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Stepping Towards Equity: Understanding Racial Variations in Gait Outcomes of Lower Extremity Amputees
Rajan M. Negassa
*1, Holly D. Shan
1, Rachel N. Rohrich
2, Umayr R. Shaikh
1, Stephen Baker
2, Karen K. Evans
2, Christopher E. Attinger
21Georgetown University School of Medicine, Washington, ; 2Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington,
Background: Understanding gait, as a measure of functionality, in patients with non-traumatic lower extremity (LE) amputations across different racial groups is vital for optimizing recovery. This study examines gait parameters among Black and White patients with LE amputations.
Methods: Adults who can safely ambulate without pain, open wounds, and LE surgery in the previous three months were offered participation and completed a standardized 120-second walk test with wearable sensors at a self-selected pace. Level of amputation was confirmed with chart review and x-ray. Data were collected and analyzed with Motility Lab software and STATA VSN 17.0, with significance defined as p < 0.05.
Results:Overall, 47 patients provided racial backgrounds and completed both a gait test and LEFS survey: 34 (72.%) identified as Black and 13 (27.7%) as White. There were 15 (31.9%) digit, 8 (17.0%) ray, 10 (21.3%) transmetarasal, 1 (2.1%) above-knee, and 12 (25.5%) below-knee amputations. The mean age was 60.7±9.3. White patients were older (66.0 vs. 58.7, p=0.015), while body mass index (31.76±7.09 kg/m
2) and Charlson Comorbidity Index (5.70 ±2.34) were similar between groups (p=0.662 and p=0.262, respectively). Rates of diabetes mellitus type II (DM II; n=47, 100%) and end-stage renal disease (n=6, 12.8%) were similar. Gait speed (0.8±0.2m/s, p=0.620), step duration (0.6±0.1s, p=0.082), cadence (97.3±11.4steps/min, p=0.296), and double limb support (30.5±5.8%, p=0.417) were comparable. Black patients had significantly lower elevation mid-swing (1.4±0.9cm vs. 2.8±2.5cm, p=0.0096) and single limb support (34.2±3.6% vs. 36.4±2.2%;p=0.046).
Conclusion:These findings underscore the importance of understanding gait outcomes in diverse patients with LE amputations, as there may be differences in functional outcomes. Given the overall high prevalence of DM II, the differences in gait parameters between groups may be influenced by neuropathic complications. This highlights the complexity of post-amputation outcomes and calls for more research into the underlying causes of disparities.
Table 1. Patient Demographics and Spatiotemporal Gait Parameters.
| Demographics | All (n=47) | Black (n=34) | White (n=13) | P-value |
| Age (years) | 60.7 ± 9.3 | 58.7 ± 8.5 | 66.0 ± 9.4 | 0.015 |
| BMI (kg/m2) | 31.8 ± 7.1 | 31.4 ± 7.9 | 32.6 ± 4.1 | 0.662 |
| CCI Score | 5.7 ± 2.3 | 5.9 ± 2.3 | 5.1 ± 2.4 | 0.262 |
| History of Smoking (n,%) | 15 (31.9%) | 11 (32.4%) | 4 (30.7%) | 0.917 |
| DM II (n,%) | 47 (100.0%) | 34 (100.0%) | 13 (100.0%) | 1.000 |
| ESRD (n,%) | 6 (12.8%) | 6 (17.6%) | 0 (0.0%) | 0.105 |
| Gait Parameters |
| Gait Speed (m/s) | 0.8 ± 0.2 | 0.8 ± 0.2 | 0.8 ± 0.2 | 0.620 |
| Elevation mid-swing (cm) | 1.8 ± 1.6 | 1.4 ± 0.9 | 2.8 ± 2.5 | 0.009 |
| Step duration (s) | 0.6 ± 0.1 | 0.6 ± 0.1 | 0.6 ± 0.9 | 0.082 |
| Cadence (step/min) | 97.3 ± 11.4 | 96.2 ± 11.7 | 100.1 ± 10.1 | 0.296 |
| Single Limb Support (%) | 34.8 ± 3.4 | 34.2 ± 3.6 | 36.4 ± 2.2 | 0.046 |
| Double Limb Support (%) | 30.5 ± 5.8 | 30.9 ± 6.4 | 29.4 ± 4.3 | 0.417 |
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