Assessment of low- and high-level task performance in people with transtibial amputation using crossover and energy-storing prosthetic feet: A pilot study

Prosthet Orthot Int. 2018 Dec;42(6):583-591. doi: 10.1177/0309364618774060. Epub 2018 May 19.


Background:: Crossover feet incorporate features of energy-storing feet and running-specific feet. As such, crossover feet may be suitable for both daily ambulation and participation in physically demanding activities.

Objectives:: To compare crossover feet and energy-storing feet on performance-based tests including a range of low-level (e.g. sit-to-stand) and high-level (e.g. jogging) activities.

Study design:: Cross-sectional, repeated measures.

Methods:: Participants with transtibial amputation completed a battery of performance-based outcome measures, including the Five Times Sit-to-Stand, Timed-Up-and-Go, Four Square Step Test, and the Comprehensive High-level Activity Mobility Predictor. Participants wore duplicate prostheses fit with crossover feet and energy-storing feet to perform the tests; the order of foot conditions was randomized. Paired t tests were used to evaluate differences between feet and order of testing.

Results:: Data from seven participants showed improvements in all measures while using crossover feet. Improvements in the second foot condition were also observed, indicating a practice effect for all measures. However, differences between feet and order of conditions were not statistically significant ( p > 0.05).

Conclusion:: Results of this study suggest that crossover feet may improve low- and high-level mobility outcomes. However, intervention effects are small and practice effects were observed in all outcomes. Future research is needed to evaluate the influence of practice effects on performance-based mobility measures.

Clinical relevance: Crossover feet may improve transtibial prosthesis users' performance compared to energy-storing feet across a range of activities, but additional research is needed. Practice effects may be an influential factor in the measurement of performance-based mobility outcomes and should be considered when performing a clinical assessment.

Keywords: Prosthetic feet; artificial limbs; evaluation studies; functional outcomes; outcome assessment; performance-based outcome measures; prosthetics; study design.

MeSH terms

  • Adult
  • Amputees*
  • Artificial Limbs*
  • Cross-Over Studies
  • Cross-Sectional Studies
  • Female
  • Foot*
  • Humans
  • Leg*
  • Male
  • Middle Aged
  • Motor Activity / physiology*
  • Outcome Assessment, Health Care
  • Pilot Projects
  • Prosthesis Design
  • Task Performance and Analysis*