Original research| Volume 100, ISSUE 7, P1259-1266, July 2019

Download started.


Does Unilateral Lower Limb Amputation Influence Ankle Joint Torque in the Intact Leg?

Published:January 09, 2019DOI:



      To investigate ankle torque and steadiness in the intact leg of transtibial and transfemoral unilateral amputees.


      Comparative study.


      Medical rehabilitation centers.


      Fifteen persons with a unilateral transfemoral amputation, 8 persons with a transtibial amputation, and 14 able-bodied male participants volunteered to participate in this study (N=37).


      Not applicable.

      Main Outcomes Measures

      Maximal isometric torque performed during ankle plantarflexion and dorsiflexion in the intact limb of amputees and in the dominant limb of able-bodied persons. The coefficient of variation (CV) of the plantarflexion torque was calculated over 5 seconds during a submaximal isometric contraction (15%) in order to assess torque steadiness. Furthermore, electromyographic activity (the root mean square amplitude) of the gastrocnemius medialis and tibialis anterior muscles was analyzed.


      Plantarflexion maximal torque was significantly higher for the able-bodied group (115±39 Nm) than for the group with a transfemoral amputation (77±34 Nm) (P<.01), and did not differ between able-bodied group and the group with a transtibial amputation (97±26 Nm) (P=.25). Furthermore, the transfemoral amputee group was 29% less steady than the able-bodied group (P=.01). However, there were no significant differences in torque steadiness between the able-bodied group and transtibial amputee group (P=.26) or between transtibial and transfemoral amputee groups (P=.27). The amputation had no significant effect between groups on dorsiflexion maximal torque (P=.10), gastrocnemius medialis electromyography (EMG) (P=.85), tibialis anterior coactivation (P=.95), and coactivation ratio (P=.75).


      The present study suggests that as the level of amputation progresses from below the knee to above the knee, the effect on the intact ankle is progressively more negative.


      List of abbreviations:

