تعديل مناقشة

Ministry of Higher Education &
Scientific Research
Al-Nahrain University
College of Engineering
GAIT ANALYSIS OF BELOW KNEE AMPUTEES

WEARING DIFFERENT PROSTHETIC FEET
A Thesis
Submitted to the College of Engineering of
Al-Nahrain University in Partial Fulfillment
of the Requirements for the Degree of Master of Science
in
Biomedical Engineering
by
Hamza Abbas Fadhel
)B.Sc. Biomedical Engineering 2015(
Rabi Al-Thani 1442

November 2020
Supervisor Certification
We certify that this thesis entitled "Gait Analysis of below Knee Amputees
Wearing Different Prosthetic Feet" was prepared under our supervision at
the College of Engineering / Al-Nahrain University in partial fulfillment of
the requirement for the degree of Master of Science in Biomedical
Engineering.
Asst. Prof. Dr. Sadiq J. Hamandi Asst. Prof. Dr. Muhammed Abdulsattar
Muhammed
Supervisor Supervisor
/12/2020 /12/2020
In view of the available recommendation, we forward this thesis for

debate by Examining Committee.
Asst. Prof. Dr. Sadiq J. Hamandi

Head of the Biomedical Engineering Department
/12/2020
Committee Certificate
We certify, as an Examining Committee, that we have read this thesis entitled

"Gait Analysis of below Knee Amputees Wearing Different Prosthetic
Feet" and examined the student "Hamza Abbas Fadhel" in its content and
what related to it, and found it adequate for the standard of a thesis for the
degree of Master of Science in Biomedical Engineering.
Prof. Dr. Kadhim K. Resan

(Chairman)
/12/2020
Asst. Prof. Dr. Mahmud Rasheed Dr. Aseel Mohammed Ali

Ismail Hussein
(Member) (Member)
/12/2020 /12/2020
Asst. Prof. Dr. Sadiq J. Hamandi Asst. Prof. Dr. Muhammed Abdulsattar
Muhammed
)Supervisor and Member) (Supervisor and Member)
12/2020/ 12/2020/
Approved by the College of Engineering / Al-Nahrain University
Prof. Dr. Basim O. Hasan

Dean of the College of Engineering
/12/2020
ABSTRACT
The suitability of the prosthetic limb of the amputee is a key factor for
rehabilitation, as well as the type of prosthetic foot, which is one of the
factors affecting the gait parameter. The study aims to assess subject
preference for prosthetic foot based of dynamic performance using different
prosthetic feet. Six male subjects with unilateral below-knee amputation were
chosen to fit with four types of prosthetic feet (1S66 SACH foot Ottobock
inc., 1C30 Trias carbon Ottobock inc., Dynastep Proteor group and Dynacity
Proteor group), asked them to walk with their usual speed on the straight
pathway perpendicularly with the camera. The Spatio-temporal parameters for
both amputated leg and the sound leg measured manually by using the
Kinovea software. Also, Skillspector was used for calculating the joint angles
in the sagittal plane, while the ground reaction forces (GRFs) were acquired
from the Advanced Mechanical Technology Incorporation (AMTI) force
platform. The results showed there are no significant differences in the
spatiotemporal parameters for p=0.05 between the four types of prosthetic
feet on the sound and amputee leg. The comparison between the amputee and
sound leg showed a significant difference p<0.05 for the single support time
when the patients fit with Trias 1C30 (18% lower than the sound side) and
Dynastep (14% lower than sound side). For joint kinematics the study found a
little effect in joint angles in the lower limb for both the amputated side and
the sound side all joint range of motion ROM at the normal value with hip
ROM 50 deg, knee ROM 50 deg and ankle ROM 35 deg. An increase in the
sound side ground reaction force when using SACH foot, Dynastep and Trias
1C30 by 6%, 12% and 19% respectively over the amputated side except for
the Dynacity foot the first peak in the sound side is lower than the amputated
side by 1.7%. With all types of used prosthetic feet.
List of Contents
Contents
Page
Abstract I
List of Contents II
Notations V
List of Tables VI
List of Figures VII
CHAPTER ONE: Introduction
1.1 Introduction 1
1.2 Literature Review 3
1.3 Aims of the Research 10
1.4 Thesis Outline 10
CHAPTER TWO: Theory
2.1 Introduction 12
2.2 Activity level 12
2.3 Prosthetic foot 13
2.4 Gait Cycle Classification 15
2.4.1 The Main Tasks of the Gait Cycle 16
2.5 Gait Analysis 17
2.5.1 Spatiotemporal Parameters 17
2.5.1.1 Normative Values 18
2.5.2 Gait Kinematics 19
2.5.2.1 Measurements of Gait Kinematics 19
2.5.2.2 Calculation of Segment and Joint Angles 21
2.5.2.3 Normal Gait Kinematics 22
2.5.3 Gait Kinetics 24
2.5.3.1 Ground Reaction Forces 24
2.5.3.2 Normal Kinetics 26
2.6 Force Platform 27
CHAPTER THREE: Subjects and Methodology
3.1 Introduction 28
3.2 Subjects 28
3.3 Ethical Approval 28
3.4 Prosthetic Foot 29
3.5 Methodology 32
3.5.1 Research Procedure 32
3.5.2 Markers and their Placements 33
3.5.3 The Gait Analysis System 35
3.5.4 Measurement of the General Gait Parameters 36
3.5.4.1 Statistical Analysis 39
3.5.5 Measurement of Kinematics 39
3.5.5.1 Digitization Process of Marker 39
3.5.5.2 Filtering of Gait Data 42
3.5.6 Measurement of Kinetics 43
CHAPTER FOUR :Results and Discussion
4.1 Introduction 47
4.2 Spatiotemporal Parameters 47
4.3 Kinematic Analysis 53
4.4 Ground Reaction Forces 77
CHAPTER FIVE : Conclusions and Recommendations for Future
Works
5.1 Conclusions 102
5.2 Recommendations for Future Works 103
REFERENCES 104
APPENDISES A-1
Appendix A A-1
Abbreviations
3D = Three Dimension
AMTI = Advanced Mechanical Technology Incorporation
AVI = Audio Video Interleaved
BH = Body Height
BM = Body Mass
BW = Body Weight
COG = Center of Gravity
COM = Center of Mass
COP = Center of Pressure
ESAR = Energy Storing and Return
GC = Gait Cycle
GRF = Ground Reaction Force
IC = Initial Contact
ISW = Initial Swing
LA = Limb Advancement
LR = Loading Response
MATLAB = MATrix LABoratory
MFCL = Medicare Functional Classification Level
MST = Mid-Stance
MSW = Mid-Swing
PSW = Pre-Swing
SACH = Solid-Ankle Cushion-Heel
SLS = Single Limb Support
TST = Terminal Stance
TSW = Terminal Swing
WA = Weight Acceptance
Notations
Symbols Notations
fs = Sampling frequency
= Medial-lateral ground reaction
Fx
force
= Forward-backward ground reaction
Fy
force
Fz = Vertical ground reaction force
FYb = Braking force
FYp = Propulsive force
Fxm = Medial force
Fxl = Lateral force
g = Gravitational acceleration
Xi, Yj = Cartesian position of the center of
joint in x-y direction
𝜃 = Angular displacement
List of Tables
Table Title Page
(2-1) Approximate ranges of the general gait parameters in 19

free speed walking for normal male subjects of
different ages
(2-2) Types of motion capture system 20
(3-1) Subject information 29
(3-2) Passive markers specific locations in the left and 34

right limbs
(4-1) Means values ± SD of spatiotemporal parameters of 49

the amputated and sound side for four types of
prosthetic feet
(4-2) Range of motion at lower limb joints for amputated 77

side and sound side
(4-3) Vertical ground reaction forces at Fz1 and Fz2 as % 101

of BW
List of Figures
Figure Title Page
(2-1) SACH foot (a) solid keel (b) flexible keel 14
(2-2) Energy storing and release feet. (a) Single axis (b) multi 14
axis
(2-3) Left extremity initial contact takes place while the right 16
extremity is at 50% of the gait cycle
(2-4) Gait cycle terminology and functional tasks 17
(2-5) Gait analysis system for measuring kinematic and kinetic 21

variables
(2-6) (a) Joint's absolute angles for a single limb, (b) Joint's 22
relative angles
(2-7) Sagittal plane joint angles measured in degrees during a 23

single gait cycle of the right limb, the flexion of the hip,
knee and ankle dorsiflexion considered positive
(2-8) Force plate data obtained from a normal individual while 25

walking at normal speed plotted against time as a percent of
the stance phase.
(A) Vertical forces; (B) Anterior-posterior forces; (C)
Medial-lateral forces
(3-1) Cross section of the Dynastep foot 30
(3-2) Design symmetry in 1- real ankle-foot skeletal and 2- Trias 31

foot
(3-3) Dynacity foot blades functions 32
(3-4) Markers placement on patient’s body 35

(3-5) Gait analysis system 36
(3-6) Kinovea application screens showing (a) first heal strike 37

and (b) the second heal strike of the same leg, stop-watch
was used to measure gait time
(3-7) Flow chart of spatiotemporal parameters calculation 38
(3-8) Skill Spector program operation: (a) selection of 40

digitization mode; (b) selection of markers' position; (c)
export digitizing point
(3-9) Flow chart of kinematics parameter calculations 41
(3-10) Padding procedure used on a signal before it enters 42

Butterworth filtering
(3-11) Differences between filtered and raw ankle angular 43

displacement data.
(A)Raw data, (B) filtered data
(3-12) Coordinate system of a force platform 44
(3-13) Force plate dimensions 45
(3-14) Flow chart of kinetics parameter measurement procedure 46
(4-1) Single support time of the sound and amputee legs for six 51
subjects
(4-2) Case-1 Hip joint angle (a) sound side (b) amputated side 56
(4-3) Case-1 knee joint angle (a) sound side (b) amputated side 57
(4-4) Case-1ankle joint angles (a) sound side (b) amputated side 58
(4-5) Case-2 hip joint angle (a) sound side (b) amputated side 60
(4-7) Case-2 ankle joint angle (a) sound side (b) amputated side 62
(4-20) Case-1 vertical ground reaction force (a) sound side (b) 79
amputated side
(4-21) Case-1 forward-backward ground reaction force (a) sound 80

side (b) amputated side
(4-22) Case-1 medial-lateral ground reaction force (a) sound side 81

(b) amputated side
amputated side


(b) amputated side
amputated side


(b) amputated side
amputated side


(b) amputated side
amputated side


(b) amputated side
amputated side
(b) amputated side
CHAPTER ONE
Introduction
1.1 Introduction
As a result of increased accidents and wars in Iraq, the number of
amputees reached 160 thousand to 180 thousand, according to the estimates
for the Iraqi Ministry of Health and civil society organizations for the year
2019 only. In the Nineveh Governorate, the number of amputations exceeds
four thousand patients with different types of amputations for the last four
years due to the war against ISIS [1].
Estimated statistics indicate that the number of lower-limb amputations
in the United States ranges from 2.8 to 43.9 per 10,000 people, most of whom
are below the knee amputation [2].
Despite scientific progress in all fields, the issue of amputees remains a
challenge for all countries [3]. Amputations may increase in the coming years
with increasing life expectancy and increasing diabetes cases, and it is
expected to be twice more when people reach the age of 65 [4].
Also, the chance of amputation is greater in accidents in the case of
vascular patients. By the middle of the 21 st century, amputations are expected
to double, according to a study done in 2008 [5]. In Korea, below-knee
amputees are the most of limb amputations [6]. Therefore, consideration
should be focused on the below knee amputations, to aid amputees to
effectively back to their earlier activities of life [7]. The suitability of the
prosthetic limb of the amputee is a key factor for rehabilitation, as well as the
type of prosthetic foot, which is one of the factors affecting the gait parameter
[8].
At present, there are many types of prosthetic feet and are described
according to the patient's condition [9]. Numerous single-axis and multi-axis
prosthetic feet exist. In the late 1950s, an inactive foot consists of a foot and
ankle connected in one set such as solid ankle-cushin heel (SACH) [10].
Because the weight of the SACH foot is light and its toughness, it turns out to
be the most recommended in the United States for trans-tibial and trans-
femoral amputation [11].
The new version of SACH is designed to be lighter than the old one,
durable, and include an elastic heel that wrappings at heel strike, make the
patient walk in a more dynamically sense [8]. The mechanical disadvantage in
SACH outcome in variations in the gait of below-knee amputees [2].
Other inactive feet offer slight energy-saving and released during the gait
because of the mechanical properties of material made from it such as energy
storing and return (ESAR), therefore, they offer some biomechanical gains
[12]. These properties offer the energy to push the amputation forward such
as that supplied by the calf muscle at the time of late stance [13]. In many
cases, the prosthetic limbs do not compensate for the amputated limb,
sometimes it affects the speed of the walk, and a difference in spatiotemporal
parameters and joint angles had been occurred compared to the non-
amputated person during gait [7]. It causes a decrease in the swing phase of
the sound side and an increase of amputated side stride-length, as a result of a
mismatch in the adaptation of the patient to the prosthetic foot is asymmetries
in gait [14,15]. Differences between a sound and amputated limb can be
recognized by measuring gait parameters, kinetics, and kinematics, and these
differences are used as an indication for the rehabilitation process [16,17]. By
comparing the Non-amputated individuals with the amputated individuals, the
first group moves with a higher pace and cadence and the stride length is
longer [18].
The research reported a quite longer step length, a longer swing time,
and a smaller stance phase for the amputated limb [19]. The patient relies on
the sound side to compensate for the performance deficiency on the prosthesis
[20]. This will lead to pain in joints and deterioration. Struyf et al. established
that impaired persons suffer from osteoarthritis in the sound side are three
times higher compared to non-amputated persons [2].
Gait analysis is an essential way in the assessment of operational events,
rehabilitation development, kinematics of joint, spatiotemporal parameters,
and many others are factors of concern such as ground reaction forces [21].
Some specialists, such as the prosthetist, measure the spatiotemporal
parameters such as stride rate, cadence, and step length to know the progress
of the rehabilitation process [22]. Currently, numerous viable motion systems
for two-dimension analysis based on the camera. Kinematic gait analysis can
be categorized into two main classes [23]. The first one contains inertial
components. The second is a visual technique using inactive makers, which
were established to do actual-time gait analysis [22].
1.2 Literature Review
Compared to the extensive literature available on numerous aspects of

