Pressure distribution at the stump/socket interface in transtibial amputees during walking on stairs, slope and non-flat road

Background: Studies examining the stump/socket interface stresses have been restricted to unsupported stance and natural gait, i.e. walking at a comfortable speed on flat and straight walkway. However, the pressure behaviour as to the interface in unilateral transtibial amputees during walking on stairs, slope and non-flat road is unclear. Methods: Pressure distribution changes at multiple points, expressed as mean peak stump/socket interface pressure, mean pressure level over 90% of peak pressure, time in which pressure exceeded 90% of peak pressure and time-pressure integral at the period of sustained sub-maximal load, were measured during natural ambulating and walking on stairs, slope and non-flat road. Findings: Compared with natural gait, the mean peak pressure and sustained sub-maximal load increase notably over the patellar tendon during walking on stairs and non-flat road, and however decrease or change insignificantly at the patellar tendon on slope and over other measured areas in all conditions; moreover the time period of sustained sub-maximal load changes remarkably, except over the patellar tendon during walking up slope and over the popliteal area on non-flat road; finally, the time-pressure integral in the time period of sustained sub-maximal load changes considerably, except at the patellar tendon during walking up slope. Interpretation: The pressure characteristics during natural ambulating seem not to be highly predictive of what occurs in the conditions of walking on stairs, slope and non-flat road, which leads to significant increase in amplitude domain of tissue loading only at the patellar tendon, and however to remarkable changes in temporal sequences of tissue (un-)loading almost in all measured regions.