Lecture four *Artificial Organs 1 * Dr.

Waleed Jasim

Prosthetic Foot Characteristics

One of the key factors in designing a new prosthesis is in the analysis of
a patients response. This view is the most important because if the foot does
not provide functional, practical or cosmetically acceptable characteristics
the patient will not feel comfortable with the prosthesis. The characteristics
deemed important by patients in achieving natural. Gait motion include :

• Dorsiflexion
• Eversion
• Impact Absorption
• Energy Return
• Ankle Torsion

In order to understand the characteristics of a prosthesis it is important to

relate them to the mechanism of a human foot.

FOOT FLEXION
The flexion of a human foot can be measured about a number of planes
• plantar : the ability for the foot to bend down
• dorsi : the ability for the foot the bend up
- sagital : the ability for the foot to rotate

1 - Dorsiflexion
Once the foot has become flat, the leg rolls over the foot until it reaches a
peak dorsiflexion of 8 to 10 degrees. As the heel rises off the ground the
ankle plantar – flexes to a position of 18 to 23 degrees. In the later part of
the stance the amount of plantar - flexion reaches up to 30 degrees.

2 - EVERSION
The ability of a human foot to roll from side to side, called
inversion and eversion, is important when walking on
uneven surfaces. The foot must make compensations in
order for the person to remain balanced, as shown in
figure.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

3 - Impact Absorption
To determine the shock absorption properties of the prosthesis at heel
strike and estimate the contact time of the prosthesis with the force plate.
Determine which prosthesis has the best shock absorption properties at heel
strike.

4 - ENERGY RETURN
The capacity for a prosthesis to store energy is very important in order to
replicate the motion of a sound foot. In the operation of a sound foot,
energy is stored during the stance phase of walking and is released on the
transferral of weight.

5 - Ankle Torsion
To measure the amount of torque generated around the ankle component
of prosthesis. For the purpose of this investigation, establishing a
measurable torsional value characterizing the various prosthesis. In
additions, determining how favorably such characteristics compare to the
torsional properties exhibited by a normal foot.

Foot Component
A prosthetic foot comprises of a heel, keel, ankle adaptor and a cosmesis.
These components vary in geometry, orientation and material composition
in each prosthesis, according to their specific function.

Keel :- The function of a keel within a prosthesis is to provide the energy

transfer from the heel strike through to the toe off and the dorsiflexion
required for natural ambulation. Depending upon the quantity of
surrounding foam it also provides rotational properties such as eversion and
torsion.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

Heel
The function of a heel within a prosthesis is to provide the impact
absorption at heel strike and also provides the kinetic energy required for a
smooth transition between the heel strike and the toe off.

Ankle
A mechanism of the ankle having the pattern of the moment of resistance
to angulations seen in an anatomical ankle joint. Power in the ankle joint
reaches its maximum at the end of stance Phase. The foot provided
smoother and more silent stops for flexion and dorsiflexion within an
anthropomorphic range in the pivoted ankle joint.

Cosmetic
The value of “cosmetics” in a prosthetic limb – such as a skin-coloured
cosmetic cover to conceal the working components of an artificial limb, or
close visual approximation of a limb‟s characteristics (including, in some
cases, veins and hair) – was frequently described as of personal value to
participants.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

** FEET TYPES **
Current prosthetic foot designs do not replicate the exact characteristics
of a normal human foot. A human foot is a multi - functional device that
can be used to perform a wide range of activities, however, a prosthetic foot
is limited to only a few. More recently, manufacturers of prosthetic feet
have looked into the characteristics of a prosthesis that may be adjustable.
The amputee may then be able to perform a number of activities without
requiring a different prosthesis.
It is important to establish the characteristics of a human foot used in its
functional operations. This investigation has limited the activities to normal
gait cycle in walking, the most common use of a prosthetic foot. The
characteristics of a human and prosthetic foot covered in the scope of this
investigation are dorsiflexion, eversion, impact absorption and the torque
generated at the ankle. These are the most important characteristics in
determining an appropriate prosthesis, according to prosthetic feet patients.

1 - SACH FOOT
There are several companies that produce the Solid Ankle Cushioned
Heel (SACH) prosthesis. This is one of the most popular prosthesis due to
its low maintenance and relatively low cost. The SACH design has a solid
ankle, made of wood, metal, or plastic, which is then surrounded by rubber
or foam with a cushioned heel. The cushioned heel is for absorbing shock in
the initial phases of the gait cycle to allow the user to mimic more nature
gait patterns. The rigid keel also provides a stable weight-bearing platform,
which provides the user with confidence in their prosthetic. The cushioned
heel lessens impact of weight transfer and the flexible material of the toe
allows for a smoother rollover at the end of the gait cycle

The SACH Foot is characterised by its:

• Wedge shaped heel cushions.
• Varying heel densities.
• Varying material keel.
• Rubber body and bolt attachment