the below-knee amputation gait analysis, few studies have been achieved on
how prosthetic feet type affect the kinetics and kinematics of gait.
In the late 20th century, there has been a rising concern in gait analysis of
amputated persons, especially in comparing and explaining the effect of
prosthetic foot type on the vertical ground reaction force, the effect on the gait
pattern, and the change in spatiotemporal parameters. But all these studies
were done using the old version of prosthetic feet founded at that time.
This chapter offers a wide-ranging of literature review focusing on gait
features of below-knee amputees with different prosthetic feet and different
types of test and ambulation procedures, sorted in sequential order.
Isakov et al. in 2000 [24], outlined the difference between the amputated leg
and sound leg depends on the kinematics of gait and the electromyography of
knee muscles. The study tested the gait cycle of fourteen below-knee
amputations at 74.96 m/min mean walking speed by using an electronic
pathway, mobile EMG system, and motion capture camera. The results have
shown significant differences in the sound leg gait parameters like the length
of step, the time of step, and the swing time longer than that in the amputated
side. They also found a significant difference at the initial contact knee angle
between the legs.
Isakov et al. in 2001 [25], recorded the EMG of lower limb muscles during
walking for eleven transtibial amputees for the amputated leg and sound leg
using surface electrodes in time-distance factors. Asymmetry in hamstring
muscle activity was found between the amputated leg and the sound leg as
well as in other parameters of the gait.
Bateni and Olney in 2002 [26], assessed the gait of below-knee subjects and
made a comparison with the non-amputated subjects' gait and with the
previous research results.
The study tested the ground reaction forces in parallel with digitized data
from the motion capture system for five males with unilateral below-knee
amputation with an age ranged from 32-77 years to find the joints kinetic.
The comparison included the following factors: moments, power, and
segments linear velocity, work lower limb joints and angles between limb
segments.
The findings indicated that below-knee amputation subjects had
asymmetrical gait cycles, unlike the non-amputated subjects.
Zmitrewicz et al. in 2006 [13], estimated the effect of the (ESAR) feet and
the multi-axis prosthetic feet on the sound side and the amputated side
loading and the reaction forces on both sides.
The fifteen unilateral below-knee vascular amputation participants donning
two feet, the single-axis foot and multi-axis foot, were examined by using
analysis of variance.
The study results show that the improvement of amputation gait by the use of
multi-axis foot which generates more pushing forward impulse by the sound
side which enhances equally load distribution between legs.
Su et al. in 2007 [19], investigated quantitatively the characteristics of
nineteen bilateral below knee amputation subjects wearing Seattle Lightfoot II
prosthetic foot for fourteen days before the test. The analyzed data have
shown symmetrically in kinetic, spatiotemporal, and kinematic parameters.
Amputated participants had lower cadences and slower speeds, wider step
widths, and shorter step lengths, and during the swing phase showed hip
hiking when compared with the non-amputated subjects. Also, knee flexion
and ankle dorsiflexion were reduced during the contact phase for the
amputated persons.
Supan et al. in 2010 [8], compared the spatiotemporal parameters, lower
limb joints kinematics, and the forces in the knee joint between the sound and
amputated legs and how they affected when the talus height adapted. The data
collected for ten traumatic below-knee amputation subjects with adjustable
talus Talux foot. The results found similarity in the major parameters between
the amputated and sound legs, excluding for the sound side with lower the
length of step and longed time, at mid and initial stance knee less extended
and lower knee ROM in the swing part of the gait. The results proved that the
Talux foot has similar properties to the healthy foot.
Mancinelli et al in 2011 [27], compared the gait and energy cost of five
below-knee amputation subjects in ground-level walk wearing two prosthetic
feet; the Ceterusby Össur, and the PowerFoot Biom.
The results shown a reduction in oxygen consumption level (8.4%) by
the use of the PowerFoot prosthetic during the test because of the
enhancements of ankle kinetics and kinematic in the terminal stance, the
power in ankle generated increased by 54% during the terminal stance.
The study reported that powered ankle feet have the effort to significantly
enhance the walking activity in below-knee amputation.
Svoboda et al. in 2012 [28], determined the effect of SACH foot and ESAR
Sureflex foot on the ground reaction force in below-knee amputation subjects
walking at their selected speed on ground-level.
The study tested the ground reaction force and time parameters for both
amputated and sound side when the subjects using both prosthetic feet for
eleven male subjects.
The results suggested that the alignment defects and prosthetic foot type
affect the ground reaction force. In the initial phase, SACH foot shown high
asymmetry in medio-lateral direction and Surflex had the high asymmetry in
the forward-backward direction.
De Asha et al. in 2013 [29], analyzed whether attaching a hydraulic joint to a
dynamic foot for below-knee amputation has reduced the adaptation of speed-
related in the kinetics of joint compared to using a fixed joint. The study tests
powers and moments at the ankle joints for each type of prosthetic foot and
the sound ankle simultaneously for eight unilateral below-knee amputation
subjects at self-selected speed and slower and faster trials.
The results suggested that work in the sound side ankle remain
unchanged as the speed changed through the trials, the work increased in the
knee and hip joints in the sound limb as the speed increased. For the
amputated side, it showed greater increases when using the hydraulic ankle in
speed levels, and so significantly lower in traveled work of the sound side at
the ankle and other joints. The study found that hydraulic ankle-foot is more
effective at walking speed greater than that designed for it.
Major et al. in 2014 [30], conducted the effect of ankle joint motion rigidity
in five non-vascular unilateral below-knee amputations during gait in
different ways reflects the daily lifestyle of the subjects. The study measured
amputated side ground reaction forces, the knee and ankle joint kinematics,
and energy cost while subjects walking on a treadmill on the ground level and
at five percent inclination and five percent declination. The procedure
repeated with four different ankle rigidity steps at the same alignment of the
prosthetic.
The results have shown that lowering the dorsiflexion rigidity leading to
higher amputated side dorsiflexion range and intact side knee flexion, and
during the weight acceptance phase at the amputated side the ground reaction
force was reduced.
Ko et al. in 2014 [31], explored the ankle joint kinematics and kinetics at
various types of ambulation level, incline, and stair lifting using different
types of prosthetic feet; élan foot (Endolite, USA), Echelon foot (Endolite,
USA), and Proprio-FootTM (Össur, Iceland).
The study measured the angle on the ankle joint and the index of symmetry of
the work generated in the amputated and the sound side at ground level
walking, seven-degree slope inclination, and 15 cm stair height for the below-
knee unilateral amputated subject.
The results have shown a higher stance phase and single support time
for the amputated side when using adaptive prosthetic foot during the level
walking than the rigid ankle. Increasing the dorsiflexion at level walking for
all types of adaptive feet for the inclined walk dorsiflexion showed increasing
for Proprio-FootTM and élan foot as well as for the Echelon foot during the
swing phase.
For stair lifting, Proprio-FootTM foot and élanElan foot have the
dorsiflexion enhancement. The study indicates the use of adaptive ankle foot
enhances the kinematics and kinetics of the amputated side ankle.
Raschke et al. in 2015 [32], tested twelve transtibial amputees to determine if
they prefer a specific type of prosthetic foot when they fitted to the prosthetic
feet randomly in a double-blind design.
The data collected in three fields; the biomechanical field, the activity field,
and the perceptual field. They concluded that patients prefer prosthetic foot
with low torques in the sagittal plane during gait without any effect on their k
level when they use the favorite foot.
Ko et al. in 2016 [33], returned to evaluate the effect of wearing ESAR
prosthetic feet of the rigid ankle joint and movable ankle joint on the kinetics
and kinematics of the sound side and the amputated side of three below-knee
amputees walking on ground level wearing the two types of prosthetic feet at
each trial.
The data collected including the spatiotemporal parameters, kinetics, and
kinematics of both sides have shown a difference in the kinetics and
kinematics and spatiotemporal parameter between both sides for the rigid
ankle and movable ankle.
Sharifmoradi et al. in 2017 [2], determined the kinetics in the lower limb
joints (knee, hip, and lumbar region) for the sound side and the amputated
side for five below-knee amputated subjects using Kistler force plate and
seven camera Qualysis motion system to record kinetics and kinematics
parameters of gait. OpenSim software and SPSS software were used to
calculate the joint contact forces and statically analyze the data with p=0.05
respectively.
The results have shown that the late stance force in the sound side was
greater than of the prosthetic side for p<0.05 also the forces at the joints of the
sound side were greater than the amputated side.
The study concluded that the increase in the sound side joint contact
forces may, with the time, leads to more complications in the sound side knee
joint (osteoarthritis) and lower back chronic pain. Balancing the forces
applied on both sides is very important this is done by the right fit of the
socket pin and the type of prosthetic feet.
Yang et al. in 2018 [12], compared the effect of the ESAR prosthetic feet
shape on the gait pattern in ten unilateral below-knee amputations wearing
1C60 Triton or 1C30 Trias. Kinetics, kinematics, and spatiotemporal data
were collected and the comparison between the two types and the sound side
and amputated side were measured.
The results have shown both feet have symmetrical gait pattern and the 1C60
Triton more symmetrical to the normal pattern than 1C30 Trias.
Barnett Cleveland T. et al. in 2018 [34], a two force plates (OR6-7; AMTI,
Watertown, MA, USA) and motion capture camera (Oqus 400; Qualysis AB,
Gothenburg, SE) were used to record the kinetic and kinematic data of five
below-knee amputee K0 and K1 subjects to examine the effect of non-ESAR
with a hydraulic compartment with the conventional one in two-minute level
walking test in ten gait trials when the subjects wearing the NON-ESAR foot
with rigid compartment and the NON-ESAR with a hydraulic compartment to
compare between them.
A decelerating effect in the initial stance phase was reduced because of the
effect of the hydraulic compartment as the articulated part that describes the
enhancement in walking activity.
Zhang Xueyi et al. in 2019 [35], collected the data of eight below-knee
amputee gait by an inertial sensor after ESAR foot fitting and over four days
after fitting to the assess spatiotemporal parameters were analyzed statically
by Friedman tests to locate the differences in the overall test time.
The results have shown gait variables had fewer changes for long fitting
periods the parameters gait speed, double support time, and cadence more
sensitive to changes when the subjects fit with a new foot.
Riveras et al. in 2020 [7], assessed three types of prosthetic feet; (ESAR)
foot with an immovable ankle, prosthetic foot with movable ankle, and
prosthetic foot with a micro-controlled movable ankle, and determined their
effect on symmetry index and spatiotemporal parameters of thirteen unilateral
below-knee amputees in walking up and down an incline.
The results displayed the use of a prosthetic foot with a micro-controlled
movable ankle reduces the speed at incline walking down. Hence, gait pattern
differences may not be revealed by spatiotemporal parameters and their
symmetry index.
In summary, researches published in this field can be classified under
groups according to the type of technique used for examination:
1- A group using the muscle activity measurements by means EMG to
assess the muscle force or the net moment of a muscle group.
2- A group using the motion analysis system in three dimensions with a
force plate to determine the kinematics and kinetics of gait.
3- A group using the inertial sensor to evaluate the gait parameters.
1.3 Aims of the Research
The aim of this study is to:
1- Observe the effects of prosthetic foot type of unilateral below-knee

amputee on the gait biomechanics in the major joints of the lower limb
by calculating the spatiotemporal parameters, joint angles, and the
ground reaction forces in the sagittal plane at a self-selected walking
speed on level ground.
2- Make a comparison between four types of feet and also between the
amputated side and the sound side for all gait parameters and limb
joints and ground reaction force.
1.4 Thesis Outline
This thesis is made up of the following chapters:

Chapter One: demonstrated an introduction, literature review, aims of the
study, and the thesis's outline.
Chapter Two: contains three main parts illustrate the theory of the thesis
including an introduction about the amputation, its types and levels, and types
of prosthetic limbs and their components, reviews the gait cycle and presents
the concepts of gait analysis containing the biomechanical model applied, the
force plate records processing, and the analysis method of the kinematic and
kinetic.
Chapter Three: shows subject characteristics, the methodology applied,
method of data gathering and analysis.
Chapter Four: shows the obtained results and their discussion.
Chapter Five: Summarizes the conclusions and recommendations for future
work.
CHAPTER TWO
Theory
2.1 Introduction
This chapter contains five main parts illustrate the amputations and their
types, defining the prosthesis and its contents, summarize the gait and its
classifications, define the gait analysis techniques, and give a short
explanation about the devices used in gait analysis.
2.2 Activity level
K-levels are a rating system used by Medicare to indicate a person’s

rehabilitation potential. The system is a rating from 0 through 4 and it
indicates a person’s potential to use a prosthetic device if they had a device
that worked well for them and they completed rehabilitation to use the device
properly [55].
1- K0 level: The patient does not have the ability or potential to ambulate
or transfer safely with or without assistance and a prosthesis does not
enhance their quality of life or mobility.
2- K1 level: The patient has the ability or potential to use a prosthesis for
transfers or ambulation on level surfaces at fixed cadence. This is
typical of a household ambulator or a person who only walks about in
their own home.
3- K2 level: The patient has the ability or potential for ambulation with
the ability to traverse low level environmental barriers such as curbs,
stairs or uneven surfaces. This is typical of the limited community
ambulator.
4- K3 level: The patient has the ability or potential for ambulation with
variable cadence. A person at level 3 is typically a community
ambulator who also has the ability to traverse most environmental
barriers and may have vocational, therapeutic or exercise activity that
demands prosthetic use beyond simple locomotion.
5- K4 level: The patient has the ability or potential for prosthetic
ambulation that exceeds basic ambulation skills, exhibiting high
impact, stress or energy levels. This is typical of the prosthetic demands
of the child, active adult or athlete.
2.3 Prosthetic foot
Its work is somewhat similar to the ankle joint, as it provides movement

in various directions to facilitate the process of movement on various terrains
and to absorb as much energy as possible at the beginning of the walking
process and release it at the end of the walking process to reduce the energy
required for the forward thrust because there are no muscles that aid in
walking safety and stability while standing and reduce body swing [51].
This study focused on the types of the prosthetic feet and their effects on
gait, so the prosthetic feet will be clarified and classified according to their
axis of motion and the materials made from them into three main sections.
a) SACH foot:
It is the oldest type of artificial feet known and the most widespread due
to its lightweight and simplicity of manufacture. It is available in two types: a
hard heel and flexible keel as shown in Figure 2-1 [53]. It is used for
amputees with little mobility and who are classified as K1 level. This foot is
considered without articulation [53].
(a) (b)
Figure 2-1 SACH foot (a) solid keel (b) flexible keel.[52]
b) Energy storing and release feet (ESAR).
Allows single-axis motion (plantarflexion) to happen at heel strike to
midstance to make certain stability for the wearer. One of the characteristics
of this foot is that it adds more balance, so it is used for amputation above the
knee and the possibility of using it for various terrains as shown in Figure 2-2
[53].
Finally, in the 1990s the dynamic response foot was produced to “lighten
the load” on the amputee using a material called carbon fiber to offer a light-
weight and strong prosthetic feet. The design provides absorption of the
impact at heel strike and releases that energy at toe-off [54].
Another design of dynamic response foot is the “split blade shape”
which allows multi-axis movements, medial and lateral ground slope, and
have a more natural transition from heel strike stage to late stance as shown in
Figure 2-4 [53].
(a) (b)
Figure 2-2 Energy storing and release feet. (a) Single axis (b) multi axis. [52]
c) Computerized feet
Powered and computerized feet similar to the intelligent knee joint the
ankle joint in this type of prosthetic feet have the ability to do the articulation
dorsiflexion and plantarflexion under microprocessor control to mimic the
activity of the calf muscle. The main challenges to this foot were to create
energy and how to store and release it [55].
2.4 Gait Cycle Classification
Normally, the gait cycle consists of two major phases: the stance phase
and the swing phase as shown in Figure 2-3. This cataloging is identified as
the Ranchos cataloging and an event that is isolated in each period. The
names of these events are created from the movement of foot [57].
The stance phase is that portion of the gait cycle when the foot is in
contact with the ground, and typically represents approximately 62% of the
total healthy adult walking gait cycle. Three-foot rockers (heel, ankle, and
forefoot) occurring during stance phase, serve to control the forward fall of
the body during normal ambulation [57].
The swing phase is defined as the period when the foot no longer
contacts the ground and the limb advances in preparation for subsequent foot
contact. The swing phase occupies the residual 38% of gait cycle [57].
The gait cycle can also have characterized by eight distinct events; each
event has its time period measured as a percentage of the gait cycle. The
stance phase consists of five events: initial contact (IC) about (0-2) %, loading
response (LR) (0-10) %, mid-stance (MST) (10-30) %, terminal stance (TST)
(30-50) %, and pre-swing (PSW) (50-60) %. The swing phase, on the other
hand, consists of the other three events: initial swing (ISW) (60-73) %, mid-
swing (MSW) (73-87) %, and terminal swing (TSW) (87-100) % [58].
The two main phases of the gait cycle are the stance and swing phases.
The body is alternating during walking from one limb to another, meaning the
events of the gait of one limb are shifted from the other by 50%, e.g. while
one limb is swinging in the air, the other limb is supporting the body on the
ground. There is a time period the two limbs supporting the bodyweight on
the ground, which is named as the double limb support as shown in Figure 2-3
[58].
The cycle time is the interval of a complete gait cycle, which is divided
into stance time and swing time [58].
2.4.1 The Main Tasks of the Gait Cycle
The sequential combination of the phases enables the limb to complete

three basic tasks. These are weight acceptance (WA), single limb support
(SLS), and limb advancement (LA) as shown in Figure (2-4) [58].
Figure 2-3 Left extremity initial contact takes place while the right extremity is at 50% of
the gait cycle.[58]
Figure 2-4 Gait cycle terminology and functional tasks.[58]
2.5 Gait Analysis
Gait analysis is the study of human movements. It includes the

measurements and analysis of specified gait parameters. The gait parameters
classified to the kinetic, kinematic, and the spatio-temporal parameters [59].
2.5.1 Spatiotemporal Parameters
Parameters used in gait analysis and related to time and distance are
known as temporal and spatial parameters, respectively. Typically, the
measured spatial parameters are stride and step length, while temporal
parameters are walking speed, gait time, single support time and cadence
[59]:
1- Walking Speed
Although everyone has a usual (free or self-selected) walking speed,
the actual speed is continuously adjusted according to the conditions. The
walking speed can be calculated from the equation [59]:
Speed (m/s) = distance (m) / time (s) (2.1)
2- Cadence
It can be defined as a number of steps per minute. The cadence can be
calculated from equation following [59]:
Cadence (steps/min) = number of steps / time (min) (2.2)
The cadence can be transformed into strides per second by dividing it by

