Indigenous substitutes for modern prostheses and orthoses

Characterisation of prosthetic feet used in low-income countries

Eleven kinds of prosthetic feet that were designed for use in low-income countries were mechanically characterised in this study. Masses of the different kinds of prosthetic feet varied substantially. Dynamic properties, including damping ratios and resonant frequencies, were obtained from step unloading tests of the feet while interacting with masses comparable to the human body. Data showed that for walking, the feet can be appropriately modeled using their quasistatic properties since natural frequencies were high compared to walking frequencies and since damping ratios were small. Roll-over shapes, the effective rocker (cam) geometries that the feet deform to under walking loads, were determined using a quasistatic loading technique and a spatial transformation of the ground reaction force's centre of pressure. The roll-over shapes for most of the prosthetic feet studied were similar to the roll-over shape of the SACH (solid-ankle cushioned heel) prosthetic foot. All roll-over shapes showed a lack of forefoot support, which may cause a "drop-off" experience at the end of single limb stance and shorter step lengths of the contralateral limb. The roll-over shapes of prosthetic feet appear useful in characterization of foot function.

Different approaches and cultural considerations in third world prosthetics

The major objective of prosthetics the world over is the same, i.e. to restore the amputee to as functional a capacity as possible in his cultural environment, whilst attaining as good a cosmetic result as can be achieved. At first glance it would seem that this would mean there would be very little difference in approach to the subject in western and in third world countries. Availability of materials, resources and skilled personnel, together with a variety of cultural differences, however, make third world prosthetics a subject in itself. This paper reviews the literature available on the subject, examines some different approaches to prosthetics in the third world, gives an overview of some materials and designs used and considers adaptations for cultural differences. It concludes that, whilst direct transfer of western prosthetics technology is useful in the short term, for long term benefit to the poorer amputees in the third world, culture-specific designs and materials are more appropriate.