthetic ankle-foot units (SACH, ESAR, PWR), walking speed, and peak ankle power. Linear regression was used to determine whether the push-off power of different prosthetic ankle-foot units varied regarding walking speed. Push-off power of the different prosthetic ankle-foot units were compared using one-way between subjects’ ANOVAs with post hoc analysis, separately for slower and faster walking speeds.


474 publications were retrieved, 28 of which were eligible for inclusion. Correlations between walking speed and peak push-off power were found for ESAR (r = 0.568, p = 0.006) and PWR (r = 0.820, p = 0.000) but not for SACH (r = 0.267, p = 0.522). ESAR and PWR demonstrated significant differences in push-off power for slower and faster walking speeds (ESAR (p = 0.01) and PWR (p = 0.02)).


Push-off power can be used as a selection criterion to differentiate ankle-foot units for prosthetic users and their bandwidth of walking speeds.

Klíčová slova:

Ankles – Body limbs – Database searching – Feet – Prosthetics – Prototypes – Systematic reviews – Walking


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