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CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, 
VANCOUVER, CANADA, 2018.  DOI: https://doi.org/10.33137/cpoj.v1i2.32029                                                                     

 

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OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

AN INNOVATIVE FOOT MODULE WITH EASILY ACCESSIBLE FRONTAL PLANE 

ADAPTATION ENHANCES THE LOCOMOTION ON UNEVEN GROUND 

Björn Altenburg*, Michael Ernst, Thomas Schmalz 

OttoBock HealthCare GmbH, Germany.  
* Email: Bjoern.Altenburg@ottobock.com 

DOI: https://doi.org/10.33137/cpoj.v1i2.32029  

 

INTRODUCTION 

Real-life outdoor walking of amputees is challenged by 

uneven ground. Uneven ground requires either a 

component adaptation in the sagittal plane or in frontal 

plane or both. The lack of adaptability of prosthetic 

components requires compensational movement 

strategies by the user. Common energy storing and 

returning (ESR) feet have some basic flexibility through 

the carbon structure allowing for some limited adaptation 

in both planes. For the frontal plane the split toe feature 

adds some functionality. However, even with split toe the 

ROM is clearly limited and needs high force impact for 

minor adaptations. Now there is a novel foot module 

allowing for 10° inversion/eversion through a dedicated 

joint. This study investigates the hypothesis that such a 

foot module with easily accessible frontal plane 

adaptation enhances the locomotion on uneven ground. 

METHODS 

12 unilateral TT amputees with activity level K3 or 

higher participated in this study. In addition the data of 

10 able-bodied was captured. For the measurements a 

stationary gait analysis system with 12 Vicon Bonita 

cameras and 2 Kistler force plates was used. A dedicated 

marker set was applied that enables the observer to 

distinguish frontal plane adaptations of the foot between 

joint adaptation, carbon base deformation and shoe/foot-

shell deformation. Observed situations: walking on level 

ground, walking on a 5° cross slope, walking on a 10° 

cross slope (all at self-selected walking speed, ), standing 

on level ground, standing on a 5° cross slope, standing on 

a 10° cross slope. All cross slopes were connected to the 

Kistler force plates. The participants completed the 

measurement tracks 3 times with 3 setups: their everyday 

foot (individual ESR), the novel foot module, a reference 

ESR (Triton LP, Ottobock or Proflex LP, Össur). The 

accommodation time to the different feet was minimum 

4 weeks each. The order of setups and type of reference 

ESR was randomized. Next to the biomechanical 

measurements the participants walked an indoor course 

(gravel, obstacles, cross slopes, tight turns) and 

completed questionnaires with respect to socket comfort, 

safety and overall satisfaction during the indoor course 

and their >4 weeks daily use of the components. 

RESULTS 

For the carbon structure of the novel foot module an early 

and nearly full adaptation to the cross slope at the 

beginning of mid stance was measured. The reference 

ESR feet showed significant (p<0,05) less adaptation 

with maxima at the end of terminal stance. The COP path 

of the novel foot clearly shows a more physiological 

pattern (referring to measurements of the sound side and 

control group) compared to the ESR feet. The measured 

external knee adduction moment (EAM) at the 10° valley 

condition was significantly reduced with the novel foot 

module. The questionnaires report significantly higher 

ratings for perceived safety and socket comfort using the 

novel foot module compared to the reference ESR foot 

used in the study. Eight out of twelve TT users preferred 

the novel foot module over the reference ESRs for their 

daily routine. 

CONCLUSION 

The study results confirm benefits of the novel foot 

module when ambulating on cross slopes as one 

condition of uneven ground. Especially for TT amputees 

it is crucial to minimize recurring improper frontal knee 

loads on the affected side. Such component functionality 

contributes to minimize frontal knee loads. Due to the 

faster and more comprehensive adaptation to the cross 

slope condition, less compensation is required and users 

feel more safe and comfortable when ambulating on 

uneven ground using the novel foot module. 

SIGNIFICANCE 

Few authors have investigated lower limb amputee gait 

on cross slopes1,2,3,4,5 with main focus on kinematics and 

compensational strategies during swing phase. This 

doi:%20https://doi.org/10.33137/cpoj.v1i2.32029
mailto:Bjoern.Altenburg@ottobock.com
https://doi.org/10.33137/cpoj.v1i2.32029


 

 

 Altenburg B, Ernst M, Schmalz T. AN INNOVATIVE FOOT MODULE WITH EASILY ACCESSIBLE FRONTAL PLANE ADAPTATION ENHANCES THE LOCOMOTION ON UNEVEN GROUND. 
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, 
VANCOUVER, CANADA, 2018.  DOI: https://doi.org/10.33137/cpoj.v1i2.32029                                                                     

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

study focuses on stance phase. In addition it’s the first 

study comparing different foot components on cross 

slopes and thus makes a valuable contribution to the 

literature of lower limb amputee’s gait. 

REFERENCES 

1. Starholm IM et al. Energy expenditure of transfemoral 

amputees walking on a horizontal and tilted treadmill 

simulating different outdoor walking conditions. Prosthet 

Orthot Int; 2010; 34; 184-94. DOI: 

10.3109/03093640903585016 

2. Hak I et al. Walking in an unstable environment: Strategies 

used by transtibial amputees to prevent falling during gait. 

Arch Phys Med Rehabil; 2013; 94; 2186-93. DOI: 

10.1016/j.apmr.2013.07.020 

3. Villa C et al. Evolution of vaulting strategy during 

locomotion of individuals with transfemoral amputation on 

slopes and cross-slopes compared to level walking. Clin 

Biomech; 2015; 30; 623-8. DOI: 

10.1016/j.clinbiomech.2015.03.022 

4. Sinitski EH et al. Fixed and self-paced treadmill walking for 

able-bodied and transtibial amputees in a multi-terrain virtual 

environment. Gait Posture; 2015; 41; 568-73. DOI: 

10.1016/j.gaitpost.2014.12.016 

5. Villa C et al. Cross-Slope  and  Level  Walking Strategies  

During  Swing  in  Individuals  With  Lower  Limb  

Amputation.  Arch Phys Med Rehabil; 2017; 98; 1149-57. 
DOI: 10.1016/j.apmr.2016.10.007 

DISCLOSURE 

Authors are full time employees of the Ottobock SE & Co. 

KGaA. 

doi:%20https://doi.org/10.33137/cpoj.v1i2.32029
https://doi.org/10.3109/03093640903585016
https://doi.org/10.1016/j.apmr.2013.07.020
https://doi.org/10.1016/j.clinbiomech.2015.03.022
https://doi.org/10.1016/j.gaitpost.2014.12.016
https://doi.org/10.1016/j.apmr.2016.10.007