120 since each stride comprise two steps (left and right), and one minute is
equal to 60 seconds. In which case it becomes popular as the stride frequency
[59].
3- Stride Length
Stride length may be measured by dividing the walking speed by
cadence. Since cadence is mostly calculated in steps/minute, it is required to
be divided by 120. The unit of the stride length is a meter. The stride length is
calculated from the equation following [59]:
Stride length (m) = walking speed (m/s) 120 / cadence (2.3)

2.5.1.1 Normative Values
Since the way each person walks is different from the other and therefore
it depends on the nature of the person himself/herself and is affected by
internal and external factors, there is no fixed normal value for the
spatiotemporal parameters, but some scientists have studied them on natural
people and estimated as a range for each of the temporal-spatial factors for
different ages as shown in Tables 2-1 [59].
Table 2-1 Approximate ranges of the general gait parameters in free speed walking for
normal male subjects of different ages.[62]
Cadence Stride length Speed

Age
(steps/min) (m) (m/s)
13-14 100-149 1.06-1.64 0.95-1.67
15-17 96-142 1.15-1.75 1.03-1.75
18-49 91-135 1.25-1.85 1.10-1.82
50-64 82-126 1.22-1.82 0.96-1.68
65-80 81-125 1.11-1.71 0.81-1.61
2.5.2 Gait Kinematics

The term kinematics simply means it is the study of bodies in motion
without considering the forces (internal and external forces) that cause the
body movement. Thus, the kinematics analysis allows us to observe and to
describe the body movements during the gait. Kinematics include the analysis
of positions, velocities, accelerations and angles of the body joints and
segments [60].
2.5.2.1 Measurements of Gait Kinematics
Human motion tracking can be performed in two or three dimensions.

Depending on the complexity of analysis, representations of the human body
range from basic stick figures to volumetric models. Tracking relies on
the correspondence of image features between consecutive frames of video,
taking into consideration information such as position, color, shape, and
texture. Edge detection can be performed by comparing the color and/or
contrast of adjacent pixels, looking specifically for discontinuities or rapid
changes. Three-dimensional tracking is fundamentally identical to two-
dimensional tracking, with the added factor of spatial calibration [59].
Motion analysis of body parts is critical in the medical field. In postural

and gait analysis, joint angles are used to track the location and orientation of
body parts. Gait analysis is also used in sports to optimize athletic
performance or to identify motions that may cause injury or strain. Tracking
software that does not require the use of optical markers is especially
important in these fields, where the use of markers may impede natural
movement [59].
The major motion capture sensors which are categorized in Table 2-2.
The two main families of sensors which have been commonly used in human
motion capture for rehabilitation engineering are optoelectronics and non-
optoelectronics sensors. The first groups may or may not use markers to track
movements. If they use, markers are attached to the body to represent major
skeletal segments and joints while the optical system (a camera and post-
processing vision system) tracks the markers and obtains the body segments
and joints’ position and orientation. In markerless systems, the image features
such as colors, edges, shapes, and/or depth are used to interpret the motions.
The non-optoelectronics sensors include inertial, mechanical, and magnetic
systems [59].
Table 2-2 Types of motion capture system.[59]
Non-optoelectronics Motion Capture Optoelectronics Motion Capture
(i) Inertial sensors (i) Marker trigonometry with IR
(ii) Magnetic systems cameras
(iii)Wearable systems (ii) Contrast-based
(iv) Mechanical systems (a)With color markers
(b)With skin detection
(iii) Depth-based
Gait kinematics can be simply measured by the use of video camera, by

recording a video of the subjects in the plane needed to be analyzed in it, and
an analysis software tools such as Skillspector software in companion with
other assisted costume programs in MATLAB for calculating the kinematics
factors as shown in Figure 2-5. In the beginning, a passive marker is placed
on the anatomical landmarks for the part of the body needed [60].
Figure 2-5 Gait analysis system for measuring kinematic and kinetic variables.[60]
2.5.2.2 Calculation of Segment and Joint Angles
The absolute segments angles can be computed from the data of the
marker trajectories by the use of simple arctangent functions as shown in
Figure 2-6 (a), the angle is always measured counterclockwise from the right
horizontal.
The general equation utilized to calculate the absolute segment angle is [61]:
Yj−Yi
𝜃ij = tan-1( Xj−Xi ) (2.4)
The Relative angles between segments (joint angle) are determined as

follow [61]:
Ankle angle (a) =3-2 (2.5)
Knee angle (k) =1-2 (2.6)
Hip angle (h) = 1-90 (2.7)
The ankle angle is the angle between the foot and an imaginary line
through the tibia vertical axis, knee angle is the angle between the tibia and
the imaginary line through the femur vertical axis, while hip angle is defined
as the angle between the trunk extension line and the femur as shown in
Figure 2-12 (b) [61].
Figure 2-6 (a) Joint's absolute angles for a single limb, (b) Joint's relative angles.[61]
2.5.2.3 Normal Gait Kinematics
The joints' kinematics of a normal gait are shown in Figure 2-7. For the
hip joint, the angular displacement curve pattern is almost sinusoidal, starting
in approximately 30° flexion at the initial contact of the foot. Then extend
when the other side is at the initial contact about (50% cycle). It reaches a
maximum extension of 10° at the end of terminal stance and back to flexion
before the foot leaves contact with the ground when the next initial contact of
the ipsilateral happens [53].
Figure 2-7 Sagittal plane joint angles measured in degrees during a single gait cycle of the
right limb, the flexion of the hip, knee and ankle dorsiflexion considered positive.[62]
While the knee joint curve shows two flexion peaks at the stance and
swing phase. The flexion peak is much smaller in the stance phase than that in
the swing phase [63].
The knee angle approximately 5° of flexion in the initial contact. During
the loading response period, the knee went from 10° to 15° of flexion. At the
mid-stance period, the knee influences 5° of full extension just before the end
of stance then beginning a period of rapid flexion going to initial swing phase,
during mid-swing, the knee influences 60° of maximum flexion before
reaching a full extension at the end of swing phase then began to flex again
prior to initial contact [63].
The angle of the ankle joint, at the initial contact, is in zero-degree angle.
After that, during the loading response, there is a momentary plantarflexion
from 5° to 12° occurs. Following by moderate dorsiflexion that continues to
the mid-stance and terminal stance reaching 10° prior to pre-swing, then when
the foot loosening contact with the ground begins to rapidly plantar-flex this
occurs during the pre-swing remains into early swing reaches a maximum of
20° for the rest swing phase. Finally, at the end of the swing phase, it backs to
the zero-degree angle [53].
2.5.3 Gait Kinetics

2.5.3.1 Ground Reaction Forces
The ground reaction force is a resultant of three orthogonal forces,

shown in Figure 2-8. These components are [57]:
1- Vertical or up-down component (Fz).
2- Anterior-posterior or forward-backward component (Fy).
3- Medial-lateral or side-side component (Fx).
The vertical component ( F z ) represents the vertical oscillation of the
body’s center of gravity. It is had a rapid rise after initial contact (with an
upward acceleration of the body center of mass) to reaching the first hump (
F z ). Then in mid-stance, as the knee flexed, a downward acceleration of the
1
center of mass occurs and the vertical force is decreased under the
bodyweight forming a concave with its bottom ( F z ) during mid-stance. At
min
the terminal-stance, upward acceleration occurs again because of the action of

the plantar-flexors muscles, generating a second hump ( F z ). At the end of the
2
stance, F z falls down as the other limb starts supporting the bodyweight.
When the limb is swinging in the air, the ground reaction forces have zero
value because there is no touching to the ground [57].
Figure 2-8 Force plate data obtained from a normal individual while walking at normal
speed plotted against time as a percent of the stance phase.
(A) Vertical forces; (B) Anterior-posterior forces; (C) Medial-lateral forces.[57]
The forward-backward force ( F y) has an initial negative component
(braking force ( F y )), that represents the backward horizontal friction between
B
the foot and (floor). The second positive F y components, directed forward,
represent the plantar-flexor muscle activity in pushing the foot against the
floor, a propulsion force ( F y ) creating the movement [57].
P
The side-side force ( F x ), after the heel contact, possess a negative

constituent (lateral force ( F x )), because of the adduction of the foot. As the
L
foot abducts for toe-off, it turns into positive (medial force ( F x )) [57].
M
2.5.3.2 Normal Kinetics
During the gait cycle, the joint moment and GRF direction and location
are changed. At heel strike, the GRF position posteriorly to the ankle joint
which makes the knee extensor muscles (i.e., triceps surae) to contract to
compensate the force. At the beginning of the gait, the bodyweight does not
expose to the limb, so the force generated by the muscle was low to overcome
the ground reaction force [64]. The vertical force must equal the body’s
weight to oppose the gravity force to keep the center of mass height above the
ground, so it has been studied [48]. When the vertical force is less than the
bodyweight, the center of mass moves downward and vice versa [48].
Most GRF graphs display normalized force data to bodyweight, where

the scale 100% is equivalent to the subject’s weight. During the initial double
support, the ground reaction forces increase as the weight is relocated from
the counterpart limb. In the early stance, the force increases about 120% of
the bodyweight, then during the mid-stance, the force decreases below body
weight about 80% and is followed by increases the force again above the
body weight in the late stance [64]. During the end of the double support
phase, the force falls quickly as weight is transferred to the opposite limb
[64]. During the loading response, the force can be more than the bodyweight
because of the body slowing from moving forward. The force is less than
100% when the body weight is relocated from one side to the other. Finally, a
spike in the vertical force is caused when the toe-off phase began the subject
increase momentum to push the body onward above 100% [48].
2.6 Force Platform
The force plate measures the ground reaction forces exerted by a person
steps on it during gait. These devices consist of a top plate (mounted level
with the surrounding floor) separated from a bottom frame by force
transducers near each corner. Its principle of work is that the applied force on
the top surface causes a certain amount of strain within the transducer. Force
plates enable one to measure not only the vertical and shear (anterior-
posterior and medial-lateral) forces but also the "center of pressure" during
gait. Modern video motion systems have made it possible to determine
ground reaction forces and moments through their kinetics software, which
requires ground reaction forces [57].
CHAPTER THREE
Subjects and Methodology
3.1 Introduction
This chapter provides a summarized overview of the subjects with

below-knee amputation involved in the study, gait analysis laboratory, gait,
and data analysis systems including markers set, equipment, and software.
3.2 Subjects
Six male subjects with unilateral below-knee amputation were chosen to

fit with four types of prosthetic feet shown in Figure 3-1 (1S66 SACH foot
Ottobock inc., Trias 1C30 carbon Ottobock inc., Dyna-step Proteor group and
Dyna-city Proteor group), Table 3-1 shows the information of each participant
in the study.
The inclusion criteria of the subject:
 K1-K3 level on the MFCL.

 The socket well fit with the residual limb.
 No pain and no change in the stump.
 All patients' amputations had traumatic causes.
 The time laps from the amputation at least 1 year.
3.3 Ethical Approval
.Table 3-1 Subject information

Mobilit Time of
Subject Height Body mass y level amputatio Affecte Own foot
Age (years)
code (cm) )kg( (K0- n d leg type
*
K4) )years(
Case-1 38 185 98 K3 10 right Echelon
Case-2 26 167 86 K3 2 left Cenator
Trias
Case-3 30 178 70 K2 1 left
1C30
Dynaste
Case-4 24 170 65 K3 3 left
p
Case-5 37 185 105 K3 12 left Echelon
Case-6 48 171 107 K1 8 left SACH
*Mean±sd 33.83±8.1 176±7.1 88.5±16.3
* 7 6 5
*Mobility level giving by the United States Medicare Functional Classification Level (MFCL)..
** Mean and standard deviation for the subjects had complete the test.
The ethical approval for the protocol was obtained from the ethical
committee at Al-Nahrain University and data were collected at Al-Warith
Derman center for prosthetic and orthosis with the supervision of the therapist
physician of the center after the subjects sign up the formal list of the ethical
committee.
3.4 Prosthetic Foot
The most popular four types of prosthetic feet in Iraq were used in this
study, these feet are the most common used by the amputees and because of
its availability at Al-Warith center they are as follows:
1- SACH FOOT 1S66 (OTTOBOCK, GERMANY) [65]

 Functional level: K1-K3
 Maximum bodyweight: 125 kg.
 Material: wood and polypropylene with polyurethane foam at the
heel.
 Design: have a natural shape, smooth surface and formed toes. The
functional properties are achieved through the proven combination
of a contoured core and functional foam. The foam at the heel
provides some shock absorber at heel strike to reduce the load at the
joints. The SACH feet are constructed for use in modular prostheses
and exoskeletal prostheses.
 Foot weight: 485 g for size 26 cm currently used in this study.
2- DYNA-STEP (PROTEOR GROUP, FRANCE) [66]
 Functional level: K2.
 Material: carbon fiber / cylindrical rubber damper.
 Design: the foam of the foot is molded on the carbon blade as
shown in Figure 3-1, which provide comfort at heel strike and
walking, a good rollover and a slight dynamic that perfectly suits
patients with activity level 2.
This provides energy saving during walking and increases the patient's
possible walking distance.
The front blade is split to help inversion-eversion motions during
walking on uneven grounds.
 Foot weight: 440 g
Figure 3-1 Cross-section of the Dynastep foot.[66]
3- TRIAS 1C30 (OTTOBOCK, GERMANY) [65]

 Functional level: K2-K3.
 Material: carbon fiber.
 Design: a prosthetic foot developed based on the natural model as
shown in Figure 3-2, representing a combination of innovative
lightweight construction and a creative design. Conjoined double
spring elements not only dampen impacts but also enable a virtually
natural rollover with excellent energy return. The combination of
the foot shell and connection cap offers to the users a visually
appealing solution and, along with the carbon look, contributes to
the attractive design.
Since the overall structure is similar to the human foot, the Trias
prosthetic foot supports controlled movement patterns of the user and also
adapts to changing walking speeds and different surfaces
 Foot weight: 345 g.
Figure 3-2 Design symmetry in 1- real ankle-foot skeletal and 2- Trias's foot.[65]
4- DYNA-CITY (PROTEOR GROUP, FRANCE) [66]

