Association between the level of partial foot amputation and gait: a scoping review with implications for the minimum impairment criteria for wheelchair tennis

Fábio Carlos Lucas de Oliveira; Samuel Williamson; Clare L Ardern; Kristina Fagher; Neil Heron; Dina Christina Christa Janse van Rensburg; Marleen G T Jansen; Nikki Kolman; Sean Richard O'Connor; Tobias Saueressig; Linda Schoonmade; Jane S Thornton; Nick Webborn; Babette M Pluim

doi:10.1136/bjsports-2022-105650

Association between the level of partial foot amputation and gait: a scoping review with implications for the minimum impairment criteria for wheelchair tennis

Br J Sports Med. 2022 Dec 5:bjsports-2022-105650. doi: 10.1136/bjsports-2022-105650. Online ahead of print.

Authors

Fábio Carlos Lucas de Oliveira^{1

2}, Samuel Williamson³, Clare L Ardern^{4

5}, Kristina Fagher⁶, Neil Heron^{7

8}, Dina Christina Christa Janse van Rensburg^{9

10}, Marleen G T Jansen^{11

12}, Nikki Kolman^{12

13}, Sean Richard O'Connor¹⁴, Tobias Saueressig¹⁵, Linda Schoonmade¹⁶, Jane S Thornton^{17

18}, Nick Webborn^{19

20}, Babette M Pluim^{9

21

22}

Affiliations

¹ Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada fclud@ulaval.ca.
² Research Unit in Sport and Physical Activity (CIDAF), University of Coimbra, Coimbra, Portugal.
³ English Institute of Sport, London, UK.
⁴ Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
⁶ Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden.
⁷ Center for Public Health, Queen's University Belfast, Belfast, UK.
⁸ School of Medicine, Keele University, Staffordshire, UK.
⁹ Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹⁰ Medical Board member, World Netball, Manchester, UK.
¹¹ Toptennis Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands.
¹² Center for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands.
¹³ Knowledge Centre for Sport & Physical Activity, Utrecht, The Netherlands.
¹⁴ School of Psychology, Queen's University Belfast, Belfast, UK.
¹⁵ Physio Meets Science GmbH, Leimen, Germany.
¹⁶ Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁷ Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
¹⁸ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
¹⁹ IPC Medical Committee, Bonn, Germany.
²⁰ School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
²¹ Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands.
²² Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands.

PMID: 36588404
DOI: 10.1136/bjsports-2022-105650

Abstract

Objective: This scoping review examines how different levels and types of partial foot amputation affect gait and explores how these findings may affect the minimal impairment criteria for wheelchair tennis.

Methods: Four databases (PubMed, Embase, CINAHL and SPORTDiscus) were systematically searched in February 2021 for terms related to partial foot amputation and ambulation. The search was updated in February 2022. All study designs investigating gait-related outcomes in individuals with partial foot amputation were included and independently screened by two reviewers based on Arksey and O'Malley's methodological framework and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

Results: Twenty-nine publications with data from 252 participants with partial foot amputation in 25 studies were analysed. Toe amputations were associated with minor gait abnormalities, and great toe amputations caused loss of push-off in a forward and lateral direction. Metatarsophalangeal amputations were associated with loss of stability and decreased gait speed. Ray amputations were associated with decreased gait speed and reduced lower extremity range of motion. Transmetatarsal amputations and more proximal amputations were associated with abnormal gait, substantial loss of power generation across the ankle and impaired mobility.

Conclusions: Partial foot amputation was associated with various gait changes, depending on the type of amputation. Different levels and types of foot amputation are likely to affect tennis performance. We recommend including first ray, transmetatarsal, Chopart and Lisfranc amputations in the minimum impairment criteria, excluding toe amputations (digits two to five), and we are unsure whether to include or exclude great toe, ray (two to five) and metatarsophalangeal amputations.

Trial registration: The protocol of this scoping review was previously registered at the Open Science Framework Registry (https://osf.io/8gh9y) and published.

Keywords: Athletic Performance; Disabled Persons; Gait analysis; Para sport; Sports medicine; Walking; amputee; classification; disability; gait; partial foot amputation.

Publication types

Review