Proposed standards for prosthetic foot reuse and considerations for donation of used prosthetic feet to low-and middle-income countries

ABSTRACT Prosthetic limb provision in low-and middle-income countries (LMICs) is complex. Prosthetics from high-income countries (HICs) are often replaced not because they are broken, but because of warranties and/or guidelines, meaning they may still be usable. However, as there are no standards/regulatory requirements guaranteeing the quality or safety of second-hand devices, they are often disposed of or donated to LMICs. Without standards to guarantee the quality of donated prosthetics could lead to a violation of the World Health Organization’s principles of good donation. Here, we compare 196 feet delivered prior to the introduction of an internal check for prosthetic foot quality introduced by a UK-based charity (STAND) with 170 feet delivered afterwards. The implementation of the check increased the percentage of usable second-hand prosthetic feet received by donation recipients from 83.16% to 94.12%. Foot brand significantly affected usability, but further data and larger samples are needed to disentangle the effects of prosthetic brand, prosthetic foot model, and donation centre on prosthetic foot usability. We propose a rapid and efficient quality checklist as a set of standards governing used prosthetic foot reuse and donation and discuss future directions for this line of work. The creation of an international set of standards/regulatory requirements governing the use of prosthetic limbs, like the international standards used for prosthetic limb design, would not only enable the safe, useful provision of prosthetics in LMICs, but would also set the groundwork for understanding how a repair, reuse, and recycle model for prosthetics might be implemented in HICs. Globally, this could decrease prosthetic provision time, create a circular economy for prosthetics, and reduce the carbon footprint of prosthetic manufacture and provision.