 Functional level: K2-K3.
 Material: carbon fiber.
 Design: Made with three composite fiber blades (carbon/epoxy) for
increased flexibility as shown in Figure 3-3:
o The lower blade covers the entire length of the foot for good
stability and a smooth continuous step.
o The intermediate blade allows quick flat foot.
o The upper blade brings the energy return needed for the push-off.
Comfort at heel strike is provided by the elastomer heel wedge.
 Foot weight: 445 g.
Figure 3-3 Dynacity foot blades functions.[66]
3.5 Methodology
3.5.1 Research Procedure
If possible, the passive markers are placed directly on the subject's skin.
If it was not possible, the markers were placed on tight fixed clothes to
minimize the errors come from marker movements during the gait [67].
Subject information such as weight and height were measured at the Al-
Warith prosthetic center. The subjects were asked about their amputation
causes, time laps and their trained prosthetic foot.
The subjects were fitted to the four types of the prosthetic feet and the
alignment procedure between their own sockets and the new prosthetic foot
was done. The alignment procedure consist three stages.
1- Bench alignment: this stage done on the bench by balancing the

prostheses.
2- Static alignment: this is to change the foot abduction or aduction,
eversion and inversion when the subject standing without ambulation.
3- Dynamic alignment: this stage done by visualize the ambulation of
the subject and correct the defect if the subject had pain in the socket.
Then, they were asked to do some walking steps in order to familiarize

themselves with the new prosthetic foot and the alignment procedure was
done in parallel if needed.
After that, the passive markers had been put on the seven joint landmarks
of the lower limb of each subject.
Some barefooted walking trials had been done on the walking path by
the subjects with their self-selected walking speed. The data were acquired for
the trials had a well-fitted foot on the force plate.
Finally, three walking trials data were collected for each subject and the
average of these data was calculated to minimize the errors.
3.5.2 Markers and their Placements
Seven passive markers (orange circular stickers) 21 mm in diameter

were located at perceptible anatomic landmarks. The marker landmarks
convergent and the joint center of rotation for various segments were
analyzed.
Table 3-2 lists of the specified positions of markers in both limbs [61],
whilst Figure 3-4 illustrates the marker's location through gait analysis.
The greater trochanter can be located accurately by using the fingers to
sense the lateral aspect of the subject's thigh. The bony rounded moving part
was the greater trochanter when the subject stands straight, flexed the knee
and rotate the femur laterally and medially.
The knee joint center of rotation can be recognized by palpating the
femoral epicondyles. It is an enlarged prominence located at the distal femur
lateral side.
The ankle joint center is located at on the outer side of ankle joint the
lateral malleolus prominence
In the foot segment, the distal marker is set at the fifth metatarsal bone.
At the lateral side, the head is palpated at the distal of the feet nearby to the
fifth toe. While the medial side the first metatarsal bone has a large head
found proximal to the first toe.
For the prosthetic side, the ankle marker was placed on the center of
rotation for the single-axis foot and at the attached adapters between the shank
and the foot for non-articulated foot.
The fifth or first based of which amputated side facing the camera
metatarsal marker was put at the distal end of the prosthetic foot.
Table 3-2 Passive markers specific locations in the left and right limbs.[61]
Marker Location Limb

1 Greater Trochanter Right hip
2 Lateral femoral epicondyle Right knee
3 Lateral malleolus Right ankle
4 Fifth metatarsal head Right forefoot
5 Medial femoral epicondyle Left knee
6 Medial malleolus Left ankle
7 First metatarsal head Left forefoot
Figure 3-4 Markers placement on the patient’s body.

3.5.3 The Gait Analysis System
The gait analysis laboratory sketch of the Department of Biomedical

Engineering /Al-Nahrain University is shown in Figure 3-5. It was installed at
Al-Warith Derman Prosthetic Center. The calibration procedure for the force
plate was done via software by using its calibration files and the zeroing step
was done every time before starting the test. It has two AMTI force platforms
arranged in tandem and located at the middle of a six meters’ wooden
walkway. Bio-analysis (Version2.2) is the analysis software that is related to
the AMTI force platforms and operated during and after the data acquisition
process. A video camera (Sony DCR-SR42) that is placed at right angles to
the force platforms at the hip height. It recorded the motions of seven markers
located in specific anatomic landmarks related to the center of rotation of the
lower extremities four considerable (hip, knee, ankle and forefoot) joints. The
kinematic and kinetic data were collected to be analyzed by using MATLAB
Software (R2018a).
Figure 3-5 Gait analysis system.

3.5.4 Measurement of the General Gait Parameters
The spatiotemporal gait parameters were calculated based on video

recorded by using image analysis software (Kinovea) for both time and
displacement parameters.
To compute the gait time, a stopwatch within the software was used
starting at the first heel strike and record the time at the second heel strike at
the same side, as shown in Figure 3-6.
Before measuring the distance, a known displacement was calibrated

into the Kinovea software then the distance and the time needed between two
points passed by the subjects were measured to find the speed via equation
3.3.
Also, the step length can be measured, the step counts in a specific time
to find the cadence and stride frequency.
General gait parameters can be calculated by using the following

formula [59]:
 Cadence (steps/min) = steps counted × (60/time (s)) (3.1)

 Stride length (m) = distance (m) × (2/steps counted) (3.2)
 Speed (m/s) = distance (m) / time (s) (3.3)
The block diagram shown in Figure 3-7 illustrates the way to calculate
the spatiotemporal parameters for the amputated side and the sound side.
(a) (b)
Figure 3-6 Kinovea application screens showing (a) first heal strike and (b) the second
heal strike of the same leg, stop-watch was used to measure gait time.
Figure 3-7 Flow chart of spatiotemporal parameters calculation.
3.5.4.1 Statistical Analysis
The data's normality distribution tested using Kolmogorov-Smirnov

and Shapiro-Wilk tests. For Equality of Variances, Levene's Test used, t-test
used for equality of means and the one-way ANOVA test with p=0.05 used to
find the significance between prosthetic feet types on the amputated leg and
the sound leg then using post hoc Tukey HSD to find the significance within
the group. The independent variable t-test with p=0.05 used to find the
significant differences between the amputated leg and the sound leg. The Data
Analysis was done using the statistical software of SPSS-24 (Statistical
Packages for Social Sciences – version 24).
More details about the statistics and their results shown in the appendix
A.
3.5.5 Measurement of Kinematics
The kinematics system was used in gait analysis to record the angles of
the joint and location of and orientation of the body segments by placing
markers on the skin surface in locations that accurately represent the action of
the underlying joints. A camera registers these markers, and their sites
converted into motion data via motion program (Skill Spector).
One camera (25 frames per second) was used and positioned at right
angles with the plane of motion (2.8 m) afar, fitted on a tripod stand for the
height of the subject hip from the floor, it was used to make two-dimensional
measurements.
3.5.5.1 Digitization Process of Marker
In the Skill Spector, the human lower limb is simplified into a model
composed of seven body positions hip, knee (left and right), ankle (left and
right), fifth metatarsal for the right foot, and first metatarsal for the left foot.
One of the digitized models for which side needed to digitize was chosen.
After that, the place of the moving markers in every single frame was marked.
Finally, the digitizing points were exported as a .txt format, so it’s ready to be
imported to MATLAB. Figure 3-8 showing marker digitizing procedure.
During a digitizing process, it’s possible to simplify and increase the

positioning accuracy using “select the point as missing” (the Skill Spector
predict the possible position using interpolation) and slandered zooming the
video image. The Skill Spector is operated on AVI video formatting only.
The flowchart in Figure 3-9 summarizes the procedure used to collect

gait kinematics.
Figure 3-8 Skill Spector program operation: (a) selection of digitization mode; (b)
selection of markers' position; (c) export digitizing point.
Figure 3-9 Flow chart of kinematics parameter calculations.
3.5.5.2 Filtering of Gait Data
It is impossible to be precise in digitizing the position of the markers.

These small inaccuracies in each coordinate lead to digitization noise in the
results. Luckily this noise tends to be rising with frequency, while the signal
(the marker trajectories) has a relatively minimum frequency. So, the noise
may be reduced by low-pass filtering, letting the lower frequencies within the
signal through and blocking the high-frequency noise [61].
The most common kind of filter used in gait analysis is a critically
damped 2nd order Butterworth low-pass filter [61]. The cut-off frequency,
which separates the wanted signal from the noise depending on the type of
data as shown in Figure 3-10, is equal to six times of the stride frequency of
the gait [58].
Figure 3-10 Padding procedure used on a signal before it enters Butterworth filtering.[61]
The implementation of the filtering process was done within MATLAB

software. Figure 3-11 shows filtered and unfiltered data for ankle joint angles.
Figure 3-11 Differences between filtered and raw ankle angular displacement data.
(A)Raw data, (B) filtered data.[67]
3.5.6 Measurement of Kinetics
The AMTI force plate has six transducers component to measure the
upper surface displacement at all three axes when there is an applied force.
Figure 3-12 illustrates the force plate axes. The force plate’s six outputs
included the three force vector magnitudes (Fx, Fy, Fz), and three moments of
force based on the center of the platform (Mx, My, Mz) [57].
Then, it is passed to the computer unit where the Net force software
permits the user to observing and save data in real-time [68].
Figure 3-12 Coordinate system of a force platform.[57]
The force platform is indispensable to the body for a spontaneous load

to behave as a normal happening as much as possible in the walking trials. As
such, the force plate is fixed in (6000×1220×100) mm3 flat wooden walkway.
The two force plates available have distinguished dimensions, the first plate
possesses a length, width and height of (508×461×100) mm3 and the second
of (498×498×40) mm3. Such that, the second force plate is mounted above a
platform made of wood with a height of (60 mm) interior to the walkway.
Figure 3-13 illustrates the force platform’s dimensions.
After the data was collected from the Netforce software, the
Bioanalysis software was utilized for monitoring the ground reaction forces
(GRFs) and exported it as a text file (.txt) and the data for F x, Fy and Fz for
three trials of each subject were interpolated for 100 sets of data throughout
the gait and the average of these sets was taken to minimize the errors. After
that, it had been normalized to the bodyweight of each subject and plotted as
the relation between the bodyweight percentage and the stance phase
percentage. Figure 3-14 shows a block diagram of the kinetic data calculation.
Figure 3-13 Force plate dimensions.

Figure 3-14 Flow chart of kinetics parameter measurement procedure.
CHAPTER FOUR
Results and Discussion
4.1 Introduction
This chapter contains the results of the experiments including the

spatiotemporal parameters, lower limb joints angles, and the ground reaction
forces, in addition to their discussions and comparison to the normal values
reported by the previous studies.
The spatiotemporal parameters including amputated leg gait time (s),

sound leg gait time (s), amputated leg stance time (s), sound leg stance time
(s), amputated leg single support time (s), sound leg single support time (s),
amputated leg step length (cm), sound leg step length (cm), cadence
(step/min) and speed (m/s), then statistically analyzed and the comparison had
been done across the four types of prosthetic feet and between the sound leg
and amputated leg for the same subject.
When talking about the kinematics part, the lower limb joint angles (hip,
knee, and ankle) also plotted for both limbs with a percentage of gait after
taking the average of trials for each joint angle for both limbs.
Similarly, for the kinetic part, the average ground reaction forces (Fx, Fy,
and Fz) for the sound and the amputated limb had been plotted as normalized
values to the bodyweight with the percent of stance phase and compared with
the normal graphs.
4.2 Spatiotemporal Parameters
Because this study assesses the difference in gait when the subjects
fitted to different types of feet, the spatiotemporal parameters of the gait had
been measured using the optical two-dimension way [22]. By using the
Kinovea software (Kinovea-0.8.15), spatiotemporal parameters were measured
manually from the videos recorded for both the amputated leg and the sound
leg.
The results in Table 4-1 show no significant differences in

spatiotemporal parameters for p=0.05 between the four prosthetic feet types
each for the sound and amputated leg. The results show a significant
difference in the single support time between the amputated leg and sound leg
when the subjects were fitted to Trias1C30 and Dynastep p<0.05, and the
difference in the single support time for the amputated leg between the four
types of feet also founded.
As shown in Table 4-1, the Dynacity is the best one to give the highest
symmetry in the gait time between the amputated leg and the sound leg. While
the highest asymmetry was found in SACH foot, with 0.2 (s) difference for the
sound leg greater than the amputated leg. The lowest gait time was recorded
when the subjects use Dynastep foot with 1.4 (s) for each leg. This makes the
subjects to walk with greater cadence and speed comparing with other types of
feet.
For the stance time, the greatest difference between sound leg and
amputated leg is found at Dynastep foot with 0.12 (s) for the sound leg, in all
feet types the stance time for the sound leg is greater than the stance time for
the amputated leg.
As shown in Table 4-1, symmetrical single support time for the

amputated leg is found at SACH and Dynacity feet at 0.47 (s), and the smallest
time is shown at Dynastep foot at 0.42 (s). While the sound leg had the
greatest single support time at SACH with 0.56 (s) and lowest at Trias 1C30
with 0.52 (s).
.Table 4-1 Means values ± SD of spatiotemporal parameters of the amputated and sound side for four types of prosthetic feet
Normal
Variables SACH Dynastep Dynacity Trias 1C30 P-Value
range[59]
Amputated leg gait time (s) 1.50±0.19 1.40±0.14 1.49±0.17 1.41±0.15 0.665
Sound leg gait time (s) 1.52±0.21 1.40±0.16 1.49±0.17 1.41±0.18 0.655
Amputated leg stance time (s) 0.95±0.13 0.84±0.08 0.95±0.10 0.88±0.12 0.303
Sound leg stance time (s) 1.00±0.21 0.96±0.17 0.99±0.14 0.95±0.14 0.948
Amputated leg single support time (s) 0.47±0.06 *0.42±0.03 0.47±0.05 *0.44±0.03 0.175
Sound leg single support time (s) 0.56±0.07 *0.54±0.12 0.53±0.08 *0.52±0.06 0.88
Amputated leg step length (cm) 47.09±3.76 47.13±6.35 44.98±6.11 44.23±5.14 0.724
62.5-92.5
Sound leg step length (cm) 46.94±2.53 48.26±4.62 48.29±4.74 49.28±4.37 0.812
Cadence (step/min) 91-135 82.62±11.51 87.79±6.70 82.63±8.72 86.40±8.65 0.68
Speed (m/s) 1.10-1.82 0.67±0.15 0.72±0.12 0.68±0.06 0.69±0.08 0.907
n=6, p=0.05
For the SACH foot, in all subjects, the single support time in the amputated
side was less than that in the sound side by 0.09 (s), which is greater than the
difference for Trias 1C30 with a difference of 0.08 (s). Trias 1C30 had a
difference in single support time between the amputated leg and the sound leg
in all subjects as shown in Figure 4-1, while SACH foot had equal single
support time for Case-5 and Case-6. For these results, SACH had no
significant difference despite it have a greater difference between the sound
and amputated leg, but the Trias 1C30 had shown a significant difference.
Equal single support times between the legs were observed in Case-5 when
fitted to SACH foot, due to a long time has passed since the amputation (10
years), as shown in Table 3-1, and being well-trained over five years on using
SACH foot, before being fitted with his Echelon foot.
In Case-6, SACH foot also shows equal single support time for both legs.
Because Case-6 has a stiff ankle joint in the sound leg, Case-6 cannot move
his ankle joint in the sound side with its normal movement during gait (Dorsi-
flexion and Planter-flexion). For that, the sound foot had transferred through
the gait like a SACH foot.
For the SACH foot, despite Case-1 had 8 years of donning prosthesis with
SACH foot, more difference in the single support time was found in Case-1,
because of the long stump, the elder one between subjects, his level of
movement K1 and the rigidity of the SACH foot, as shown in Figure 4-1. So
Case-1 trained to no longer depend on the amputated leg during the gait and
tried to transfer the bodyweight to the sound leg more time during gait to get
more stable walking.
0.9
0.8
single support time (s)
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 2 3 4 5 6
sach foot sound side Dynastep sound side Trias1c30 sound side Dynacity sound side
.Figure 4-1 Single support time of the sound and amputee legs for six subjects
A significant difference between the amputated leg and sound leg in the
single support time appears when the subjects fitted to Dynastep foot, this
difference came from the greatest difference observed in Case-1 and Case-2.
That is because these two subjects had the greatest body masses, 107 and 105
kg respectively. So, the rubber heel compressed rapidly and released the
energy at the earlier time of gait making the subjects to transfer the
bodyweight to the sound leg for a longer time.
The greatest difference in single support time between the sound side
and the amputated side recorded for Case-1 when fitted to Trias 1C30.
The results suggested the Dynastep foot to be used for Case-6. Because
it is perfect for his situation with a sound limb ankle defect. The records had
shown a low single supporting time on the sound leg than the amputated leg.
This will help Case-6 in lowering the time of weight support on the defected
sound leg.
The Dynacity had the lowest difference in single support time between
the amputated leg and sound leg for Case-1. So, the foot is the best choice for
K1 level subjects, Case-1 needed some extra training time to be a K2 level
with a more stable walk without the need for a crutch.
The greater cadence 87.79±6.70 step/min and walking speed 0.72±0.12

