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.
- Athletic Performance
- Disabled Persons
- Gait analysis
- Sports medicine
- Para sport
- partial foot amputation
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Contributors FCLO, SW, CLA and BMP contributed to the conception and study design. LS contributed to the search strategy. FCLO, SW and BMP conducted the data extraction, analysis and interpretation. TS performed the statistical analysis. FCLO, NH, CJvR, SW and BMP drafted the manuscript. All authors contributed to the manuscript with critical reviews and approved the final version of this paper.
Funding All authors thank the International Tennis Federation and the Royal Dutch Lawn Tennis Association (KNLTB) for supporting this research. We thank Dr Mohd Sameer Qureshi, MBBS, DNB Orthopaedics, for creating the illustrations.
Competing interests CA is Editor-in-Chief for JOSPT and JST is Editor for BJSM. At the time of writing, BMP was a classification consultant for the ITF, tasked to review the ITF minimum impairment criteria, and Chair of the ITF Classification Working Group.
Provenance and peer review Not commissioned; externally peer reviewed.
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