Comparison of static balance and pressure distribution in individuals with unilateral lower limb amputation: The role of barefoot, heel support, and vision

Abstract

Background: In some cultures, shoes are not worn indoors. Prosthesis use barefoot can lead to pressure injuries and loss of balance due to abnormal residual limb loading. Objective: This study aimed to compare the effect of wearing standard alignment prostheses using barefoot at home and visual alteration on static balance and pressure distribution in individuals with unilateral transfemoral amputations (TFAs) or transtibial amputations (TTAs). Study design: Prospective parallel experimental study. Methods: Participants with unilateral TTAs (n = 44) and TFAs (n = 37) were included. Balance and load distribution were assessed using MatScan pressure platforms, both with a heel (3 x 2 cm(2) area; 1.8 cm height) support (the use of shoes with a heel is mimicked) and barefoot. Results: Balance parameters were disrupted in all groups when eyes closed position (p < 0.05). Using heels reduced anterior-posterior and medial-lateral sway in TTA group during eyes closed (p < 0.05). When standing barefoot with the eye open position, TFA group had more load on the rear foot of the prosthetic foot and less load on the forefoot than TTA group (p < 0.05). The opposite pattern was observed in the intact foot (p < 0.05). Using heels in TTA group increased the load on the front of the intact side and the rear of the prosthetic side (p < 0.05). Conclusion: The balance parameters were impaired in both groups while standing barefoot in the absence of vision. However, using heel supports improved static balance in the TTA but not in the TFA group. Using heel support changed this load distribution in both groups, especially in the TTAs, and created positive changes.