m/s were recorded when the patients used Dynastep foot, because of its design
with rubber material helping in damping during the heel strike and the two
separated built-in carbon blades acting as a leaf spring which gives the
subjects the push-up force during late stance due to the energy stored.
The results of this study were consistent with previous studies where
below knee amputation subjects walking with reduced speed [69, 70].
High symmetry of step length between legs is found in SACH foot with
sound leg step length shorter than the amputated leg, matched with the finding
of Isakov e. et al [24]. Subjects had to depend on the curved shape of the
SACH planter during gait and on the hip flexor muscle to transfer the
amputated leg forward for a long step because SACH is an inactive foot and
can’t store energy that brings the body forward during the late stance. The
highest asymmetry of step length was found in Trias 1C30 of 44.23±5.14 cm
for amputee leg and 49.28±4.37 cm for sound leg [71].
High asymmetrical stance time was found in Dynastep foot were

0.84±0.08 (s) for the amputated leg and 0.96±0.17(s) for the sound leg. The
types of feet have less effect on the gait time, Table 4-1 shows nearly equal
gait time for the sound and amputated leg in all types of feet.
The results in Table 4-1 show a little difference in spatiotemporal
parameters between the amputated side and the sound side for all types of feet,
which agrees with the previous studies [72].
4.3 Kinematic Analysis
The sagittal plane angular displacement for the sound and the amputated side
of each subject were plotted for the hip joint, the knee joint, and the ankle
joint. These joint angles were computed with equations 2.5, 2.6 and 2.7 for
ankle, knee, and hip joints, respectively.
For the subject case-1, Figures 4-2, 4-3 & 4-5 show the hip, knee, and
ankle angles for the amputated side and the sound side, respectively.
As shown in Figure 4-2, the sound side hip angle in the case of using
Trias1C30 had a flexion angle with 27º at the heel strike greater than that
when using the other feet types, creating an extension in the sound side-step
length.
At about 55% of the gait, at the pre-swing, the sound side hip angle shows the
maximum extension angle of 22º, then it reflexed gradually through the
terminal swing until the second heel strike.
This hyperextension 22º in the sound side causes lower back pain to Case-1
during the gait.
For both Dynastep and Dynacity feet, the sound hip angle curve shown
in Figure 4-2 has a symmetry pattern with 20º of flexion at heel strike. A
slower decrease in angle and extension at 55% for Dynastep, at 59% it
reaches 13º of extension, then reflexed again to the terminal swing.
When using the feet Trias 1C30, Dynastep, and Dynacity, the sound hip angle
curve has higher symmetry compared to the normal curve in Figure 2-7, but
in lower flexion angle peaks except for Trias 1C30 which has the greater
flexion peak.
Only SACH foot has the lowest sound hip flexion angle at the heel strike of 9º
and a lower extension angle of 6º.
For the amputated side, the hip angle pattern exhibit symmetry to the
normal pattern when using Dynastep and Dynacity feet.
The amputated side hip had flexed when the SACH foot was used,
which means Case-1 elongated his amputated step length.
Trias 1C30 shows late stance maximum extension of gait. Dynacity has
the highest symmetry to the normal pattern over the other type of feet but in
less flexion and extension angles.
For the knee joint angle, Figure 4-3 shows the angles during the gait for
the amputated side and the sound side.
For the sound side, the knee joint angles curve exhibited a normal curve
like when the subject uses Dynacity and Dynastep, with a double flexion
curve of 3º flexion at the beginning of heel strike and maximum knee flexion
10º at mid-stance, then it has fully extended at 45% of the gait (terminal
stance) finally to transfer the leg for the next gait, it is back to maximum
flexion at the mid-swing.
For the sound side knee angle, when using the SACH foot, the knee
began the gait with 5º of extension and at the mid-stance, the sound knee had
lower peak flexion with 5º, the maximum peak flexion at the mid-swing about
40º.
Trias1C30 had affected the sound knee angles with 16º of knee flexion at the
heel strike then extended slowly throughout the stance phase to the pre-swing
reaching 5º, and reflexed at the mid-swing with 30º.
For the amputated side, Dynastep, Dynacity, and SACH feet appear to
have normal curve patterns as shown in Figure 4-3 with initial contact of 11º
of flexion. While the knee is fully extended during the stance when the Trias
1C30 was used. This had appeared to cause pain in the knee joint during
ambulation because the foot was aligned in the plantar-flexion position. This
situation can be corrected by realigning the foot position.
Also, the prosthetic foot had affected the ankle angles during the gait.
Figure 4-4 shows the sound side and the amputated side ankle joint angles.
At the sound side, the more familiar angular displacement curve
compared to the normal curve was that when using Trias 1C30, which shows
small plantar-flexion at the loading response, dorsal flexion at the terminal
stance, and small plantar-flexion at the initial swing.
The other three feet had asymmetry in the sound side curves compared to
the normal curve, with no plantar-flexion, because these feet are more
flexible, which makes the sound side ankle do more dorsiflexion until transfer
the amputated side to the second heel strike.
For the SACH foot, the sound side appears to have 14º dorsiflexion
which is more than the normal value due to the shape of the SACH which
makes the subject to make longer step length.
For the amputated side shown in Figure 4-4, the Dynastep and Trias
1C30 had been aligned in plantar-flexion position which appears at the initial
contact, while SACH, which is a fixed foot, appears to has little dorsiflexion
at the mid-stance and it still throughout the gait.
Trias 1C30 has maximum dorsiflexion at the terminal stance for storing
the energy then reposition to the neutral at the swing phase.
Dynastep and Dynacity have the same kinematic curve pattern for the
amputated side.
Since the amputated side had no leg muscle function in the planter and
dorsal flexion, the recorded ankle angles result from the flexibility of the
prosthetic feet during the gait phases.
sound carbon sound sach
30 sound dynastep sound dynacity
sound hip angle (θ) in
20 Flexion
10
degrees
0
Extension
-10
-20
-30
(a)
amputee carbon amputee sach

amputee dynastep amputee dynacity
30
25
20
amputee hip angle (θ) in
15
Flexion
10
degrees
-5
Extension
-10
-15
-20
(b)
Figure 4-2 Case-1 Hip joint angle (a) sound side (b) amputated side.
60
sound dynastep sound dynacity
50
sound knee angle (θ) in
40 Flexion
degrees
30
20
10
0
Extension
-10
(a)
60 amputee dynastep amputee dynacity
50
Amputee knee angle (θ)
40
Flexion
30
in degrees
20
10
0
Extension
-10
(b)
Figure 4-3 Case-1 knee joint angle (a) sound side (b) amputated side.
16
14
12
Dorsalflexion
10
sound ankle angle (θ) in
6
degrees
0
Plantarflexion
-2
-4
(a)
20
amputee ankle angle (θ)
Dorsalflexion
15
in degrees
10
0
Plantarflexion
-5
(b)
Figure 4-4 Case-1 ankle joint angles (a) sound side (b) amputated side.
For Case-2, the amputated side and the sound side hip angles shown in
Figure 4-5. He had a more symmetrical curve between the two sides when
using the Dynastep foot. Also, they are similar to the normal curve.
The Dynacity foot has both side symmetrical curve with slower hip extension
throughout the stance phase to the mid-swing until it re-flexed when reaches
the terminal swing.
For Case-2, the knee had osteoarthritis on the amputated side. Figure 4-
6 shows the knee joint angle for both sides. The Trias 1C30 shows rapid knee
extension at 45% of gait at the amputated side. This caused knee joint pain to
the subject when using the foot.
Also, Trias 1C30 affects the sound side knee to stay in a fully extended
position through the stance phase.
The more normal curve appearance is at the Dynastep foot with
maximum knee flexion 42º at the sound side and 52º at the amputated side.
Because Dynastep foot has an articular joint, so it makes 5 º planter-flexion at
heel strike at the amputated side and shows symmetrical ankle joint angles in
both sides as shown in Figure 4-7.
Dynacity show dorsiflexion through the gait because of
For subject Case-3, who has a sound leg ankle fixation plate, hence
unable to walk barefoot and needs to use shoes while walking to help him in
the process of attaching the joint and to relieve the pressure on the foot instep
while walking. Figures 4-8, 4-9 and 4-10 show the joint angles of the hip,
knee, and ankle, respectively.
Dynacity had a symmetrical pattern for the sound side and the
amputated side with 28º flexion at the initial contact in the amputated side and
24º at the contralateral side, 5º extension at the pre-swing in the amputated
side and 7º at the contralateral side, then back to the flexion position in the
swing phase.
Dynacity has the longest period of hip flexion-extension through the
stance extend from 0-77 % of gait.
40
30
20
Flexion
degrees
10
0
Extension
-10
-20
(a)
35
30
25
20
Flexion
15
degrees
10
0
Extension
-5
-10
-15
(b)
Figure 4-5 Case-2 hip joint angle (a) sound side (b) amputated side.
80
70
60
50
Flexion
40
degrees
30
20
Extension
10
-10
(a)
60
50
amputee knee angle (θ)
40
Flexion
30
in degrees
20
10
Extension
-10
(
b)
The same thing for the Dynastep except for the sound side which has a
regular pattern in companion with Trias1C30 with maximum extension angle
at 55% equal to 7º. SACH foot had the maximum sound hip extension angle
at 55% equal to 15º and 11º at the amputated side.
For the knee joint angles shown in Figure 4-9, the sound side knee angle,
when using Dynastep and Dynacity, shows 20º knee flexion at the loading
response to mid-stance which is good for subject Case-3 to absorb the forces
at the initial contact. The second peek flexion is with 66º more than the
normal curve shown in Figure 2-7 at the mid-swing with Dynastep and
Trias1C30.
35
25
Dorsalflexion
20
15
degrees
10
0
Plantarflexion
-5
-10
(a)
12 amputee carbon amputee sach
10
8
Dorsalflexion
4
in degrees
-2
Plantarflexion
-4
-6
(b)
Figure 4-7 Case-2 ankle joint angle (a) sound side (b) amputated side.
SACH foot has the normal pattern at the sound side with lowest knee
flexion at the heel strike, but in the amputated side begin with knee flexion
flowed by extension at the terminal stance and reflexed at the mid-swing.
For the amputated side, the knee stays flexed with all the feet when the
subject wants to absorb the force during the gait.
40
30
20
degrees
Flexion
10
0
Extension
-10
-20
(a)
35
25
20
Flexion
15
10
degrees
0
Extension
-5
-10
-15
(b)
80
60
50
Flexion
40
degrees
30
20
Extension
10
-10
(a)
70
50
Flexion
40
in degrees
30
20
10
Extension
-10
(b)
At the ankle joint, the sound side angle shown in Figure 4-10 has the
maximum plantar-flexion with 2º at Dynacity in the loading response, then
prolonged dorsiflexion until reaching 13º maximum peak at 47% of gait with
SACH. When using SACH, the sound side kept on dorsiflexion through the
swing phase.
The good characteristic of sound side ankle joints appears at Dynacity, it
has prolonged dorsiflexion during the stance phase, and this helps the subject
to slowly do the dorsiflexion motion at the sound foot without making it
painful for him.
15 sound carbon sound sach
10
Dorsalflexion
5
degrees
0
Plantarflexion
-5
-10
(a)
14
12
Dorsalflexion
10
8
in degrees
2
Plantarflexion
-2
(b)
In the amputated side shown in Figure 4-10, the Trias1C30 (carbon foot)
and SACH have no plantar-flexion. The SACH has the lowest dorsiflexion at
the terminal stance because of its stiffness. At the loading response, the
maximum plantar-flexion is for Dynastep, because it has an articular joint.
The maximum dorsiflexion is for Dynastep in the terminal stance phase, the
energy-storing period, more than the normal by 2º.
Dynacity has a prolonged and ideal dorsiflexion angle 10º similar to the
normal curve in Figure 2-7.
At the terminal stance, the amputated side does not record any planter
flexion because of the absence of the leg muscle.
The hip angles, for the sound side and amputated side, for subject Case-4
is shown in Figure 4-11.
The sound side was affected according to the type of foot, similar to the
normal curve that appeared when using the SACH foot. For the remaining
three feet, the effect was the same. It appeared to be in the flexion position at
25º and gradually decrease during the stance period with maximum hip
extension at 15º with Trias1C30 at the mid-swing.
For the amputated side, the similar to normal curve of hip angle was
found at the Trias1C30 with initial contact flexion angle 22º, terminal stance
extension angle 12º, and flexion with 25º at the mid-swing.
The rest prosthetic feet shows the same hip angles during the gait, with
initial contact flexion angle 15º-17º then extend gradually until reaching 10º
of hip extension during the mid-swing.
The amputated side and sound side for subject Case-4 knee joint angles
are plotted in Figure 4-12.
As shown in Figure 4-12 (a) and (b), Trias 1C30 shows knee angle
symmetry for the amputated side and sound side, with maximum knee flexion
at the sound side reaching 53º and 48º at the amputated side.
The Dynacity foot was the only foot at the amputated side has to show
knee flexion in the mid-stance equal to 15º, this knee flexion helps the subject
to absorb the forces during the initial to the mid-stance, so the gait with this
foot is more comfortable for him.

30
25
20
Flexion
15
10
degrees
-5
Extension
-10
-15
-20
(a)

30
25
Flexion
20
15
degrees
10
5
0
-5
Extension
-10
-15
-20
(b)
60
50
40 Flexion
30
degrees
20
10
0
Extension
-10
(a)

50
40
Flexion
in degrees
30
20
10
0
Extension
(b)
The ankle joint angles for subject Case-4, for the amputated side and the
sound side, are shown in Figure 4-13. The sound side ankle shows plantar-
flexion with SACH and Trias1C30 at the mid-stance. While Dynastep and
Dynacity do not show sound side plantar-flexion because of the high forward
pushing force from the amputated side.
On the amputated side, the only foot has a plantarflexion during the
initial contact is the Dynastep foot about 3º because it has an articular joint.
When the subject at the heel strike phase, the foot was plantar flexed then
dorsiflexed to 5º at the terminal stance.
Dynacity has the maximum dorsiflexion angle of 9º at the terminal
stance which is the phase for energy storing. Because of that, the subject
changes his foot to the Dynacity at the end of the test.

