title: Effects of heel lifting on transtibial amputee gait before and after treadmill walking: a case study.
abstract: BACKGROUND
  Prosthetic alignment is usually unchanged once optimized. However, a previous study indicated that long-distance walking significantly altered gait patterns, suggesting some alignment adjustments after walking are required. This study investigated the effects of alignment changes (by inserting a heel lift) on gait of a transtibial amputee before and after treadmill walking.
  
  
  METHODS
  The subject walked, without heel lifts, on a treadmill until perception of fatigue. Gait changes upon heel lifting at the prosthetic side were studied before and after the treadmill walking
  
  
  RESULTS
  For this subject before the treadmill walking, heel lifting induced drop-off with increased prosthetic-side knee flexion at mid-stance and pre-swing. The sound limb outreached to stabilize the gait. After the treadmill walking, the same heel lift did not induce drop-off. It reduced the plantar flexor power generation, potentially delaying its fatigue.
  
  
  CONCLUSIONS
  After walking prosthetic-side heel lifting could be beneficial.
  
  
  CONCLUSIONS
  Many lower-limb amputees have difficulties in long-distance walking due to muscle fatigue. This case study proposes that appropriate alignment changes after some walking potentially relieve fatigue and encourage them to walk longer distances.
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: L F
authors.initials: LF
authors.lastname: Yeung
authors.forename: Aaron K L
authors.initials: AK
authors.lastname: Leung
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.forename: Winson C C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D005080:Exercise Test; D005221:Fatigue / Q000517:prevention & control; D005684:Gait / Q000502:physiology*; D006365:Heel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Gait; heel lift; long-distance walking; muscle fatigue; prosthetic alignment; transtibial amputees