title: Comparison of gait after Syme and transtibial amputation in children: factors that may play a role in function.
abstract: BACKGROUND
  Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes.
  
  
  METHODS
  Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted.
  
  
  RESULTS
  Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05).
  
  
  CONCLUSIONS
  Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans: kelly.jeans@tsrh.org.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Jeans
authors.affiliation: Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans: kelly.jeans@tsrh.org.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Karol
authors.affiliation: Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans: kelly.jeans@tsrh.org.
authors.forename: Donald
authors.initials: D
authors.lastname: Cummings
authors.affiliation: 117 Coronado Drive #1113, Denton, TX 76209.
authors.forename: Kunal
authors.initials: K
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000671:Amputation, Surgical / Q000379:methods*; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D013977:Tibia; D055815:Young Adult