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

Advantages. The SACH prosthetic design has many variations, but they are
all based on a similar concept.
 THE SACH foot is generally used when mid-stance stability is desired
for the user.
 The SACH foot has been considered the standard prosthetic
prescribed to those with low function and activity levels.
 The SACH foot was the first prosthetic foot to exhibit roll-over shape.
The minimal parts allow for easier use and maintainability.
 The SACH foot is available at low cost because of the minimal parts
needed and is the most prescribed. `

Disadvantages Several shortcomings of the SACH foot have been

discovered in clinical trials and in human subject testing.
 The SACH foot often exhibits shortcomings in plantar flexion due to
its rigid design. This aspect of the foot also plays into its success
because the rigidity in turn offers stability in the early phases of the
gait cycle.
 The SACH foot has also had issues with low energy return when
compared to the Flex Foot.
 The SACH foot has a shorter roll-over shape than a human foot and
other prosthetic feet.
SACH FOOT Characteristics :
Dorsiflexion Due to deflection of the foam and timber keel
Eversion Large amount of foam on the underside of the keel.
Energy Return Strain energy of the foam surrounding keel in fore foot.
Torsion Distortion of the foam around keel on ankle base.
Impact Absorption Varying density foam of heel wedge.
SACH FOOT Components :
Heel Polyurethane Foam - Soft Density
Keel Rigid wooden, metal, carbon fibers or plastic
Ankle Block Cosmesis surrounding keel
Cosmesis Moulded Polyurethane Foam

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

2 - SAFE FOOT
The SAFE Foot (Stationary Ankle Flexible Endoskeleton) has a solid
ankle and provides large amounts of transverse rotation as well as inversion
and eversion. The advantage of the SAFE Foot is that it is moisture and grit
- resistant. This makes this prosthesis very low maintenance. The SAFE
foot and other soft keel designs should be viewed as offering increased
shock absorption and comfort at the expense of responsiveness in a
competitive situation.

The SAFE foot has a keel composed of a rigid polyurethane bolt block
(stationary attachment) joined to a polyurethane elastomer section (flexible
endoskeleton) at a 45-degree angle in the sagittal plane to correspond with
the orientation of the normal subtalar joint. The bolt block is manufactured
with a slot permitting the wearer to adjust the angle of plantar flexion,
thereby accommodating shoes of various heel heights. The SAFE assembly,
by passively inverting and everting, adapts to ground irregularities much
more than does the SACH foot.
The SAFE unit incorporates (polyester fiber) bandson the plantar surface,
which tighten at heel-off to make the foot more rigid during late stance. The
component is made in adult sizes and in a version to be used with the
Syme's prosthesis. The SAFE foot is heavier than the SACH foot, although
lighter than the Greissinger component whose action it approximates. The
SAFE assembly is also slightly more expensive than the SACH foot.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

SAFE FOOT Characteristics :

Dorsiflexion Deflection of the ligament bands and keel.

Eversion Keel flexion and elasticity of rubbers about the base.
Energy Return Elastic energy store due to rubbers about the base.
Torsion Ankle block movement in the second urethane foam.
Impact Absorption Density of heel foam.

SAFE FOOT Components :

Heel Polyurethane Foam.
Keel Flexible urethane.
Ankle Block Maple.
Cosmesis Moulded Polyurethane Foam.

3 - STEN FOOT
The STEN foot is one of the simplest designs in prosthetic feet. Keel
redesign is evident in several new nonarticulated components that are
sometimes referred to as "energy storing." These innovations have a keel
that changes shape under load bearing, storing energy that is then released
when the amputee advances over the foot. The "STored ENergy" (STEN)
foot* has a three-piece maple keel with dense foam-rubber cylindrical plugs
at the metatarsophalangeal and tarsometatarsal joints (Fig).

The keel is undergirded by a strong woven belting. A cushion heel lies

under the belting in the posterior portion of the foot. The keel and cushion
heel are surrounded by synthetic foam rubber molded to simulate toes and
toenails.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

Motion at the keel segments accommodates ground irregularities and

smooth's stance transition with a mild spring action. The STEN foot is
intermediate in weight and cost as compared with the light, inexpensive
SACH assembly and the heavier, more costly SAFE foot. It comes in a
wide variety of sizes and heel heights from a child (18cm keel) through to
an adult (30cm keel). The heels also come is soft, medium or hard densities.
Although it is slightly heavier than the conventional SACH foot, it differs in
its keel which allows for smooth roll - over of the prosthesis. As the name
suggests the STEN, Stored ENergy, has the capacity to store energy.

The STEN Foot is characterised by its :

• Varying density heel
• Polyurethane bumpers
• Reinforcement bands

STEN FOOT Characteristics :

Dorsiflexion Flexible keels with bumper spacers and reinforced belting.

