# Optimizing Prosthetic and Bicycle Fit for Veterans with Transtibial Amputations

> **NIH VA I21** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2020 · —

## Abstract

Over one million people in the United States have a leg amputation and this number continues to grow due to
the prevalence of diabetes and recent military conflicts. Because of the functional impairment caused by an
amputation, it is extremely important to advance rehabilitation that optimizes the use of prostheses so that
Veterans with amputations can regain the greatest possible level of health, function, and physical activity.
[Low-impact exercise such as bicycling could facilitate return to work/duty after amputation by improving
cardiovascular fitness, muscle strength, endurance, and quality of life for Veterans with transtibial amputations
(TTAs). Bicycling as exercise could also prevent the deleterious effects of vascular disease and diabetes by
improving cardiovascular function, controlling body weight, decreasing the rate of re-amputation, and improving
quality of life for Veterans with TTAs. However, it is likely that discomfort and the increased potential for
secondary musculoskeletal injury due to the lack of a proper prosthetic/bike fit discourages Veterans with TTAs
from using bicycling for rehabilitation and exercise. Moreover, it is unclear how prosthetic and bicycle
components, such as pylon length (PL), pedal attachment position (PAP) beneath the prosthetic forefoot
versus the pylon, and crank arm length (CAL) affect the biomechanics, metabolic costs, and comfort/
satisfaction of Veterans with TTAs. Thus, our goal is to challenge the state-of-the-science by developing
evidence-based prosthetic and bicycle fit guidelines that optimize the biomechanics, metabolic costs, efficiency
(mechanical power/metabolic power) and comfort/satisfaction for Veterans with TTAs.] The Department of
Veterans Affairs (VA) and Department of Defense (DoD) Rehabilitation Directive has put forth an initiative that
aims to dramatically improve and restore function in wounded Veterans and Service members so that they
have the choice to return to active duty or productive civilian employment. Our proposed research will establish
optimal prosthetic/bicycle fit guidelines, which would enhance function by improving cardiovascular health,
controlling body weight, decreasing re-amputation rates, and enhancing quality of life of Veterans with TTAs,
thus helping to fulfill this initiative and having high potential impact. Specifically, we aim to: 1) Study 15
Veterans with unilateral TTAs to determine the effects of systematically varying PL, PAP beneath the
prosthetic forefoot versus the pylon, and CAL for the affected leg on bicycling biomechanics, metabolic costs,
and comfort/satisfaction. 2) Synthesize and disseminate our findings into practical, evidence-based quantitative
prosthetic/bicycle fit guidelines for Veterans with TTAs. We hypothesize that a longer PL and shorter CAL for
the affected compared to the unaffected leg along with a PAP beneath the pylon compared to beneath the
forefoot will maximize mechanical power symmetry and reduce metabolic cost and...

## Key facts

- **NIH application ID:** 9925065
- **Project number:** 5I21RX003010-02
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Alena Grabowski
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-05-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9925065

## Citation

> US National Institutes of Health, RePORTER application 9925065, Optimizing Prosthetic and Bicycle Fit for Veterans with Transtibial Amputations (5I21RX003010-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9925065. Licensed CC0.

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