Effects of Above-Ankle Orthoses on Individuals with Diabetic Partial Foot
Partial foot amputation is becoming more prevalent and costly and if not treated correctly can lead to higher levels of amputation. Despite this, partial foot orthotic research and development has been inadequate. Furthermore, in order to contribute to improved orthotic management, there is a need to understand the biomechanical discrepancies during gait. Biomechanical goals of orthotic fitting include normalizing the three functional impairments of the transmetatarsal amputee. The first goal is to improve balance, the second is to normalize the toe-off phase of gait, and the third goal involves supporting the plantar surface of the foot to evenly distribute pressure. In this study, all subjects were evaluated with a below-ankle condition and an above-ankle condition. The below-ankle condition consisted of a total contact foot orthosis fitted into Drew' shoes with rocker bottom soles. The below-ankle orthosis was then fitted with a Blue Rocker© ankle foot orthosis and gait was re-evaluated as the above-ankle orthotic gait condition. Three specific goals were proposed in this study: 1) to determine the differing, if any, effects on balance and vertical ground reaction symmetry during level walking and obstacle crossing between the two orthotic designs, 2) to determine the plantar pressure distribution differences between a below-ankle and an above-ankle design, 3) to learn about patient preferences to provide realistic feedback for quality patient care. We hypothesized that improved balance, symmetry and distribution of pressure would occur with the above-ankle design in individuals with greater disability.