Eversion Twisting of the keel, bumpers and foam deflection.
Energy Return Elasticity of bumpers and reinforced keel.
Torsion Distortion of keel within surrounding foam of ankle block.
Impact Absorption Foam heel wedge

STEN FOOT Components

Heel Polyurethane Foam
Keel Varying density foams between bumpers and keel.
Ankle Block Wooden.
Cosmesis Moulded Polyurethane Foam

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

4 - SEATTLE NATURAL FOOT

The Seattle Natural Foot is the best alternative to any SACH foot on the
market today. The Natural Foot has all of the performance characteristics of
a compliant foot plus the additional benefits of Seattle cosmesis and less
weight, all blended to perform naturally. Features
of the Seattle Natural foot include
• Slim, sculpted, natural-looking cosmesis
• 3/8" heel rise
• Low to medium-low activity level
• Available in various skin colours

The Seattle Foot has (acetal polymer) semirigid keel with Kevlar fabric toe
pad and a cushion heel (Fig). The foot is covered with polyurethane molded
to provide the most anatomic external replication of any commercially
available foot. Energy storage is achieved by a cantilevered, sagittally
wedged keel that is fastened at its wide portion posterior to the ankle bolt
and tapers to the metatarsophalangeal area.
The amputee can The Seattle Natural Foot meets the requirements of
amputees of all ages with low to medium-low activity levels. It is
appropriate for use by unilateral and bilateral lower extremity amputees.

SEATTLE NATURAL FOOt Characteristics :

Dorsiflexion Due to keel deflection and intermediate rubbers.
Eversion Deflection of rubbers about the base of the keel.
Energy Return strain energy store due to keel and intermediate
rubbers within keel.
Torsion Distortion of keel within foam
Impact Absorption Density of heel foam.

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

SEATTLE NATURAL FOOT Components :

Heel Polyurethane Foam.
Keel Flexible, nylon with varying density foam inserts.
Ankle Block Cosmesis surrounding keel.
Cosmesis Moulded Polyurethane Foam – realistic

5 - SEATTLE LIGHT FOOT

The Seattle Light Foot set the standards of performance, versatility,
and cosmesis for dynamic response prosthetic feet. The keel affords the
Light foot a unique combination of fatigue resistance, toughness, and
spring-like resilience without the transmission of shock for a smooth,
dynamic gait.

Features of the Seattle Lite foot include :

• dynamic response keel
• Lightweight design
• Sculpted life-like appearance
• Available in various skin colours

The result is a prosthetic foot that employs a plastic keel or leafspring

embedded in a cosmetic foam foot. This keel deflects under load, storing
the amputee's stance energy and then returns this energy when the amputee
steps off his foot giving him a noticeable "push". The action is somewhat
like that of the achilles tendon in a normal foot.

The Seattle Light foot is appropriate for amputees of all ages and activity
levels and can be fit on all unilateral and bilateral lower extremity amputees
down to the Symes level. The light foot is available in sizes 22-30 cm and is
limited to use on individuals under 135 kg

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

SEATTLE LITE FOOT Characteristics :

Dorsiflexion Density of encasing foam and flexible keel.
Eversion Distortion of the foam about the keel.
Energy Return Elastic properties of keel and foam.
Torsion Rubber surrounding keel at ankle base.
Impact Absorption Density of heel foam.
SEATTLE LITE FOOT Components :
Heel Polyurethane Foam.
Keel Flexible, nylon
Ankle Block Hollow section.
Cosmesis Moulded Polyurethane Foam - realistic.

6 - DYNAMIC FOOT
Another SACH design is the Dynamic Foot which has a short keel that
adjusts automatically to the alignment needed for flat-soled and low-heeled
shoes. Cushion heels are manufactured in several grades of resilience to
accommodate the force that the wearer applies. Force depends on the
patient's body weight and activity level. In all instances, the action
influences the location of the floor reaction relative to the superior joints. A
soft cushion, a very resilient plantar bumper, and flaccid dorsiflexor
muscles all permit the floor reaction to pass anterior to the ankle and knee.
The cushion heel also yields somewhat to frontal and transverse plane
stresses. The Dynamic Foot consists of a wooden ankle block encased by
two layers of varying density foam. It is constructed so that it can produce
excellent shock absorption at heel strike and provide a smooth transition
from heel strike to toe off.

The Dynamic Foot is characterised by its.

• Rigid keel surrounded by foams
• Varying density foam construction

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Lecture four *Artificial Organs 1 * Dr. Waleed Jasim

The Dynamic Foot is ideal for all patient groups and prosthesis adaptors so
it can be used for a maximum weight of up to 150 kilograms.

SACH feet have no moving parts and an internal keel. In dynamic SACH
feet a flexible or dynamic keel allows forefoot to flex under load. As load is
released, the keel returns to its original shape. The flex acts as a shock
absorber and gives the user a little extra „push‟ as their weight is transferred
over the toe. A heel wedge compresses at heel strike. This lowers the
forefoot to the ground as weight is transferred onto the foot. As the user
rolls over the toe the toe break flexes to smooth the transition.

DYNAMIC FOOT Characteristics :

Dorsiflexion Deflection of the keel and secondary foam
Eversion Distortion of keel and secondary foam
Energy Return Elastic properties of the two foams
Torsion Distortion of keel within surrounding foam of ankle Block
Impact Absorption Density of primary and secondary foams

DYNAMIC FOOT Components :

Heel Polyurethane Foam.
Keel Short, rigid with secondary polyurethane surrounding
Ankle Block supplied with installed titanium adapters
Cosmesis Molded Polyurethane Foam

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