Patient-specific finite element models of transtibial amputation in several prosthetic users: The inter-subject variability

Active transtibial amputation (TTA) patients are at risk for developing pressure ulcers and deep tissue injury (DTI) while using their prosthesis. It is therefore important to obtain knowledge of the mechanical state in the internal soft tissues of the residuum, as well as the mechanical state upon its surface. For this purpose we employed patient-specific MRI-based non-linear 3D finite element models to quantify the internal mechanical conditions in 3 residual limbs of TTA prosthetic users during load-bearing. The geometrical characteristics of the residuum of the TTA participants varied significantly between patients, e.g. the residuum lengths were 7.6, 9.2 and 13.3cm. We generally found that internal strains were higher in the bone proximity than in the muscle periphery. The highest strains were found in the 7.6cm-long residuum. Correspondingly, the lowest strains were found in the 13.3cm-long residuum, which had the thickest muscle flap. Yet even in the case of a long residuum, a third of the distal tibial proximity area was occupied by internal principal compression strains above 5%. For both patients with shorter residual limbs, the internal principal compression strains above 5% occupied almost the entire distal tibial proximity area. We conclude that the wide viability between residual limbs necessitate quantitative analysis of internal mechanical state in the TTA individual to assess the risk for DTI onset.