You are on page 1of 10

BELOW-KNEE PROSTHESES AND COMPONENTS

The basic components of below-knee prostheses are a foot-ankle
assembly, shank, socket, and suspension element.

FOOT-ANKLE ASSEMBLY
All prostheses terminate in a foot-ankle assembly which substitutes for
the anatomic foot and ankle and satisfies several basic requirements. The
assembly should:
1. Provide a base for weight bearing
2. Absorb shock at heel contact and rapidly reach foot-flat position
3. Provide for metatarsopharyngeal hyperextension late in stance phase
4. Resemble the general contour of the missing foot
In addition, many components offer additional functions such as mediolateral
motion or energy storage and return.

Types:
1. Non-articulated Components
 Most below-knee prostheses incorporate a non-articulated
assembly; that is, the foot is attached directly to the shank with
neither a joint nor movement in the region corresponding to the
natural ankle. The popularity of non-articulated assemblies
relates to their streamlined appearance at the ankle and their
relative durability. They are also generally quieter and lighter
than articulated components.
 Non-articulated assemblies share basic design characteristics.
The weight supporting structure inside the foot, designated as
the keel, is surrounded by resilient material. In particular, the
heel are includes a considerable amount of such material.
Consequently, at heel contact, when the wearer first applies
weight to the foot, the posterior material compresses, simulating
plantar flexion and absorbing shock. As the individual moves
forward over the prosthetic foot, the keel provides a firm base of
support. When weight has been transferred to the end of the
keel, which is at a point corresponding to the
metatarsophalangeal joints, the foot bends into toe
hyperextension, allowing the heel to lift from the ground. During
swing phase, the unloaded foot reverts to a neutral position.
Differences among feet relate primarily to the design of the keel,
materials and the models which are available to accommodate
shoes of various sizes and heel heights.

a. SACH Foot (Solid Ankle Cushion Heel)

Mediolateral and transverse motion. improving the appearance of the prosthesis. affording the patient a small amount of mediolateral and transverse motion to accommodate to irregular terrain. however.  SACH foot with an external keel may be selected. The most frequently prescribed assembly is the SACH foot. The amount of this simulated plantar flexion depends on the resilience of the heel material and the weight and activity level of the wearer. Belting. If the patient does not transfer substantial weight to the prosthesis. MAIN DISADVANTAGE of SACH Feet is the risk of delay in reaching the foot-flat position in early stance. the SACH foot does not provide dorsiflexion. It consists of a wooden keel covered by relatively incompressible foam. it can be covered with the same plastic laminate finishing as on the shank. suitable for young children’s to large adult’s feet. the cushion heel compresses when weight is applied. the foot has greater mediolateral stability. are minimized by this design. permitting the forefoot to approach the floor. The keel is wider than in the basic SACH foot. sometimes with a separation between the first and second toes to enable the wearing of tonged sandals. underlies the keel preventing it from puncturing the sole. . the material surrounding the keel does yield slightly upon application of weight. Active or obese users require a firmer heel than feeble or slender individuals. thus tending to cause the knee to flex excessively. and the prosthesis will rotate forward on the heel as a pivot. Versions with the forepart molded to suggest toes and toenails can be ordered. and a synthetic rubber heel wedge. Models are available to accommodate flat-soled and high- heeled shoes as well as all amputation levels from Syme’s upward. Because the keel is rigid.  In both types. a strip of tough fabric. Consequently. Because the dorsum of the keel is exposed. the heel cushion will not compress adequately. A bolt through the keel attaches the foot to the shank.  SACH feet are relatively inexpensive and are manufactured in a wide range of sizes. Although rather firm. the forefoot will fail to reach the floor quickly.

