Sensitivity of lower-limb joint mechanics to prosthetic forefoot stiffness with a variable stiffness foot in level-ground walking

This paper presents the effects of the Variable Stiffness Foot (VSF) on lower-limb joint mechanics in level-ground walking. Persons with transtibial amputations use lower-limb prostheses to restore level-ground walking, and foot stiffness and geometry have been shown to be the main factors for evaluating foot prostheses. Previous studies have validated the semi-active and stiffness modulation capabilities of the VSF. The core aim of this study is to investigate the mechanical effects of adjusting stiffness on knee and ankle mechanics for prosthetic users wearing the VSF. For this study, seven human participants walked with three different stiffnesses (compliant, medium, stiff) of the VSF across two force plates in a motion capture lab. Linear mixed models were utilized to estimate the significance and coefficients of determinations for the regression of stiffness on several biomechanical metrics. A stiffer VSF led to decreased ankle dorsiflexion angle (p < 0.0001, r2 = 0.90), increased ankle plantarflexor moment (p = 0.016, r2 = 0.40), increased knee extension (p = 0.021, r2 = 0.37), increased knee flexor moment (p = 0.0007, r2 = 0.63), and decreased magnitudes of prosthetic energy storage (p < 0.0001, r2 = 0.90), energy return (p = 0.0003, r2 = 0.67), and power (p < 0.0001, r2 = 0.74). These results imply lower ankle, knee, and hip moments, and more ankle angle range of motion using a less stiff VSF, which may be advantageous to persons walking with lower-limb prostheses. Responsive modulation of the VSF stiffness, according to these findings, could help overcome gait deviations associated with different slopes, terrain characteristics, or footwear.