FUNCTIONAL ASSESSMENT OF BALANCE AND GAIT IN TRANSTIBIAL AMPUTEES USING K2 VS. K3 PROSTHETIC FEET

Purpose (a): The K-Level classification of prosthetic feet is used in conjunction with a similar classification of functional level of amputees to determine which prosthetic feet will be prescribed and reimbursed. Individuals classified as ambulatory level 2, receive a K2 prosthetic foot and not the higher functioning K3 prosthetic. This provides less technology to the patients who need it most, limiting them in their current and potential abilities. We aimed to evaluate gait and balance in transtibial amputees ambulating with either a lower cost K2 prosthetic foot or the more functional dynamic response K3 prosthesis. We hypothesized that K3 prosthesis will show immediate improvements in gait and balance, and a 2- week trial with a K3 would increase functional level and quality of life. Methods (b): Research participants with transtibial amputations secondary to diabetes or vascular disease were fitted by a certified Prostestist-Orthotist with either a K2 or K3 prosthesis. On the initial study visit the quality of life baseline established using standardized questionnaires for reintegration after amputation. Also, the V-gait CAREN (Computer Assisted Rehabilitation Environment Network) system was used to establish baseline balance and gait measures and immediate effects of switching type of prosthesis. The participants were then randomized into groups for a 2-week trial period of wearing a prosthetic foot (K2 or K3) that was either at, above or below the current functional level of the amputee. Post-trial measurements of balance, gait, and quality of life were reassessed. Results (c): To date two subjects have been enrolled in the study. Both subjects expressed limitations and changes in quality of life due to amputation. Balance was compromised in conditions of dual tasks and subjects had significant difficulties walking up and down ramps illustrated by changes in lower limb kinematics. When tested with a K2 prosthetic, one subject was unable to maintain baseline gait velocity even on level ground. Conclusions (d): Preliminary results confirm that K3 prosthetic foot provides additional benefits for balance and gait function compared to K2. Providing higher level prosthetic feet to patients who are classified at lower functional level could improve their balance, prevent serious costly injuries caused by trips and falls, and facilitate transition to higher functional status. Therefore, it is pertinent that the proper K level prosthetic be prescribed.