is heavier and more expensive than SACH feet of comparable size. c. similar to the plantar aponeurosis in the anatomic foot.b. and can be used for all amputation level. Seattle Foot  The earliest energy storing design to become commercially available was the Seattle foot whose DeIrin keel is in a C shape with the lower arm considerably elongated as a cantilever. the amount of energy return is quite modest. Transfer of body weight over the foot first compresses the plugs. a small amount of bending of the flexible keel after heel-off simulates dorsiflexion. it includes a cushion heel for shock absorption and simulated plantar flexion.  The SAFE foot is available in adult sizes. This is of some significance because yielding in the foot reduces stresses that would otherwise be applied to the encased limb by the socket. . Like the SACH foot. It consists of a rigid bolt lock (the stationary attachment) embedded in a flexible keel (the endoskeleton). the bands on the plantar surface tighten to increase structural stability. d. including Syme’s. SAFE Foot (Stationary Attachment/Flexible Endoskeleton)  foot. then permits them to recoil.  Also. more frontal and transverse plane motion is available to accommodate uneven terrain. With this design. At the same time. Hence. unlike the SACH foot. though it is somewhat heavier and more expensive. It permits mediolateral and transverse motion not only through compression of resilient foam (as does the SACH foot) but also through the keel’s flexibility.  STEN foot duplicates the SACH foot. STEN Foot (Stored Energy)  The STEN foot includes a wood keel which is in three pieces joined by two rubber plugs.

Carbon Copy II  Considerable energy is stored and returned by the Carbon Copy II foot whose keel is composed of two strong but light plates constructed of carbon composites.  Though somewhat heavy. e. while the shorter. An alternate version of reduced weight and springiness (the Seattle Lite Foot) has recently become available. This stored energy is returned during late stance. The longer deflection place which terminates at the level of the distal interphalangeal joints. Quantum  Lightweight non articulated foot  Its keel is in the form of a spring module consisting of a lower and upper deflection plate attached to the ankle base. upper plate is activated under very high loads such as may be produced by jumping or running. The lower of the two plates that project .  Differs from previously described designs by not including a cushion heel. f.  Transfer of body weight over the foot bends the cantilevered arm. It is manufactured in adult sizes to suit shoes of two low-heel height. This foot is relatively lightweight and durable. but provides little mediolateral motion.  The plates are available in three levels of resistance to suit the anticipated vigor of the user. thus contributing to forward propulsion during walking and cunning. returns energy during walking. From the base. the plates project forward to the metatarsophalangeal joints and backward into the heel. the Seattle foot provides excellent function and is made in a range of adult sizes. The functions of simulated plantar flexion and impact absorption ace provided by the heel deflection plates.

Flex-Foot. The foot is manufactured in adult sizes to fit low heeled shoes. while the secondary upper plate acts as an overload spring in case of unusually high forces. Flex-Walk  Is another energy storing.or a low-heeled shoe.  Requires sufficient space between the floor and the residuum end. rather. forward is the primary spring that stores and returns energy during the last half of stance phase. g. non- articulated foot-ankle assembly whose keel is made of a lightweight carbon graphite composite.  Interestingly.  The relatively broad keel provides little inversion-eversion. bending when loaded and then straightening forcibly when the load is reduced.  The spring module or keel. As a result.  The prosthesis incorporating this design is lighter than one with other foot-ankle components. and it is appreciably more expensive than other feet. . the keel extends forward to the metatarsophalangeal joint line and includes a heel section which substitutes for a compressible cushion heel.  Extends from the metartarso-phalangeal joint line to the bottom of the below-knee socket or. for above- knee wearers. the Flex-Foot stores and returns more energy than any other foot-ankle assembly. which is available in several degrees of firmness.  The shank portion acts as a long leaf spring.  As in the Quantum foot. the heel section comes in two versions suitable for either a high. h. affording the wearer inversion and eversion to accommodate ground irregularities. to the knee unit and the keel forms the shank of the prosthesis. it is stable medio-laterally and resists torsion. is encased in a semi-flexible cosmetic shell which yields to medial and lateral loads.  The module is encased in a plastic foam cosmetic cover to create a pleasing appearance and is sized for both adults and children.

