Physiological responses to multiple speed treadmill walking for Syme vs. transtibial amputation--a case report.

PURPOSE: To date, there have been no longitudinal studies comparing walking at different levels of amputation. The objective of this study was to compare the self-selected walking velocity (SSWV) and selected physiologic variables during walking between a Syme and a later transtibial level of amputation for a single subject. Additional comparison was made between the SACH foot prosthesis and a dynamic response foot prosthesis.

METHOD: A 35-year-old male with a traumatic Syme amputation later underwent elective transtibial amputation. SSWV and multiple speed treadmill walking tests (53.64, 67.05, 80.46, 93.87 and 107.28 m/min) were evaluated under three conditions (Syme prosthesis with SACH foot, transtibial prosthesis with SACH foot, and transtibial prosthesis with Flex-Foot).

RESULTS: Walking with transtibial prosthesis showed minimal differences in oxygen consumption (0 - 5% reduction), heart rate response (0 - 1% reduction), or gait efficiency (0 - 5% improvement) across all speeds when compared with Syme prosthesis (both with SACH foot). However, the SSWV was 6 - 8% faster for the transtibial SACH foot. Walking with transtibial Flex-Foot required less cardiovascular demand than with transtibial SACH foot at higher speeds.

CONCLUSIONS: In this case report, it seemed that transtibial amputation did not have adverse effects on selected physiological responses at a variety of walking speeds when compared to Syme amputation, and that the use of a dynamic response foot enhanced his gait performance. Further experimental studies involving more subjects with traumatic Syme and transtibial amputations are required to better understand the effect of these two levels of amputation on energy cost of walking.