      BMI (body mass index), CV (coefficient of variation), EMG (electromyography), MVC (maximal voluntary contraction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Narici M.V.
        • Roi G.S.
        • Landoni L.
        • Minetti A.E.
        • Cerretelli P.
        Changes in force, cross-sectional area and neural activation during strength training and detraining of the human quadriceps.
        Eur J Appl Physiol Occup Physiol. 1989; 59: 310-319
        • Powers S.K.
        • Lynch G.S.
        • Murphy K.T.
        • Reid M.B.
        • Zijdewind I.
        Disease-induced skeletal muscle atrophy and fatigue.
        Med Sci Sport Exerc. 2016; 48: 2307-2319
        • Seynnes O.
        • Hue O.A.
        • Garrandes F.
        • et al.
        Force steadiness in the lower extremities as an independent predictor of functional performance in older women.
        J Aging Phys Act. 2005; 13: 395-408
        • van Velzen J.M.
        • van Bennekom C.A.
        • Polomski W.
        • Slootman J.R.
        • van der Woude L.H.
        • Houdijk H.
        Physical capacity an walking ability after lower limb amputation: a systematic review.
        Clin Rehabil. 2006; 20: 999-1016
        • Bussmann J.B.
        • Grootscholten E.A.
        • Stam H.J.
        Daily physical activity and heart rate response in people with a unilateral transtibial amputation for vascular disease.
        Arch Phys Med Rehabil. 2004; 85: 240-244
        • Goujon-Pillet H.
        • Sapin E.
        • Fodé P.
        • Lavaste F.
        Three-dimensional motions of trunk and pelvis during transfemoral amputee gait.
        Arch Phys Med Rehabil. 2008; 89: 87-94
        • Devan H.
        • Carman A.
        • Hendrick P.
        • Hale L.
        • Ribeiro D.C.
        Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: systematic review.
        J Rehabil Res Dev. 2015; 52: 1-19
        • Schmalz T.
        • Blumentritt S.
        • Marx B.
        Biomechanical analysis of stair ambulation in lower limb amputees.
        Gait Posture. 2007; 25: 267-278
        • Gaffney B.M.M.
        • Christiansen C.L.
        • Murray A.M.
        • Davidson B.S.
        Trunk movement compensations and corresponding core muscle demand during step ambulation in people with unilateral transtibial amputation.
        J Electromyogr Kinesiol. 2018; 39: 16-25
        • Reeves N.D.
        • Maganaris C.N.
        • Ferretti G.
        • Narici M.V.
        Influence of 90-day simulated microgravity on human tendon mechanical properties and the effect of resistive countermeasures.
        J Appl Physiol. 2005; 98: 2278-2286
        • Narici M.V.
        • Maganaris C.N.
        Plasticity of the muscle-tendon complex with disuse and aging.
        Exerc Sport Sci Rev. 2007; 35: 126-134
        • Mattes S.J.
        • Martin P.E.
        • Royer T.D.
        Walking symmetry and energy cost in persons with unilateral transtibial amputations: matching prosthetic and intact limb inertial properties.
        Arch Phys Med Rehabil. 2000; 81: 561-568
        • Sanderson D.J.
        • Martin P.E.
        Lower extremity kinematic and kinetic adaptations in unilateral below-knee amputees during walking.
        Gait Posture. 1997; 6: 126-136
        • Kobayashi Y.
        • Hobara H.
        • Matsushita S.
        • Mochimaru M.
        Key joint kinematic characteristics of the gait of fallers identified by principal component analysis.
        J Biomech. 2014; 47: 2424-2429
        • Bilodeau M.
        • Keen D.A.
        • Sweeney P.J.
        • Shields R.W.
        • Enoka R.M.
        Strength training can improve steadiness in persons with essential tremor.
        Muscle Nerve. 2000; 23: 771-778
        • Chung-Hoon K.
        • Tracy B.L.
        • Dibble L.E.
        • Marcus R.L.
        • Burgess P.
        • LaStayo P.C.
        The association between knee extensor force steadiness, force accuracy, and mobility in older adults who have fallen.
        J Geriatr Phys Ther. 2016; 39: 1-7
        • Paxton R.J.
        • Feldman-Kothe C.
        • Trabert M.K.
        • Hitchcock L.N.
        • Reiser R.F.
        • Tracy B.L.
        Postural steadiness and ankle force variability in peripheral neuropathy.
        Motor Control. 2016; 20: 266-284
        • Tracy B.L.
        • Byrnes W.C.
        • Enoka R.M.
        Strength training reduces force fluctuations during anisometric contractions of the quadriceps femoris muscles in old adults.
        J Appl Physiol. 2004; 96: 1530-1540
        • Tracy B.L.
        • Enoka R.M.
        Steadiness training with light loads in the knee extensors of elderly adults.
        Med Sci Sports Exerc. 2006; 38: 735-745
        • Almuklass A.M.
        • Price R.C.
        • Gould J.R.
        • Enoka R.M.
        Force steadiness as a predictor of time to complete a pegboard test of dexterity in young men and women.
        J Appl Physiol. 2016; 120: 1410-1417
        • Lloyd C.H.
        • Stanhope S.J.
        • Davis I.S.
        • Royer T.D.
        Strength asymmetry and osteoarthritis risk factors in unilateral trans-tibial, amputee gait.
        Gait Posture. 2010; 32: 296-300
        • Curtze C.
        • Hof A.L.
        • Postema K.
        • Otten B.
        The relative contributions of the prosthetic and sound limb to balance control in unilateral transtibial amputees.
        Gait Posture. 2012; 36: 276-281
        • Bendall M.J.
        • Bassey E.J.
        • Pearson M.B.
        Factors affecting walking speed of elderly people.
        Age Ageing. 1989; 18: 327-332
        • McGibbon C.A.
        • Krebs D.E.
        Effects of age and functional limitation on leg joint power and work during stance phase of gait.
        J Rehabil Res Dev. 1999; 36: 173-182
        • Rougier P.R.
        • Bergeau J.
        Biomechanical analysis of postural control of persons with transtibial or transfemoral amputation.
        Am J Phys Med Rehabil. 2009; 88: 896-903
        • Adams G.R.
        • Hather B.M.
        • Dudley G.A.
        Effect of short-term unweighting on human skeletal muscle strength and size.
        Aviat Space Environ Med. 1994; 65: 1116-1121
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Day H.J.
        The assessment and description of amputee activity.