It provides only slight assistance for mediolateral stability but resists forces that tend to move the knee into hyperextension. Most amputees.2. passes over the superior edge of the patella. Cuff Suspension Strap  The basic PTB prosthesis is suspended by means of a cuff which is attached to the medial and lateral socket walls. . find the stump- socket pressures well within their tolerance with this type of suspension. with the possible exception of those with short or painful residua. and encircles the thigh above the femoral condyles. Suspension Systems a. The cuff serves primarily to retain the prosthesis on the limb.

Therefore. The higher walls encompass the femoral epicondyles fully and terminate proximally with a smaller mediolateral diameter than that at the apices of the epicondyles. .b. the space is filled with a removable plastic wedge inserted between the socket wall and the medial epicondyle. is to incorporate into the soft insert a contoured proximomedial buildup which serves the same function as the removable wedge. Supracondylar (SC) System  Supracondylar suspension employs medial and lateral walls higher than those of the original PTB design. probably more commonly used. The second method. b. the prosthesis cannot slip down over the epicondyles. a proximolateral soft insert buildup may be added. if donning is difficult. Once the amputee has inserted the limb into the socket. Two methods facilitates donning: a. The compressible but resilient buildup allows the epicondyles to enter the socket and yet retains firm suspension. once donned. The first involves forming the medial and lateral walls of the socket with sufficient with to permit the relatively protuberant epicondyles to enter the socket. Occasionally.

and the high anterior brim of the SC/SP may protrude uncosmetically when the wearer sits. and increases sensory feedback.c. In addition to sespending the prosthesis.  These variants require more attention in fitting than those the standard PTB. provides mediolateral stability. In some . but effectively resists and tendency toward recurvatum. has a high anterior wall which covers the entire patella. d.  Both of the above suspension variants provide greater mediolateral stability at the knee and eliminate the cuff. The proximal brims of both the SC and the SC/SP are somewhat bulkier. the corset supports part of the body weight. The high molded anterior wall of the SC/SP not only helps retain the prosthesis on the limb. Thigh Corset  The thigh corset is attached to the socket and shank by the side bars and knee joint assembly. Supracondylar/Suprapatellar (SC/SP) System  The supracondylar/suprapatellar (SC/SP) suspension system has similarly high medial and lateral socket walls/ and in addition.

extends from the posterior aspect of the thigh corset to the shank and checks the motion of the shank as the knee approaches full extension. e. irritation. and pressures on the residuum. Though somewhat heavier and less durable. cases a flexible waist belt and fork-strap assembly are used to aid in suspension. when the knee is flexed. so that the residual torque is not troublesome. particularly for the very short stump. polycentric mechanical joints may be useful in solving these problems. the socket tends to twist on the amputated limb.  In as much as the human knee joint is not a simple single- axis joint. some relative motion between the prosthesis and the limb will occur when single-axis mechanical joints are used. by an elastic strap. the elastic strap is stretched further and the increased tension acts to extend the knee. causing a shearing effect at the stump-socket interface. The fork strap is attached to the shank of the prosthesis and. to the waist belt. its constricting effect may cause atrophy of the thigh. preventing the metal stops of the knee jointfrom coming into abrupt and noisy contact. Other disadvantages of the thigh corset are that it is bulky. This relative motion can cause chafing. the torque . if used. The elastic straps exerts an upward pull on the prosthesis to aid in suspension. Some of the torsional forces are absorbed in the foot- ankle assembly. In addition. Rotator Unit  When an amputee walks. In other cases. and it may aggravate any edema in the amputated limb. adds to the weight of the prosthesis. particularly with active amputees. A check strap.

A resilient element that is incorporated between the upper and lower attachments of the unit permits the rotation of the shank to take place while the foot is in contact with the floor. . Different models are available for use with exoskeletal and endoskeletal shank construction. applied to the stump is a source of discomfort. a torque-absorber rotator mechanism mat be used.  To cope with this problem. It is not indicated for most below-knee amputees but may be useful for those who have thigh corsets or are active athletes encountering discomfort.  The rotator unit is interposed between the lower end of the shank and the foot ankle-assembly.