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Comparison of Gait After Syme and Transtibial Amputation in Children: Factors That May Play a Role in Function

Jeans, Kelly A. MS; Karol, Lori A. MD; Cummings, Donald CP/LP; Singhal, Kunal PT, PhD

Journal of Bone & Joint Surgery - American Volume: 1 October 2014 - Volume 96 - Issue 19 - p 1641–1647
doi: 10.2106/JBJS.N.00192
Scientific Articles
Supplementary Content

Background: Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes.

Methods: Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted.

Results: Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05).

Conclusions: Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans:

2117 Coronado Drive #1113, Denton, TX 76209

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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