Eva Pröbsting, Thomas Schmalz, Malte Bellmann

IMPACT OF AMPUTATION LEVEL AND VAULTING ON LOADING PARAMETERS DURING LEVEL GROUND WALKING

Introduction

Impact of amputation level and vaulting on loading parameters during level ground walking. Discover how lower limb amputation level and compensatory vaulting impact contralateral limb loading during walking. This study analyzes biomechanical forces and knee moments across diverse amputation types.

Abstract

BACKGROUND: Previous studies show that during level walking, the load on the contralateral side increases with more proximal amputation levels. Furthermore, a typical compensation mechanism, vaulting on the contralateral side, may also influence the load. However, no study has compared the load applied to the contralateral side across more than two different amputation levels. OBJECTIVE: The objectives of this study were to analyze the biomechanical impact of different lower limb amputation levels and vaulting on the load applied to the locomotor system. METHODOLOGY: Gait data from 82 individuals with different amputation levels (44 transtibial (TT), 30 transfemoral (TF), and 8 hip disarticulation (HD)) were retrospectively analyzed in this study. Peak knee adduction, flexion and extension moments, vertical ground reaction force peaks, and force rates were statistically analyzed between different amputation levels and between two groups “TF with vaulting” and “TF without vaulting”. FINDINGS: As the level of amputation increases, walking speed decreases and asymmetry of stance duration increases. TF individuals with vaulting tend to walk faster than those without vaulting. The first peak of vertical ground reaction forces, the peak knee adduction and extension moments increase, and the peak knee flexion moments decrease with higher amputation level. The higher the amputation level, the curve of the vertical ground reaction force becomes significantly steeper during the first 5% of the gait cycle (GC). The first peak of ground reaction forces, the knee flexion, extension and adduction moments tend to be higher in TF individuals with vaulting. CONCLUSION: In summary, a higher lower limb amputation level can increase loading on the contralateral limb and contribute to a higher incidence of vaulting during gait. The effect of vaulting as a compensation pattern leads to an additional increase in contralateral limb loading. Layman's Abstract Gait characteristics in people using lower limb prostheses deviate from normal gait patterns in individuals without amputation. Furthermore, some people with amputation rise onto the toes of their intact side (a movement known as vaulting) as a compensatory mechanism during walking, which helps them clear the ground on the prosthetic side. In people with lower limb amputation, the load applied to the intact side during level walking is higher compared to able-bodied individuals, and it increases as the level of amputation progresses from below the knee to hip disarticulation. No previous study has compared the load applied to the intact side across more than two different amputation levels. The aims of the present study were to analyze the influence of the amputation level and of vaulting on the load applied to the lower limb. Therefore, we analyzed previously collected gait data from 82 individuals with amputation (44 transtibial, 30 transfemoral, and 8 with hip disarticulation). As the level of amputation increases, walking speed decreases and individuals tend to spend more time on the intact side than the prosthetic side during each gait cycle. Individuals with transfemoral amputation who use vaulting as a compensatory movement tend to walk faster than those who do not use this strategy and experience higher forces on the intact limb. As the level of amputation increases, most of the forces applied to the body during level walking also increase. Furthermore, vaulting is more common in individuals with higher amputation levels. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44416/33698 How To Cite: Pröbsting E, Schmalz T, Bellmann M. Impact of amputation level and vaulting on loading parameters during level ground walking. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 2. Https://doi.org/10.33137/cpoj.v8i1.44416 Corresponding Author: Eva Pröbsting, Dipl.-Ing (FH)Affiliation: Clinical Research and Services, Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany.E-Mail: Eva.Proebsting@ottobock.deORCID ID: https://orcid.org/0000-0002-6349-2992

Review

This study rigorously investigates the critical biomechanical implications of varying lower limb amputation levels and the common compensatory mechanism of vaulting on the intact limb during level ground walking. Addressing a notable gap in existing literature, which has primarily focused on comparing only two amputation levels, the authors set out to comprehensively analyze the load applied to the locomotor system across transtibial, transfemoral, and hip disarticulation amputations. The work provides a timely and important contribution to understanding the complex interplay between amputation severity, gait adaptations, and the resultant forces experienced by the contralateral limb, an area with significant implications for long-term musculoskeletal health and prosthetic rehabilitation. Utilizing a robust retrospective analysis of gait data from 82 individuals, the methodology carefully examined peak knee moments and vertical ground reaction force (vGRF) parameters. The findings reveal a clear and concerning trend: as the level of amputation becomes more proximal, walking speed decreases, stance duration asymmetry increases, and several key loading parameters on the contralateral limb intensify. Specifically, the first peak vGRF, peak knee adduction and extension moments were found to increase, while peak knee flexion moments decreased with higher amputation levels, alongside a steeper vGRF curve in early stance. Furthermore, the study effectively isolated the impact of vaulting, demonstrating that transfemoral individuals who exhibited this compensatory pattern tended to walk faster but experienced notably higher first peak vGRF and all analyzed knee moments (flexion, extension, and adduction) compared to their non-vaulting counterparts. In conclusion, this research compellingly demonstrates that both a higher lower limb amputation level and the presence of vaulting as a compensatory gait pattern independently, and in concert, contribute to increased loading on the contralateral limb. The finding that vaulting leads to an *additional* increase in contralateral limb loading is particularly significant, highlighting the potential for this seemingly beneficial compensation to accelerate degenerative changes in the intact limb over time. The study's comprehensive analysis across multiple amputation levels, coupled with its focus on a specific compensatory mechanism, offers invaluable insights for clinicians, prosthetic designers, and rehabilitation specialists in developing strategies to mitigate adverse loading effects and improve the long-term health outcomes for individuals with lower limb amputations.

Full Text

Comments

You need to be logged in to post a comment.