Biomechanical analysis of an improvement of prosthetic liner using polyurethane focusing at the anterior-distal part of residual limb: A case study

Abstract

Most transtibial prosthesis users always experience pain sensation at the distal of the residual limb due to bony prominences and nerve endings. Many initiatives have been taken to resolve this problem, including using softer materials such as silicone or gel liner and designing a distal off load prosthetic socket. Another promising approach is to incorporate polyurethane foam in the manufacturing of prosthetic liner. This study aimed to design a new prosthetic liner using polyurethane at the anterior-distal part of the residual limb as a Pelite replacement and to compare the biomechanical gait analysis between the new modified polyurethane liner and the common Pelite liner. A unilateral transtibial amputee was recruited as the subject. Two Patellar Tendon Bearing transtibial prostheses with different liners were fabricated for the subject, which were Pelite liner and a modified polyurethane foam liner. The modified liner using polyurethane foam consisted of Ethylene vinyl-acetate - Polyurethane - Ethylene vinyl-acetate sandwich placed at the anterior-distal part of the residual limb. The Ethylene vinyl-acetate - Polyurethane - Ethylene vinyl-acetate sandwich function was to improve the walking gait and compensate for the pain sensation experienced by the subject when wearing the Pelite liner. Biomechanical analysis was done using the Vicon Motion Analysis System on the subject when using the two newly fabricated transtibial prostheses and the subject's original prosthesis with Pelite liner. During the loading response phase, the original liner exerted a slightly higher force than the Pelite and the modified liner. At 30% and 50% of the gait cycle, the original liner exerted low force than the Pelite liner and the modified liner for Ground Reaction Force at the amputated side. However, no significant difference (p>0.05) was found between all prosthetic liners for Ground Reaction Force (Non-Amputated). The biomechanical analysis showed that the modified liner using polyurethane foam improved the prosthesis user gait cycle and the walking gait of the prosthesis user.