The Influence of Footwear on Gait and Standing in People with Transtibial Amputation: A Scoping Review

Background: People with lower limb amputation can have multiple walking gait deviations influencing their stability and ability to generate power at toe-off. These deviations could be compounded by footwear choice influencing the footwear-prosthesis system. Objective: Conduct a scoping review to examine research quantifying the impact of footwear and footwear characteristics on standing and walking gait in people with transtibial amputation. Study Design: A systematic search of the literature was undertaken. Results: Seventy records were returned from the search and after screening for relevance, six studies met the predefined inclusion criteria. Study designs investigated small samples, laboratory settings, and only straight-line walking or bilateral standing. Footwear characteristics included in studies were shoes versus barefoot, mass, heel height, and insole hardness. Stability was a particular focus, alongside walking speed, muscle activation, lower limb kinematics, and symmetry. Conclusions: Small samples, disparate methods, and subjective interpretation limit conclusions; however, increasing heel height made users less stable, as did softer insoles. Wearing shoes versus barefoot largely influenced ankle and knee angles in early stance, but did not influence temporal-spatial parameters consistently. Altering shoe mass influenced gait symmetry, but heel height did not. Shoe mass closest to the users own footwear mass resulted in the most symmetrical gait. Consideration of footwear characteristics is essential when investigating gait in people with transtibial amputation.