        Prosthet Orthot Int. 1981; 5: 23-28
        • Toumi A.
        • Leteneur S.
        • Gillet C.
        • et al.
        Enhanced precision of ankle torque measure with an open-unit dynamometer mounted with a 3D force-torque sensor.
        Eur J Appl Physiol. 2015; 115: 2303-2310
        • Simoneau-Buessinger E.
        • Leteneur S.
        • Toumi A.
        • et al.
        Bilateral strength deficit is not neural in origin; rather due to dynamometer mechanical configuration.
        PLoS One. 2015; 10e0145077
        • Toumi A.
        • Jakobi J.M.
        • Simoneau-Buessinger E.
        Differential impact of visual feedback on plantar- and dorsi-flexion maximal torque output.
        Appl Physiol Nutr Metab. 2016; 41: 557-559
        • Hermens H.J.
        • Freriks B.
        • Disselhorst-Klug C.
        • Rau G.
        Development of recommendations for SEMG sensors and sensor placement procedures.
        J Electromyogr Kinesiol. 2000; 10: 361-374
        • Wong C.K.
        • Wong R.J.
        Standard and amputation-adjusted body mass index measures: comparison and relevance to functional measures, weight-related comorbidities, and dieting.
        Am J Phys Med Rehabil. 2017; 96: 912-915
        • Amputee Coalition
        BMI calculator for amputees.
        (Available at:) (Accessed January 1, 2018)
        • Cattagni T.
        • Scaglioni G.
        • Laroche D.
        • Gremeaux V.
        • Martin A.
        The involvement of ankle muscles in maintaining balance in the upright posture is higher in elderly fallers.
        Exp Gerontol. 2016; 77: 38-45
        • Honeine J.L.
        • Schieppati M.
        • Gagey O.
        • Do M.C.
        By counteracting gravity, triceps surae sets both kinematics and kinetics of gait.
        Physiol Rep. 2014; 2e00229
        • Alkner B.A.
        • Tesch P.A.
        Knee extensor and plantar flexor muscle size and function following 90 days of bed rest with or without resistance exercise.
        Eur J Appl Physiol. 2004; 93: 294-305
        • Sarabon N.
        • Rosker J.
        Effect of 14 days of bed rest in older adults on parameters of the body sway and on the local ankle function.
        J Electromyogr Kinesiol. 2013; 23: 1505-1511
        • Nolan L.
        • Lees A.
        The functional demands on the intact limb during walking for active trans-femoral and trans-tibial amputees.
        Prosthet Orthot Int. 2000; 24: 117-125
        • Hunt M.A.
        • Hatfield G.L.
        Ankle and knee biomechanics during normal walking following ankle plantarflexor fatigue.
        J Electromyogr Kinesiol. 2017; 35: 24-29
        • de Boer M.D.
        • Maganaris C.N.
        • Seynnes O.R.
        • Rennie M.J.
        • Narici M.V.
        Time course of muscular, neural and tendinous adaptations to 23 day unilateral lower-limb suspension in young men.
        J Physiol. 2007; 583: 1079-1091
        • Duchateau J.
        • Hainaut K.
        Effects of immobilization on contractile properties, recruitment and firing rates of human motor units.
        J Physiol. 1990; 422: 55-65
        • Czerniecki J.M.
        • Turner A.P.
        • Williams R.M.
        • Hakimi K.N.
        • Norvell D.C.
        Mobility changes in individuals with dysvascular amputation from the presurgical period to 12 months postamputation.
        Arch Phys Med Rehabil. 2012; 93: 1766-1773
        • Gray E.
        • Shields C.
        • Fowles J.R.
        Building competency and capacity for promotion of effective physical activity in diabetes care in canada.
        Can J Diabetes. 2017; 41: 491-498
        • Miquelon P.
        • Castonguay A.
        Motives for participation in physical activity and observance of physical activity recommendations among adults with type 2 diabetes.
        Can J Diabetes. 2016; 40: 399-405
        • Nolan L.
        A training programme to improve hip strength in persons with lower limb amputation.
        J Rehabil Med. 2012; 44: 241-248
        • Bragaru M.
        • Dekker R.
        • Geertzen J.H.
        • Dijkstra P.U.
        Amputees and sports: a systematic review.
        Sport Med. 2011; 41: 721-740
        • Nolan L.
        Lower limb strength in sports-active transtibial amputees.
        Prosthet Orthot Int. 2009; 33: 230-241
        • Deans S.A.
        • McFadyen A.K.
        • Rowe P.J.
        Physical activity and quality of life: a study of a lower-limb amputee population.
        Prosthet Orthot Int. 2008; 32: 186-200
        • Legro M.W.
        • Reiber G.E.
        • Czerniecki J.M.
        • Sangeorzan B.J.
        Recreational activities of lower-limb amputees with prostheses.
        J Rehabil Res Dev. 2001; 38: 319-325
        • Yeung L.F.
        • Leung A.K.
        • Zhang M.
        • Lee W.C.
        Long-distance walking effects on trans-tibial amputees compensatory gait patterns and implications on prosthetic designs and training.
        Gait Posture. 2012; 35: 328-333
        • Brown R.E.
        • Edwards D.L.
        • Jakobi J.M.
        Sex differences in force steadiness in three positions of the forearm.
        Eur J Appl Physiol. 2010; 110: 1251-1257
        • Johannsson J.
        • Jakobi J.
        • Duchateau J.
        • Baudry S.
        Do mechanical properties of Achilles tendon influence torque steadiness?.
        Comput Methods Biomech Biomed Engin. 2015; 18: 1958-1959
        • Smart R.R.
        • Baudry S.
        • Fedorov A.
        • Kuzyk S.L.
        • Jakobi J.M.
        Influence of biceps brachii tendon mechanical properties on elbow flexor force steadiness in young and old males.
        Scand J Med Sci Sports. 2018; 28: 983-991
        • Cronin N.J.
        • Barrett R.S.
        • Carty C.P.
        Long-term use of high-heeled shoes alters the neuromechanics of human walking.
        J Appl Physiol. 2012; 112: 1054-1058
        • Csapo R.
        • Maganaris C.N.
        • Seynnes O.R.
        • Narici M.V.
        On muscle, tendon and high heels.
        J Exp Biol. 2010; 213: 2582-2588
        • Harwood B.
        • Cornett K.M.
        • Edwards D.L.
        • Brown R.E.
        • Jakobi J.M.
        The effect of tendon vibration on motor unit activity, intermuscular coherence and force steadiness in the elbow flexors of males and females.
        Acta Physiol. 2014; 211: 597-608