What is the Jaipur foot, its manufacturing process, components, indications, prerequisites, and contraindications, as well as pre and post-prosthetic training for patients with below-knee amputations?

The Jaipur Foot: A Comprehensive Guide

The Jaipur Foot is an affordable, durable prosthetic foot designed specifically for lower limb amputees in developing countries, providing excellent functionality for barefoot walking, squatting, and cross-legged sitting while being manufactured from locally available materials at low cost.

What is the Jaipur Foot?

The Jaipur Foot is a prosthetic foot developed by Dr. P.K. Sethi in India specifically designed for barefoot amputees using locally sourced, biodegradable, and inexpensive materials 1. It has become widely used throughout India, South East Asia, and Africa due to its affordability, durability, and cultural appropriateness.

Key Features:

• Enables amputees to work in rural conditions, muddy fields, and even climb trees
• Allows for squatting and cross-legged sitting (important for cultural activities)
• Can be manufactured in approximately one hour
• Designed for barefoot use but can accommodate footwear
• Provides a more natural gait compared to some Western prosthetics

Manufacturing Process and Materials

The Jaipur Foot is constructed using locally available materials that are both affordable and functional:

• Woods: Two types of wood are commonly used:

  • Ardu wood: Preferred for its lighter weight and suitable mechanical properties
  • Cheed wood: Has higher modulus of elasticity but greater density 2

• Rubber components:

  • Microcellular rubber
  • Tire cord (for structural integrity)
  • Cushion compound
  • Tread compound
  • Skin-colored rubber for cosmetic finishing 2

• Manufacturing process:

  • Components are assembled using local artisanal techniques
  • Materials undergo vulcanization, which significantly alters their mechanical properties
  • The vulcanization process increases the modulus of skin-colored rubber, cushion compound, and tread compound while decreasing the moduli of microcellular rubber and tire cord 2

Components and Structure

The Jaipur Foot consists of several key components:

1. Wooden core: Forms the structural base of the foot
2. Rubber shell: Provides flexibility and cosmetic appearance
3. Ankle block: Allows for some degree of ankle movement
4. Tire cord: Provides structural integrity to hold the foot together 2
5. Various rubber compounds: Different densities used for different functional areas of the foot

Indications for Use

The Jaipur Foot is particularly indicated for:

• Below-knee (transtibial) amputees
• Amputees in developing countries with limited resources
• Patients who need to walk barefoot regularly
• Individuals who require squatting or cross-legged sitting for cultural or occupational reasons
• Patients who work in rural or agricultural settings with uneven terrain
• Cases where cost is a significant barrier to prosthetic provision 1, 3

Prerequisites for Fitting

Before fitting a Jaipur Foot, several prerequisites should be considered:

• Properly healed amputation stump without open wounds or infections
• Adequate stump length for proper attachment
• Assessment of the patient's activity level and functional needs
• Evaluation of the patient's living and working environment
• Consideration of the patient's cultural needs (squatting, cross-legged sitting)
• Absence of contraindications (listed below)

Contraindications

The Jaipur Foot may not be appropriate in certain situations:

• Unhealed or infected amputation sites
• Severe phantom limb pain that requires specialized socket designs
• Patients requiring highly specialized biomechanical properties for specific activities
• Cases where more advanced prosthetic technology is indicated and accessible
• Situations where standardized manufacturing quality cannot be assured 4

Pre-Prosthetic Training

Before fitting the Jaipur Foot, patients should undergo:

1. Stump conditioning:

   • Proper wrapping to shape the residual limb
   • Desensitization exercises
   • Range of motion exercises for the knee joint

2. Strength training:

   • Core strengthening exercises
   • Hip and knee strengthening
   • Upper body strengthening for crutch or walker use if needed

3. Balance training:

   • Static balance exercises
   • Weight shifting activities
   • Proprioception training

Post-Prosthetic Training

After fitting with the Jaipur Foot, training should include:

1. Initial weight bearing:

   • Gradual weight bearing with parallel bars
   • Proper gait training
   • Balance exercises with the prosthesis

2. Advanced mobility training:

   • Walking on different surfaces (including uneven terrain)
   • Stair climbing
   • Squatting and sitting cross-legged (cultural activities)
   • Occupational-specific activities

3. Maintenance education:

   • Proper care of the prosthesis
   • Recognizing signs of damage
   • Stump hygiene and skin care

Check-Out Process

The check-out process for the Jaipur Foot should include:

1. Fit assessment:

   • Proper socket fit without pressure points
   • Alignment check
   • Gait analysis

2. Functional testing:

   • Walking on different surfaces
   • Squatting capability
   • Cross-legged sitting
   • Other culturally relevant activities

3. Patient education:

   • Usage guidelines
   • Maintenance instructions
   • When to seek adjustments or replacement

Outcomes and Performance

Research has shown that the Jaipur Foot:

• Allows a more natural gait compared to some Western prosthetics
• Performs closer to a normal foot in biomechanical testing compared to SACH and Seattle feet in some parameters
• May have less shock absorption capacity than the SACH foot but better overall functional performance 5
• Has proven durability in various environmental conditions
• Enables return to agricultural and rural work activities

Limitations and Considerations

Despite its advantages, the Jaipur Foot has some limitations:

• Lack of standardization in materials and manufacturing processes can affect consistency and durability 4
• May not provide the same technical specifications as more advanced prosthetics
• Requires specific expertise for proper fitting and alignment
• May need more frequent replacement than higher-cost alternatives

Follow-Up Care

According to guidelines for lower extremity amputees, patients with minor amputations should receive:

• Customized follow-up care including local wound care
• Pressure offloading
• Serial evaluation of foot biomechanics
• Use of therapeutic footwear to prevent wound recurrence 6

These principles should be applied to Jaipur Foot users as well, with regular follow-up to assess fit, function, and any signs of damage or wear.