Most people with lower-limb amputation (LLA) rely on a prosthetic foot for participation at home and in the community. The published literature describes problems with mobility after LLA, yet there have been few published accounts of peoples' participation experiences. The purpose of this study was to increase understanding of the impact of prosthetic feet on participation in the activities of daily life by examining the experience of prosthetic users and professionals.Materials and Methods
Users of prosthetic feet and health care professionals who prescribe prosthetic feet were invited to complete a brief online questionnaire before participating in one of five focus groups. Descriptive statistics were used to summarize questionnaire data. Focus group sessions were audio recorded and transcribed. Each transcript was thematically coded independently by four researchers. Emergent themes were discussed, categorized, and cross-referenced.Results
Eleven prosthetic foot users (68.8%) and 11 professionals (100%) completed the online questionnaires. Although the prosthetic foot users rated their difficulty with usual activities as none to slight, 36% reported falling within the last 6 months, and 45% indicated that they modified their participation because of the potential for falls. Sixteen prosthetic foot users and 11 health care professionals took part in focus groups. There was a significant overlap in themes discussed by prosthetic foot users and health care professionals. Identified barriers to full participation included the ability to stand for extended periods, navigate in confined spaces, carry heavy objects, and change body posture. Absence of sensory feedback created significant concerns about safety when driving a car, navigating uneven terrain, or climbing ladders. Characteristics of existing prosthetic feet that impact participation included limited durability, lack of waterproofing, and limited range of motion. Current designs limited choices of footwear and created difficulties donning and doffing shoes.Conclusions
Participants' reported confidence in forward walking on even ground suggests that current prosthetic feet are well-suited for this limited use. However, they also identified a number of situations in which their current prosthetic feet caused significant difficulties, often with safety implications. While some stories, such as rocks on the sidewalk, are consistent with the literature, other stories describe situations such as ladders and stepstools that are not well documented. Our study highlights the utility of focus groups in identifying previously unrecognized needs and concerns, with significant implications for the design of prosthetic feet. Future studies should include more diverse participants, particularly with regard to age and overall physical health.