Prosthetic model, but not stiffness or height, affects maximum running velocity in athletes with unilateral transtibial amputations

The running-specific prosthetic (RSP) configuration used by athletes with transtibial amputations (TTAs) likely affects performance. Athletes with unilateral TTAs are prescribed C- or J-shaped RSPs with a manufacturer-recommended stiffness category based on body mass and activity level, and height based on unaffected leg and residual limb length. We determined how 15 different RSP model, stiffness, and height configurations affect maximum running velocity (v(max)) and the underlying biomechanics. Ten athletes with unilateral TTAs ran at 3m/s to v(max) on a force-measuring treadmill. v(max) was 3.8-10.7% faster when athletes used J-shaped versus C-shaped RSP models (p<0.05), but was not affected by stiffness category, actual stiffness (kN/m), or height (p=0.72, p=0.37, and p=0.11, respectively). v(max) differences were explained by vertical ground reaction forces (vGRFs), stride kinematics, leg stiffness, and symmetry. While controlling for velocity, use of J-shaped versus C-shaped RSPs resulted in greater stance average vGRFs, slower step frequencies, and longer step lengths (p<0.05). Stance average vGRFs were less asymmetric using J-shaped versus C-shaped RSPs (p<0.05). Contact time and leg stiffness were more asymmetric using the RSP model that elicited the fastest v(max) (p<0.05). Thus, RSP geometry (J-shape versus C-shape), but not stiffness or height, affects v(max) in athletes with unilateral TTAs.