25
Dorsalflexion
20
15
degrees
10
0
Plantarflexion
-5
-10
(a)
10
Dorsalflexion
6
in degrees
0
Plantarflexion
-2
-4
(b)
Figure 4-13 Case-4 ankle joint angle (a) sound side (b) amputated side
Hip joint angles for the sound side and the amputated side for the subject
Case-5 were plotted in Figure 4-14.
The graphs show a normal pattern but with lower flexion angles at the
sound side with 12º-17º at initial contact while the amputated side with 20º-
28º.
The two curves in Figure 4-14 do not show any abnormal pattern during
the gait.

20
15
Flexion
10
degrees
0
Extension
-5
-10
-15
-20
(a)
30
20
Flexion
10
degrees
0
Extension
-10
-20
-30
(b)
For the knee joint as shown in Figure 4-15 of Case-5, the maximum
flexion angle on the sound side appears when using Dynastep, but in general,
the sound side shows high symmetry to the normal curve especially when
using Dynastep.
At the amputated side, as shown in Figure 4-15; all feet begin the gait
with knee flexion because the subject needs to start the gait with foot flat not
with heel strike to get more balance during the ambulation over the amputated
side.
50
sound knee angle(θ) in
40
Flexion
30
degrees
20
10
Extension
-10
(a)
40
Flexion
30
in degrees
20
10
Extension
-10
(b)
At the ankle, the joint angles show different curves when using different
feet for the sound and amputated side as shown in Figure 4-16.
In the sound ankle, the curves when using Dynacity and Trias1C30 are the
closest curves to the normal with small plantar-flexion at the mid-stance 3º-5º,
dorsal flexion 12º-13º at the terminal stance, and a plantar-flexion at heel off
and pre-swing phase. That is because of the action of the calf muscle for
pushing the body forward.
At the amputated side, Dynastep has the maximum first planter flexion
because it has an articular joint, so it gives the closer initial contact pattern to
the normal gait. The second planter flexion occurs with Trias1C30 and
Dynacity at the pre-swing phase because of the alignment and fixation of the
foot in the plantar-flexion position.
The Maximum dorsiflexion occurs with Trias1C30 of 7º at 40 % of gait.
For subject Case-6, sound and amputated side; hip, knee, and ankle joint
angles are shown in Figures 4-17, 4-18 and 4-19, respectively.
The hip joint curve at the sound side shows a normal pattern when using
Trias 1C30 and Dynacity feet. SACH and Dynastep have prolong decreasing
in hip flexion angle because of the subject with these two feet used the crutch,
which makes him walk in flex hip position.
On the amputated side only Dynacity shows a normal pattern.
Knee joint angles are also recorded for the sound side and amputated
side for the subject Case-6 as shown in Figure 4-18a. Trias 1C30 and
Dynacity have the normal pattern on the sound side, but Dynastep and SACH
feet have flexed sound knee through the stance phase because of the use of a
crutch.
For the amputated side, shown in Figure 4-18b, knee contracture has
been diagnosed because all feet appear knee flexion throughout the gait.
Dynacity gives a good sound side ankle joint angles curve as shown in
Figure 4-19a. On the amputated side, the foot exhibits some dorsiflexion
through the terminal stance.

20
Dorsalflexion
15
10
degrees
0
Plantarflexion
-5
-10
(a)
12
Dorsalflexion
10
8
in degrees
6
4
2
0
Plantarflexion
-2
-4
-6
(b)
Trias1C30 shows sound side plantar-flexion with 15º at the mid-stance

and back to the neutral position in the pre-swing. On the amputated side, the
curve shows a high dependence of the patient over other feet.

40
30
Flexion
20
degrees
10
0
Extension
-10
-20
(a)
35
25
20
Flexion
15
10
degrees
-5
Extension
-10
-15
(b)
60

50
40
Flexion
30
degrees
20
10
Extension
-10
-20
(a)
60
50
Flexion
40
in degrees
30
20
10
0
Extension
(b)
25
20
Dorsalflexion
15
10
degrees
5
Plantarflexion
-5
-10
(a)
30
20
Dorsalflexion
15
in degrees
10
5
Plantarflexion
-5
-10
(b)
Table 4-2 Range of motion at lower limb joints for the amputated side and sound side.
range of motion
sound side amputated side
(deg)
subjects joints Trias1C30 SACH Dynastep Dynacity Trias1C30 SACH Dynastep Dynacity
hip 49.3 28.3 32.9 34.3 29.6 36 26.9 28.3
case-1 knee 32.9 44.5 50.6 53.9 45 40.3 44.5 46.6
ankle 9.4 14.6 12.8 12.8 17.8 15.9 11.9 9.3
hip 22.3 36 35.4 28.1 39.5 31.2 41.7 32.1
case-2 knee 31.5 57.4 57.9 41.3 33.5 42.4 52 38
ankle 18.8 14.9 17.1 31.2 11.8 9.1 12.2 10.9
hip 35 35 36.1 32.4 32.6 42.5 34.9 33.4
case-3 knee 55.5 52.9 56.6 52.7 39.8 50.8 43.5 46.5
ankle 16.1 13.4 15.7 14.2 9.8 6.3 12.2 10.6
hip 37.8 26.5 27.7 29.4 38.3 41.8 36.3 40.2
case-4 knee 49.7 36.2 43.6 48.4 42.9 33.9 45 38.1
ankle 13.4 15.4 19.8 24.4 8.8 1.8 7.5 9.2
hip 29.6 25.7 31.8 29.8 49.3 35.4 31.6 40.4
case-5 knee 45 45.8 47.5 45.9 32.9 38.1 29.1 32.6
ankle 17.8 14.3 18.6 17.2 9.4 13.7 14.1 10
case-6 hip 39 24.2 28.5 39.4 24.2 20.1 20.2 36.1
knee 36.3 27.9 33.2 58.1 36 19.3 24.7 26
ankle 13.7 17.4 21.1 28 26 10.9 8.9 10.5
4.4 Ground Reaction Forces
The vertical, the anterior-posterior, and the medial-lateral components of

the ground reaction forces for the amputated side and sound side, of each
subject, were plotted as a percentage of the bodyweight with the percentage of
stance.
The subject Case-1 vertical GRFs are shown in Figure 4-20. On the
sound side, a maximum push-off force was found when using SACH foot
because the subject depends on his plantar-flexion muscle to push the body
upward against the ground, but the other feet have the ability to store and
release the energy which reduces the pressure on the muscle in the sound leg.
The step in the sound leg vertical force came from the higher push-off
energy in the amputated leg when using Dynacity.
At the amputated leg, the more similar vertical force curve to the normal
characteristics was found with Dynacity, with the lowest mid stance force and
highest push-off force.
Trias1C30 has a higher mid stance force at the amputated side which
caused pain in the knee and back.
Forward-backward GRFs, for the subject Case-1, are shown in Figure 4-
21. The sound side shows some braking force which is maximum with
Trias1C30, 12% of BW, and minimum with SACH foot, about 5% of BW.
Also, the propulsive force has a minimum peak when using SACH.
At the amputated leg, the braking force is at the minimum value for all
types of feet, the higher braking force is with SACH. Also, the propulsive
force is high with SACH which means the high horizontal frictional force
between the foot and the ground, while the rest feet types have lower
propulsive force but high vertical component as shown previously.
The medial-lateral GRFs, at the sound side, show a normal pattern with
different types of prosthetic feet but in lower peaks compared to the normal in
Figure 2-8 (c).
Like other subjects, Case-1 medial-lateral amputated side GRF shows an
extended single hump directed medially over the stance phase.
sound leg SACH sound leg Dynacity

sound leg Dynastep sound leg Trias1c30
140
120
Fz % of BW
100
80
60
40
20
-20
(a)
Amputated leg SACH Amputated leg Dynacity
Amputated leg Dynastep Amputated leg Trias1c30
120
100
Fz % of BW
80
60
40
20
(b)
Figure 4-20 Case-1 vertical ground reaction force (a) sound side (b) amputated side.
Sound leg SACH Sound leg Dynacity
Sound leg Dynastep Sound leg Trias1c30
15
10
Fy % of BW
-5
-10
-15
(a)
15
10
Fy % of BW
-5
-10
-15
-20
(b)
Figure 4-21 Case-1 anterior-posterior ground reaction force (a) sound side (b) amputated
side.

8
Fx % of BW
-2
-4
-6
(a)
4
3
Fx % of BW
2
1
0
-1
-2
-3
-4
-5
(b)
Figure 4-22 Case-1 medial-lateral ground reaction force (a) sound side (b) amputated side.
The ground reaction forces for the subject Case-2 had been plotted as a
percentage of the bodyweight with the percentage of stance phase for the
sound side and amputated side in Figures 4-23, 4-24 and 4-25.
The sound side vertical GRF in Figure 4-23 (a) shows a higher first peak
with SACH about 118 % of BW, but a lower extended peak with Dynacity
and a similar second peak when using different feet.
At the amputated side, the vertical GRF in Figure 4-23 (b) shows similar
curves to the normal for Dynastep and Trias1C30, but the two peaks are lower
in Trias1C30 with a late first peak at about 30% of stance.
Dynacity has a stepped first peak with some period of steady then rising
upward to make the first peak of about 107% of the BW then decrease to 90%
of BW and suddenly increase upward at late stance to give the push-off force,
the higher ones, and 115-117 % of BW, with Dynacity and Dynastep but
earlier in Dynastep than Dynacity.
SACH foot shows mid stance hump about 100% of BW, because, as
shown previously, the subject had no knee flexion with this foot at the mid-
stance to absorb the force which causes the middle peak appearance at the
mid-stance.
At the sound side, all feet have a clear shape of forward-backward force
with 10% BW braking and 15% BW push-off force greater than the
amputated side, as shown in Figure 4-24 (a).
The forward-backward force shows a maximum braking force of 10% of
BW at the amputated side with Dynastep foot and 12% of BW forward force,
as shown in Figure 4-24 (b). It has the most curve symmetry between the
sound side and the amputated side.
Trias 1C30 has the lowest braking force with 3% BW on the amputated
side as shown in Figure 4-24 (b).
The sound side medial-lateral forces shown in Figure 4-25 (a) have
appeared some lateral force at initial contact and small medial force in the
mid-stance, 1% of BW, then 4-6% of BW at toe-off.
At the amputated side in Figure 4-25 (b), all feet have appeared only
medial force with two expanded peaks during the gait, the maximum one with
SACH and the minimum with Trias1C30.
140
120
Fz % of BW
100
80
60
40
20
(a)
140 amputated leg SACH amputated leg Dynacity
amputated leg Dynastep amputated leg Trias1c30
120
100
Fz % of BW
80
60
40
20
-20
(b)
20
15
Fy % of BW
10
-5
-10
-15
(a)
amputated leg SACH amputated leg Dynacity

15 amputated leg Dynastep amputated leg Trias1c30
10
Fy % of BW
-5
-10
-15
(b)
side.
Fx % of BW
8
-2
-4
-6
(a)

5
4
Fx % of BW
-1
(b)
The subject Case-3 had done the test on the force plate with shoes at the
sound leg because he has an ankle joint fixation plate, the shoes have helped
him to tight the ankle joint during walking.
The vertical GRF for the sound side shown in Figure 4-26 (a) has the
maximum initial contact peak with Trias1C30 about 124% of BW, while the
rest feet have about 115% of BW which is lower than normal, and the keel off
hump is similar at all feet with a range of 114-119% of the BW, which is in
the normal range.
For the amputated side shown in Figure 4-26 (b), Dynacity and Dynastep
have the same vertical GRF, but the increasing of force slop in Dynastep is
more than the slop in Dynacity at the initial contact. This causes pressure in
the socket.
Trias1C30 has a maximum initial peak with 120% of BW, while SACH
has a spike rising about 122% of BW at the beginning of the mid-stance, these
two feet have greater mid stance force, which caused lower back pain for the
subject.
The forward-backward forces for the amputated and sound side, for all
types of feet, are represented in Figure 4-27.
On the sound side shown in Figure 4-27 (a), Case-3 shows 8% of BW braking
force and 8 % of BW propulsive force with Dynastep foot. The clear shape
was recorded at the sound side with all feet except SACH, which has the
lowest braking force.
At the amputated side in Figure 4-27 (b), the feet have shown a
propulsive peak force that came from the energy stored in the feet which was
released at the keel off phase, but with irregular braking force at mid-stance
with a small hump for all feet which represent the backward force between
the foot and the ground, the lesser one with Dynacity is 5% of BW.
The medial-lateral forces at the sound side with different types of feet of
Case-3 are shown in Figure 4-28 (a). A little effect on the pattern was
recognized, a maximum lateral force at the initial contact with SACH is 6%
of BW, the lowest with Trias1C30 is 1% of BW, and a maximum first medial
peak with Trias1C30 is 5% of BW. The second medial peak, with all feet,
shows regular shape and value.
At the amputated side, all feet have only a medial single peak through
the stance. The maximum one with Trias1C30 is about 9% of BW and a
smaller one with Dynacity is below 6% of BW.
140 Sound leg SACH Sound leg Dynacity

120
100
Fz % of BW
80
60
40
20
(a)

120
100
Fz % of BW
80
60
40
20
-20
(b)
Figure 4-26 Case-3vertical ground reaction force (a) sound side (b) amputated side.
10 Sound leg Dynastep Sound leg Trias1c30
8
Fy % of BW
-2
-4
-6
-8
-10
(a)

10
Fy % of BW
-5
-10
-15
-20
(b)
Figure 4-27Case-3 anterior-posterior ground reaction force (a) sound side (b) amputated
side.
The study suggests that subject Case-3 to use the Dynacity foot because the
forces graphs have shown a clear pattern with less effects on the sound side.
8 Sound leg SACH Sound leg Dynacity
6
4
Fx % of BW
-2
-4
-6
-8
(a)

10 amputated leg Dynastep amputated leg Trias1c30
8
Fx % of BW
-2
(b)
For the subject Case-4, at the end of the test, the subject decided to
change his prosthetic foot with Dynacity foot, the following graphs of the
forces will clarify the causes.
The vertical GRF shown in Figure 4-29 shows a clear pattern and high
symmetrical between the amputated side and the sound side with Dynacity
foot, with a lower mid stance force 80% of BW and a higher push-off force in
the amputated side comparing with other types.
The sound side push-off force has a high similar shape to the normal
with all feet because it depends on the forces come from the plantar-flexion
muscle.
The first small hump at initial contact in the sound side, with the use of
Dynacity, comes from the high pushing energy in the amputated side, which
causes some impact force at the heel strike of the sound leg.
The forward-backward forces, for the subject Case-4, are shown in

Figure 4-30. On the sound side, Dynacity has a damped braking force and a
lowest horizontal propulsive force, 7% of BW, the same thing for the
amputated leg.
The amputated side shows a maximum horizontal propulsive force with

Dynastep and the lowest with Dynacity. This means that a larger component
of the stored energy was released as a vertical pushing force.
120
100
80
Fz % of BW
60
40
20
(a)

120
100
Fz % of BW
80
60
40
20
(b)
10
8
Fy % of BW
-2
-4
-6
(a)

20
Fy % of BW
15
10
-5
-10
-15
-20
(b)
side.
The sound and amputated side medial-lateral forces for Case-4 are
shown in Figure 4-31. Which indicates a low lateral force than the normal
about 3% of BW and two medial forces at the mid-stance and the terminal
stance.
Also, the amputated side shows one extended medial force through the stance.
4
3
Fx % of BW
-1
-2
-3
-4
(a)

7
6
Fx % of BW
5
4
3
2
1
0
-1
-2
(b)
Vertical GRFs of subject Case-5, for the amputated and sound legs, were
plotted in Figure 4-32. The amputated side has initial contact effects
concerning the types of feet with a maximum hump at 13% of stance with
Dynastep equal to 66% of BW which is more than the normal value of 40% of
BW that had been shown in Figure 2-8 (a).
On the sound side, the vertical GRFs are nearly similar to each other.
The lowest one is when using Dynacity foot. This is favorable to decrease the
load on the sound limp joints. Also, the Dynacity has symmetrical vertical
GRFs for the sound and amputated side.
160
140
Fz % of BW
120
100
80
60
40
20
(a)
140
120
Fz % of BW
100
80
60
40
20
(b)
The forward-backward forces, for the subject Case-5, are shown in
Figure 4-33. For the sound side, it shows a clear shape with lower braking and
propulsive forces than the normal shape.
For the amputated side, the maximum horizontal propulsive force of
about 12% of BW is with Dynacity and irregular braking force because of less
friction effect between the ground and the prosthetic feet at the heel strike.

