Amputee Gait on Slopping Ground and Uneven Surfaces: A State of the Art Review

Abstract Objective: to clarify the current state of the art on transtibial amputee gait on sloping ground and uneven surfaces by means of the analysis of kinetic, kinematic, spatiotemporal and physiological variables, so that prostheses can be designed to suit the specific needs of the rural context. Methods: A systematic literature search was performed using specific electronic databases, search terms, and inclusion/exclusion criteria to identify studies on transtibial amputee gait in uneven terrain. Additionally, a reasoning model was created to facilitate structured extraction of pertinent data from the literature. Results: Transtibial amputees adapt their gait on uneven surfaces by adjusting foot positioning and increasing base of support. Research indicates heightened hip and knee flexion during both stance and swing phases, aiding in lowering the center of mass and improving toe clearance compared to level ground walking. Conclusions: Transtibial amputees utilize compensatory strategies to maintain dynamic stability on uneven surfaces, like non-amputees, due to limited ankle mobility and sensory feedback. However, existing research predominantly focuses on level ground biomechanics, neglecting uneven terrains combined with slopes. Given the prevalence of such terrain in rural Colombia and Latin America, further investigation is vital to understand amputees’ gait. This research would aid in designing prostheses that improve stability and address the unique needs of transtibial amputees in these environments.