Increasing Shoe Choice for Lower-Limb Amputees

An estimated 150,000 Americans experience lower extremity amputation each year, including more than 1,400 Minnesotans. Many individuals with amputations wear a leg prosthesis, including a prosthetic foot that is aligned for use with a single shoe heel rise. Changing shoes and deviating from this single heel rise can cause misalignment of the prosthesis and can result in pain and discomfort, balance impairment, or damage to the remaining limb. Some prosthetic foot options exist that allow prosthesis users to wear shoes with different heel rises, but these feet do not accommodate heel rises above two inches and the shapes of the plantar surfaces of the feet do not change to closely fit the footwear insole shapes, decreasing cosmetic appearance and stability.

The Rehabilitation & Engineering Center for Optimizing Veteran Engagement & Reintegration (RECOVER) at the Minneapolis VA Health Care System (MVAHCS) has developed a modular prosthetic ankle-feet system to expand footwear options for people with lower extremity amputations. This system incorporates a multi-axial ankle unit which interfaces with additively manufactured foot shapes designed to match the shape of the shoe and accommodate heel rises up to four inches.

As a result of funding provided by the UMII MnDRIVE Graduate Assistantship Program, PhD Candidate Nicole Walker (Rehabilitation Science) and the RECOVER team iterated the design and clinical implementation of the ankle-feet system during 2023. Project tasks included communicating with prosthetists regarding their preferences for patient data collection and trialing the system with prosthesis users.

Prosthetists in the Twin Cities indicated their comfort using 3D scanning technologies in the O&P clinic and suggested they would be comfortable using scanning techniques to collect patient images in the foot shape manufacturing process. Ms. Walker and the RECOVER team also used 3D scanning to manufacture foot shapes for prosthesis users included in this project. Using a handheld white light scanner (EinScan Pro HD, Shining3d, Hangzhou, China), 3D image data were collected to manufacture foot shapes in three different heel heights for three women participants with amputations. Additively manufactured foot shapes were evaluated by the study team for quality and fit into the participants’ selected footwear.

Participants in this project also trialed the modular system and shoes in the Clinical Motion Analysis Laboratory at the MVAHCS. Analysis of ankle-foot rollover shape during walking indicated the preservation of prosthesis alignment for all participants as they switched between foot shape and shoe combinations; this finding was crucial to ensuring the viability of the modular ankle-feet system as a useable device for people with lower extremity amputations.

Ms. Walker did this research under the supervision of Professor Andrew Hansen (Rehabilitation Science; Biomedical Engineering). They have secured funding to study the impact of the modular ankle-feet system and improved footwear options on body image and participation in important roles among women Veterans with lower extremity amputations.

Publications and articles resulting from this project include:

  • Walker N.R., C.M. Olney, A.H. Hansen. Influencers of participation among women veterans with lower extremity amputations: An exploratory qualitative study. February 2024; In review for inclusion in Disability and Rehabilitation.
  • Walker N.R., M.P. Laine Dyreson, J.E. Cave II, K. Mansur, K. Yun, J. Looft, A. Hansen. Prosthetic alignment maintained between foot-shoe combinations in a novel prosthetic ankle-feet system. Poster presented at American Academy of Orthotists and Prosthetists (AAOP) Annual Meeting & Scientific Symposium. March 2024, Chicago, Illinois.
  • Contributor to Magazine Article – St. Louis-Sanchez M. Addressing the Unique Needs of Women Who Wear Prostheses. Spridgen A, ed. The O&P Edge. Published online and in print, January 2024.
  • Project Featured in Newspaper Article – Olson J. This prosthetic leg can wear high heels. (Minneapolis) Star Tribune. Published online February 24, 2024.

A video showing the foot in use can be seen in a YouTube video. 

The UMII MnDRIVE Graduate Assistantship program supported U of M PhD candidates pursuing research at the intersection of informatics and any of the five MnDRIVE areas: 

  • Robotics
  • Global Food
  • Environment
  • Brain Conditions
  • Cancer Clinical Trials

This project was part of the Robotics MnDRIVE area.

The UMII program was converted to the Data Science Initiative-MnDRIVE Graduate Assistantship program  in the fall of 2023. Research supported by the program is at the intersection of data science and the five MnDRIVE areas. The most recent Assistantships were announced in January 2024. The application period for the next awards will be announced in Fall 2024.

photos of prosthetic leg being transferred from a flat shoe to a shoe with a high heel