10
Fy % of BW
-2
-4
-6
-8
(a)
15 Amputated leg Dynastep Amputated leg Trias1c30
Fy % of BW
10
-5
-10
-15
(b)
side.
The medial-lateral GRFs, of the subject Case-5, are shown in Figure 4-
34. For the sound side, the curve shows a normal pattern for all types of feet.
But at the amputated side, it is only a medial force with one extended hump
without lateral force at the initial contact. This means the subject moves
through the stance without foot adduction.
4
3
Fx % of BW
-1
-2
-3
-4
(a)
7
6
Fx % of BW
-1
-2
(b)
As mentioned previously, subject Case-6 is a K1 level amputee. He used
a crutch during the test. It affects the GRFs recorded as shown in Figures 4-
35, 4-36 and 4-37.
The sound side vertical forces, when using the four types of feet, have
irregular patterns with a very high hump at heel strike when using SACH foot
(the subject's foot). The clear sound side vertical GRF appears when using
Dynastep foot.
A small rise in the sound side force at the mid-stance has appeared with
all feet except Dynastep. This made this foot type is more compatible with the
subject by reducing the lower back pain and knee pain.
At the amputated side, the forces showed a big and single convexity
through the stance because the subject has knee contracture so he can't flex
the knee more to absorb the vertical force during the mid-stance.
Also, Dynastep has a regular rise in the vertical force at the initial
contact and a small decrease at mid-stance because of the subject with a long
stump. Dynastep is the only one having an articular joint, so it has a little
effect on the sound side and smooth rise in the amputated side.
All the vertical forces recorded are below the bodyweight, because some
of the bodyweight was transferred to the crutch during the stance phase.
For the forward-backward forces, the curve shows a symmetrical pattern
between the amputated and sound side for all types of feet. With high braking
force for SACH and Trias1C30 is 10% BW at the sound side and is 13% BW
at the amputated side as shown in Figure 4-36.
The horizontal pushing forward force at the sound side is similar, with
6% of BW, despite the foot type in the contralateral leg.
The medial-lateral forces of the sound side, shown in Figure 4-37 (a),
have no lateral forces because of the use of the crutch which supports the
body medially during walking causing an increase in the medial force in the
amputated side over the sound side.

120
100
Fz % of BW
80
60
40
20
(a)
90
80
70
Fz % of BW
60
50
40
30
20
10
(b)
10
Fy % of BW
-5
-10
-15
(a)

15
Fy % of BW
10
-5
-10
-15
(b)
Figure 4-36 Case-6anterior-posterior ground reaction force (a) sound side (b) amputated
side.
5
4
Fx % of BW
-1
-2
(a)
10
Fx % of BW
-2
-4
(b)
The results summarized in Table 4-3 for the Fz1 and Fz2 show an increase at
Fz1 in the vertical GRF at the sound side when using SACH foot, Dynastep
and Trias 1C30 by 6%, 12% and 19% respectively over the amputated side
except for the Dynacity foot the first peak in the sound side is lower than the
amputated side by 1.7%.
At Fz2 the high asymmetry between the amputated side and sound side found
at SACH foot by 43% lower than the sound side.
And high symmetry with Dynacity with 3% lower than the sound side which
means that Dynacity has the ability to store and release the energy to mimic
the sound side calf muscle to give the body the push up force for ambulation.
Table 4-3 Vertical ground reaction forces at Fz1 and Fz2 as % of BW.
Sound side Amputated side
Forces Dyna- Dyna- Trias Dyna- Dyna- Trias
Subject SACH SACH
(% BW) city step 1C30 city step 1C30
Fz1 111 105 107 103 111 104 105 105
case-1
Fz2 120 107 106 107 106 111 108 108
Fz1 118 100 104 97 109 107 112 104
case-2
Fz2 119 114 119 116 106 115 117 109
Fz1 111 115 114 124 123 111 109 119
case-3
Fz2 109 117 112 113 113 114 115 109
Fz1 97 108 97 10 103 110 94 106
case-4
Fz2 100 105 105 63 100 107 100 95
Fz1 122 112 127 133 112 110 115 106
case-5
Fz2 12 114 119 59 105 107 106 111
Fz1 98 76 72 79 75 75 80 80
case-6
Fz2 85 75 72 77 70 74 74 78
CHAPTER FIVE
Conclusions and Recommendations for Future Works
5.1 Conclusions
From the obtained data, the following conclusions can be summarized:
1- The types of prosthetic feet have a little effect on patient's spatiotemporal

parameters with K2-K3 levels and the well-trained patients for a long time,
but the effect appears more at the K1 level with SACH foot and less
asymmetry with the ESAR feet.
2- Also, the study obtained that subjects' weight affected the single support
time parameter when fitted to Dynastep foot. The difference is greater at
heavy subjects and is lower with lightweight subjects.
3- For joint angles, the types of prosthetic feet have no effect on the hip angle
for the amputated side and sound side. All feet have symmetrical hip angles
curves. Trias 1C30 foot only affects the sound side knee angles curve by
reducing the knee flexion angle at the initial stance. Ankle joint angles
appear high asymmetrical curves especially for SACH foot and Dynacity
foot, while Trias1c30 had less effect on the sound side ankle joint angles.
4- The results show an increase in the sound side vertical GRFs, especially at
the period of initial contact, when using SACH foot, Dynastep and Trias
1C30 by 6%, 12% and 19% respectively over the amputated side except for
the Dynacity foot the first peak in the sound side is lower than the
amputated side by 1.7%. Because of the fear of the amputee to support his
body on the amputated side for that Dynacity is the best foot in lowering the
forces at the sound side.
5- Prosthetic feet had fewer effects on the forward-backward component of
the GRFs on the sound side, but at the amputated side, the propulsive force
depends on the energy stored in the prosthetic foot materials.
6- The amputated side has only medial forces in the medial-lateral

components because of an attempt by the amputee to push himself to the
sound side due to his fear of leaning on the amputated side.
5.2 Recommendations for Future Works

1- The study suggests the researchers use more sample size with fairly close
specifications to each other's, so they can generalize the results.
2- Many factors affect the choice of the appropriate type of foot, which can
be studied in the future with finding appropriate relationships between a
specific type of foot and the extent to which it is affected by several
variables, like the subjects’ weight, subject activity level, the length of the
residual limb, suspension type, and the duration of wearing the prosthetics
foot.
3- Several procedures can be followed in the analysis of prosthetic feet, such
as using the analysis to go up and down stairs or an inclined surface.
4- It is possible to take into account the period of using the foot and to
conduct an examination after certain periods to note the extent of the
impact of the foot and if there is a noticeable improvement.
5- Study the effect of the prosthetic foot type on the pressure inside the
socket.
6- Study the effect of the foot type on impact at gait cycle.
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APPENDISES
Appendix A
Statistical analysis
T-Test
Independent statistical analysis for two group (amputated and sound side) for
each prosthetic foot.
As shown in figure 1 the gait time in V2 was selected as test variable and the
limb side in V2 was selected as grouping variable.
Figure A-1 SPSS application with data input.
Notes
Output Created 10-APR-2020 15:16:44
Comments
Input Active Dataset DataSet5
Filter <none>
Weight <none>
Split File <none>
A- 1
N of Rows in Working Data
12
File
Missing Value Handling Definition of Missing User defined missing values are treated
as missing.
Cases Used Statistics for each analysis are based

on the cases with no missing or out-of-
range data for any variable in the
analysis.
Syntax T-TEST GROUPS=V1(1 2)
/MISSING=ANALYSIS
/VARIABLES=V2
/CRITERIA=CI(.95).
Resources Processor Time 00:00:00.02
Elapsed Time 00:00:00.08
[sach foot]
Group Statistics
V1 N Mean Std. Deviation Std. Error Mean
V2 Sound side 6 1.520000000000001 .217950045244827 .088977733377722
Amputated side 6 1.501666666666666 .198009539613064 .080837056042570
Independent Samples Test
Levene's Test for t-test for
Equality of Equality of
Variances Means
F Sig. t df
V2 Equal variances .053 .822 .153 10
assumed
A- 2
Equal variances
.153 9.909
not assumed
t-test for Equality of Means
95%
Confidence
Interval of the
Difference
Mean Std. Error
Sig. (2-tailed) Difference Difference Lower
V2 Equal variances assumed .018333333333 .120215085021 -.24952256819

.882
334 251 7349-
Equal variances not .018333333333 .120215085021 -.24985516506

.882
assumed 334 251 0788-
95% Confidence Interval of the

Difference
Upper
V2 Equal variances assumed .286189234864017
Equal variances not assumed .286521831727456
A- 3
T-Test
Notes
Comments
Filter <none>
Weight <none>
Split File <none>

12
File
as missing.

analysis.
/MISSING=ANALYSIS
/VARIABLES=V2
/CRITERIA=CI(.95).
A- 4
[dynastep]
Group Statistics
V2 1 1.408888888888 .1662483639574 .0678706103780

6
889 19 31
2 1.406666666666 .1462418088874 .0597029684726

6
667 27 35

Variances Means
F Sig. t df
V2 Equal
variances .281 .608 .025 10
assumed
Equal
9.84
variances not .025
0
assumed
95%
Confidence
Interval of the
Difference
Mean Std. Error
A- 5
V2 Equal variances .0022222222 .0903928326 -.1991855601
.981
assumed 22222 66815 83803-
Equal variances not .0022222222 .0903928326 -.1996304103

.981
assumed 22222 66815 29005-

Difference
Upper
T-Test
Notes
Comments
Filter <none>
Weight <none>
Split File <none>

12
File
as missing.

analysis.
A- 6
/MISSING=ANALYSIS
/VARIABLES=V2
/CRITERIA=CI(.95).
[dynacity]
Group Statistics
V2 1 1.491111111111 .1735212656409 .0708397600570

6
111 29 35
2 1.492777777777 .1742082619123 .0711202251103

6
778 40 94

Variances Means
F Sig. t df
V2 Equal
-.017
variances .015 .906 10
-
assumed
Equal
-.017 10.0
variances not
- 00
assumed
A- 7
95%
Confidence
Interval of the
Difference
Mean Std. Error
V2 Equal variances -.0016666666 .1003810640 -.2253296155

.987
assumed 66666- 74313 34367-
Equal variances not -.0016666666 .1003810640 -.2253300888

.987
assumed 66666- 74313 72798-

Difference
Upper
T-Test
Notes
Comments
Filter <none>
Weight <none>
Split File <none>
A- 8
12
File
as missing.

analysis.
/MISSING=ANALYSIS
/VARIABLES=V2
/CRITERIA=CI(.95).
[carbon]
Group Statistics
V2 1 1.411111111111 .1846397894600 .0753788783986

6
112 51 73
2 1.413333333333 .1557205474203 .0635726472744

6
333 35 49

Variances Means
F Sig. t df
A- 9
V2 Equal
-.023
variances .010 .924 10
-
assumed
Equal
-.023 9.72
variances not
- 3
assumed
95%
Confidence
Interval of the
Difference
Mean Std. Error
V2 Equal variances -.0022222222 .0986075899 -.2219336244

.982
assumed 22222- 21484 27009-
Equal variances not -.0022222222 .0986075899 -.2227843075

.982
assumed 22222- 21484 63692-

Difference
Upper
Explore
Notes
A- 10
Comments
Filter <none>
Weight <none>
Split File <none>

24
File
Missing Value Handling Definition of Missing User-defined missing values for

dependent variables are treated as
missing.
Cases Used Statistics are based on cases with no

missing values for any dependent
variable or factor used.
Syntax EXAMINE VARIABLES=gaittime BY

foottype
/PLOT BOXPLOT NPPLOT
/COMPARE GROUPS
/STATISTICS DESCRIPTIVES
/CINTERVAL 95
/MISSING LISTWISE
/NOTOTAL.
[DataSet2] foot type
Case Processing Summary
A- 11
Cases
Valid Missing Total
foot type N Percent N Percent N Percent
gait time sach 6 100.0% 0 0.0% 6 100.0%

for sound
dynastep 6 100.0% 0 0.0% 6 100.0%
side
dynacity 6 100.0% 0 0.0% 6 100.0%
carbon 6 100.0% 0 0.0% 6 100.0%
Descriptives
foot type Statistic Std. Error
gait time 1 Mean 1.52000000000 .088977733377

0001 722
95% Confidence Interval for Lower Bound 1.29127545480

Mean 5033
Upper Bound 1.74872454519

4968
5% Trimmed Mean 1.51851851851

8519
Median 1.54666666666
6667
Variance .048
Std. Deviation .217950045244

828
Minimum 1.22666666666
66666
Maximum 1.83999999999
99999
Range .613333333333
3333
A- 12
Interquartile Range .373333333333
3357
Skewness .069 .845
Kurtosis -.281- 1.741
2 Mean 1.40888888888 .067870610378

8889 031

Mean 9021

8757
5% Trimmed Mean 1.40543209876

5432
Median 1.33333333333
3333
Variance .028

419
Minimum 1.25333333333
33332
Maximum 1.62666666666
66667
Range .373333333333
3335

3335
Skewness .829 .845
Kurtosis -1.828- 1.741
3 Mean 1.41111111111 .075378878398

1111 673

Mean 0450
A- 13
1773
5% Trimmed Mean 1.40345679012

3457
Median 1.40000000000
0000
Variance .034

051
Minimum 1.22666666666
66666
Maximum 1.73333333333
33334
Range .506666666666
6668

6693
Skewness 1.065 .845
Kurtosis 1.462 1.741
4 Mean 1.49111111111 .070839760057

1111 035

Mean 9172

3050
5% Trimmed Mean 1.48938271604

9383
Median 1.50666666666
6667
Variance .030
A- 14
928
Minimum 1.28000000000
00000
Maximum 1.73333333333
33334
Range .453333333333
3334

3333
Skewness .078 .845
Kurtosis -1.269- 1.741
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
foot type Statistic df Sig. Statistic df Sig.
gait time 1 .167 6 .200* .976 6 .929
2 .342 6 .027 .787 6 .045
3 .215 6 .200* .890 6 .316
4 .171 6 .200* .957 6 .793
*. This is a lower bound of the true significance.
a. Lilliefors Significance Correction
Gait time
A- 15
Normal Q-Q Plots
A- 16
A- 17
Detrended Normal Q-Q Plots
A- 18
A- 19
ONEWAY gait time BY foottype
/PLOT MEANS
/MISSING ANALYSIS
/POSTHOC=TUKEY ALPHA(0.05).
Oneway
Notes
Comments
Filter <none>
Weight <none>
A- 20
Split File <none>

24
File
Missing Value Handling Definition of Missing User-defined missing values are treated
as missing.

on cases with no missing data for any
variable in the analysis.
Syntax ONEWAY gaittime BY foottype
/PLOT MEANS
/MISSING ANALYSIS
/POSTHOC=TUKEY ALPHA(0.05).
95% Confidence Interval

for Mean
Std. Lower Upper

N Mean Deviation Std. Error Bound Bound
1 1.5200000 .21795004 .08897773 1.2912754 1.7487245

6
00000001 5244827 3377722 54805033 45194968
2 1.4088888 .16624836 .06787061 1.2344219 1.5833558

6
88888889 3957419 0378031 30679021 47098757
3 1.4111111 .18463978 .07537887 1.2173435 1.6048786

6
11111112 9460051 8398673 35510450 86711774
4 1.4911111 .17352126 .07083976 1.3090117 1.6732105

6
11111111 5640929 0057035 10669172 11553051
Tota 1.4577777 .18106146 .03695901 1.3813222 1.5342333

24
l 77777778 1437920 6050460 27951400 27604157
A- 21
Descriptives
gait time
Minimum Maximum
1 1.2266666666666666 1.8399999999999999
2 1.2533333333333332 1.6266666666666667
3 1.2266666666666666 1.7333333333333334
4 1.2800000000000000 1.7333333333333334
Total 1.2266666666666666 1.8399999999999999
ANOVA
gait time
Sum of Squares df Mean Square F Sig.
Between Groups .057 3 .019 .548 .655
Within Groups .697 20 .035
Total .754 23
Post Hoc Tests
95%
Confidence
Mean
Interval
(I) foot (J) foot Difference (I-
type type J) Std. Error Sig. Lower Bound
1 2 .1111111111 .1077583029 -.190497505

.734
11112 36952 871645-
3 .1088888888 .1077583029 .745 -.192719728

88889 36952 093868-
A- 22
4 .0288888888 .1077583029 -.272719728
.993
88889 36952 093867-
2 1 -.111111111 .1077583029 -.412719728

.734
111112- 36952 093868-
3 -.002222222 .1077583029 -.303830839

1.000
222223- 36952 204979-
4 -.082222222 .1077583029 -.383830839

.870
222222- 36952 204979-
3 1 -.108888888 .1077583029 -.410497505

.745
888889- 36952 871645-
2 .0022222222 .1077583029 -.299386394

1.000
22223 36952 760534-
4 -.080000000 .1077583029 -.381608616

.879
000000- 36952 982756-
4 1 -.028888888 .1077583029 -.330497505

.993
888889- 36952 871646-
2 .0822222222 .1077583029 -.219386394

.870
22222 36952 760534-
3 .0800000000 .1077583029 -.221608616

.879
00000 36952 982757-
Multiple Comparisons
Dependent Variable: gait time
Tukey HSD
95% Confidence Interval
(I) foot type (J) foot type Upper Bound
1 2 .412719728093868
3 .410497505871645
4 .330497505871646
A- 23
2 1 .190497505871645
3 .299386394760534
4 .219386394760534
3 1 .192719728093868
2 .303830839204979
4 .221608616982757
4 1 .272719728093867
2 .383830839204979
3 .381608616982756
Homogeneous Subsets
gait time
Tukey HSDa
Subset for alpha

= 0.05
foot type N 1
2 1.408888888888
6
889
3 1.411111111111
6
112
4 1.491111111111
6
111
1 1.520000000000
6
001
Sig. .734
Means for groups in homogeneous

subsets are displayed.
A- 24
a. Uses Harmonic Mean Sample Size =
6.000.
Means Plots
A- 25
A- 26
‫شكر و تقدير‬
‫ُ‬
‫ك الحم ُد رّبي على ه ِ‬
‫ذه‬ ‫َ‬ ‫إلنج ِاز هـذا َ‬
‫الب ْحث َفل َ َ َ‬ ‫ق ْ‬ ‫والعزيم ةَ والتوفي َ‬
‫اإلرادةَ َ‬
‫َ‬ ‫نحي‬
‫أح َم دهُ تَعالـــى َعلى َم َ‬ ‫ْ‬
‫النِ َعم أبداً مـ ــا َبـ ـ ـ ّ‬
‫ـقيت‪.‬‬
‫ِ‬ ‫اُألستاذ المس ِ‬

‫ِ‬ ‫ِ‬ ‫العزي ِز‬ ‫ان و ِ‬
‫العرف ِ‬ ‫بجزي ِل ُ‬
‫صـــادق‬ ‫الد ْكتور‬
‫اعد ُ‬ ‫ُ‬ ‫الفاض ل‬ ‫ان ُألستاذي َ‬ ‫واإلمتن ِ َ‬
‫ْ‬ ‫الش ْك ِر‬ ‫أتقد ُم َ‬
‫َ‬
‫عم وإ رش ٍاد‬
‫تفض له بِمنحي فُرص ةَ العم ِل مع هُ ول ُك ِل م ا قَدم هُ لـ ـ ـــي ِم ْن ُنص ٍح و َد ٍ‬
‫َ‬ ‫ّ‬ ‫ََ َ‬ ‫َ‬
‫ِ‬
‫َجعـْـــ ـفَر َعبـــّــــاس ل ُ‬
‫كر ال تَّفيه حقه فَشكراً لَه لع ِ‬
‫طاءه‪.‬‬ ‫مات ُّ‬
‫الش ِ‬ ‫كل ُ‬‫مام هـ ــذا العمل فَ ِ‬
‫ستمر إلتْ ِ‬
‫ُم ٍ‬
‫َ‬ ‫َ‬ ‫َ‬
‫كما اتقدم بجزيل الشكر لالستاذ المساعد الدكتور محمد عبد الستار محمد لتقديمه النصح ومشاركته‬
‫ــذت َعلــى ْأي دي ِهم‬
‫تلمـ ُ‬ ‫ِّ‬ ‫ِ‬ ‫ِ‬ ‫ِ‬
‫ين تَ َ‬
‫كر َم ْوصول ل ُك ل أســات َذتـــي األفاض ل الذ َ‬ ‫الش ُ‬
‫بعد فَ ُ‬
‫الفاعلة التمام هذا العمل‪َ .‬و ُ‬
‫رحل ِة‬
‫علم َعلى ْأي دي ِهم فــي َم َ‬ ‫رفت بِ التَ ِ‬
‫ين تَ َش ُ‬ ‫ِّ‬ ‫ِ‬ ‫راحـــ َل ِدراسـَــتي ِّ‬
‫الس يما أس ات َذتي الك رام ال ذ َ‬
‫فــي جمي ع م ِ‬
‫َ‬ ‫َ‬
‫ِ‬ ‫ناء واإلمتِ ِ‬
‫مات الثَّ ِ‬
‫أسمى َكِل ُ‬
‫األفاض ل في مركز الوارث‬ ‫فين‬
‫ظ َ‬ ‫كر المو َ‬
‫نان‪َ .‬وال ْأنسى ُش َ‬ ‫المــا ِجستير َفل ُكم ْ‬
‫وكذلك شكر خاص للمتطوعين الذين لوالهم لما تم هذا العمل‪.‬‬
‫زو َجتي‪َ ،‬ع َملي هـذا لَم‬ ‫ِ‬ ‫تزاز واإل ْف ِ ِ ِ‬ ‫واإلع ِ‬ ‫مل ِع ِ‬
‫بارات ُّ‬
‫الش ِ‬ ‫أج ِ‬
‫تقدم بِ ْ‬
‫تخار لوالدي َووال َدتي َو ْ‬ ‫ْ‬ ‫كر‬ ‫أود الَ َ‬
‫َكذلك ُ‬
‫ودعاِئ ُكم فَ ُشكراً لَ ُكم ِمن القَ ـ ـ ـْلب‪.‬‬ ‫يكتَمل لَوال مساعدتِكم و ِ‬
‫دعم ُكم ُ‬ ‫َ‬ ‫ُ َ‬ ‫َ‬
‫ميع ُكم ُشكراً‪.‬‬

‫َج ُ‬
‫الخالصة‬
‫تعتبر مالءمة الطرف الصناعي للمبتور ع``امالً رئيس``يا ً في إع``ادة التأهي``ل‪ ،‬وك``ذلك ن``وع الق``دم‬
‫االصطناعية‪ ،‬وهي أحد العوام``ل ال``تي ت``ؤثر على عوام``ل المش``ي‪ .‬ته``دف الدراس``ة إلى قي``اس العوام``ل‬
‫الزمانية‪-‬المكانية والحركية وردود افعال القوى لحاالت البتر تحت الركبة وكيف تت``أثر عن``دما يس``تعمل‬
‫األشخاص أقدام صناعية مختلفة‪ .‬تم اختيار ستة ذك``ور` ب``ترت أط``رافهم من ج``انب واح``د أس``فل الركب``ة‬
‫ليستخدمو̀ا أربعة أنواع من األقدا̀م االص``طناعية (‪1S66 SACH foot Ottobock inc., 1C30‬‬
‫‪Trias carbon Ottobock inc., Dynastep Proteor group and Dynacity Proteor‬‬
‫‪ )group‬طلب منهم المش``ي بالس``رعة المعت``ادة على المس``ار المس``تقيم عموديً``ا م``ع الك``اميرا‪ ،‬تم قي``اس‬
‫العوامل الزمانية‪-‬المكانية لكل من الساق المبتورة والساق الس``ليمة ي``دويً̀ا باس``تخدا̀م برن``امج ‪Kinovea‬‬
‫أيض`ا‪ ،‬تم اس``تخدام برن`امج تتب``ع الحرك``ة (‬
‫(برنامج ‪ )Kinovea-0.8.15‬من مقاطع الفيديو المس`جلة‪ً .‬‬
‫‪ )Skillspector‬لقياس زواي̀ا مفاصل االطراف` السفلية‪ ،‬بينما تم تس``جيل ق``وى رد الفع``ل األرض``ي من‬
‫منصة قوة شركة التكنولوجيا الميكانيكية المتقدمة (‪ .)AMTI‬أظه``رت النت``ائج ع``دم وج``ود ف``روق` ذات‬
‫داللة إحصائية في العوامل الزمانية‪-‬المكانية لـ( (‪ p = 0.05‬بين األن``واع األربع``ة لألق``دام الص``ناعية‬
‫للساق السليمة والمبت``ورة والمقارن``ة بين الس``اق الس``ليمة والمبت``ورة‪ .‬تظه`ر` ف``رق ذو دالل``ة احص``ائية ‪p‬‬
‫(‪Trias 1C30‬‬ ‫‪ <0.05‬ل```وقت االس```تناد على ط```رف واح```د عن```د االش```خاص عن```د اس```تعمال‬
‫‪ .)Dynastep‬تمت مناقشة ك``ل زواي``̀ا االط``راف` الس``فلى عن``د المش``ي وق``وى رد فع``ل أرض``ية بش``كل‬
‫منفصل‪ .‬لخصت هذه الدراسة إلى أن هناك تأثيرًا طفيفًا لنوع القدم االصطناعية على العوامل الزمانية‪-‬‬
‫المكانية لمس``توى` نش``اط األجس``ام ‪ ،K1-K3‬وك``ذلك` األجس``ام المدرب``ة جي`دًا ك``انت أق``ل ت``أثراً‪ ،‬بالنس``بة‬
‫لحركية المفاصل وجدت الدراسة تأثيرًا طفيفًا في زوايا المفاصل في الط``رف الس``فلي لك``ل من الج``انب‬
‫المبتور والجانب السليم وزيادة قوة رد فعل األرض على الجانب الس``ليم اعلى من الج``انب المبت``ور م``ع‬
‫جميع أنواع االقدم الصناعية‪-‬المستخدمة‪.‬‬
‫وزارة التعليم العالي والبحث العلمي‬
‫جامعة النهــــــــرين ‪ /‬كلية الهندسة‬
‫(تحليل المشي لحاالت بتر أسفل الركبة باستخدام انواع مختلفة من االقدام الصناعية)‬
‫رسالة مقدمة‬
‫الى كلية الهندسة في جامعة النهرين‬
‫وهي جزء من متطلبات نيل شهادة ماجستير علوم‬
‫في‬
‫هندسة الطب الحياتي‬
‫من قبل‬
‫حمزة عباس فاضل‬
‫(بكالوريوس في هندسة الطب الحياتي ‪ 2015‬م)‬
‫‪1442‬هـ‬ ‫ربيع الثاني‬
‫‪ 2020‬م‬ ‫تشرين الثاني‬

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Ministry of Higher Education &

GAIT ANALYSIS OF BELOW KNEE AMPUTEES

Rabi Al-Thani 1442

In view of the available recommendation, we forward this thesis for

Asst. Prof. Dr. Sadiq J. Hamandi

We certify, as an Examining Committee, that we have read this thesis entitled

Prof. Dr. Kadhim K. Resan

Asst. Prof. Dr. Mahmud Rasheed Dr. Aseel Mohammed Ali

Approved by the College of Engineering / Al-Nahrain University

Prof. Dr. Basim O. Hasan

Table Title Page

(2-1) Approximate ranges of the general gait parameters in 19

(2-2) Types of motion capture system 20

(3-1) Subject information 29

(3-2) Passive markers specific locations in the left and 34

(4-1) Means values ± SD of spatiotemporal parameters of 49

(4-2) Range of motion at lower limb joints for amputated 77

(4-3) Vertical ground reaction forces at Fz1 and Fz2 as % 101

Figure Title Page

(2-1) SACH foot (a) solid keel (b) flexible keel 14

(2-4) Gait cycle terminology and functional tasks 17

(2-5) Gait analysis system for measuring kinematic and kinetic 21

(2-7) Sagittal plane joint angles measured in degrees during a 23

(2-8) Force plate data obtained from a normal individual while 25

(3-2) Design symmetry in 1- real ankle-foot skeletal and 2- Trias 31

(3-3) Dynacity foot blades functions 32

(3-4) Markers placement on patient’s body 35

(3-6) Kinovea application screens showing (a) first heal strike 37

(3-7) Flow chart of spatiotemporal parameters calculation 38

(3-8) Skill Spector program operation: (a) selection of 40

(3-9) Flow chart of kinematics parameter calculations 41

(3-10) Padding procedure used on a signal before it enters 42

(3-11) Differences between filtered and raw ankle angular 43

(3-12) Coordinate system of a force platform 44

(3-13) Force plate dimensions 45

(3-14) Flow chart of kinetics parameter measurement procedure 46

(4-21) Case-1 forward-backward ground reaction force (a) sound 80

(4-22) Case-1 medial-lateral ground reaction force (a) sound side 81

(4-24) Case-2 forward-backward ground reaction force (a) sound 84

(4-25) Case-2 medial-lateral ground reaction force (a) sound side 85

(4-27) Case-3 forward-backward ground reaction force (a) sound 88

(4-28) Case-3 medial-lateral ground reaction force (a) sound side 89

(4-30) Case-4 forward-backward ground reaction force (a) sound 92

(4-31) Case-4 medial-lateral ground reaction force (a) sound side 93

(4-33) Case-5 forward-backward ground reaction force (a) sound 95

(4-34) Case-5 medial-lateral ground reaction force (a) sound side 96

1.2 Literature Review

Compared to the extensive literature available on numerous aspects of

The aim of this study is to:

1- Observe the effects of prosthetic foot type of unilateral below-knee

1.4 Thesis Outline

This thesis is made up of the following chapters:

2.2 Activity level

K-levels are a rating system used by Medicare to indicate a person’s

of the child, active adult or athlete.

2.3 Prosthetic foot

Its work is somewhat similar to the ankle joint, as it provides movement

2.4 Gait Cycle Classification

2.4.1 The Main Tasks of the Gait Cycle

The sequential combination of the phases enables the limb to complete

Figure 2-4 Gait cycle terminology and functional tasks.[58]

2.5 Gait Analysis

Gait analysis is the study of human movements. It includes the