Practical and research implications
This case report has the following implications: (1) the lack of
push-off after toe amputation should be carefully observed, as this may
cause increased contralateral limb loading and subsequent
musculoskeletal comorbidities. (2) Understanding the musculoskeletal
comorbidities in the contralateral limb after toe amputation is an
interesting future direction to determine the relationship between the
former and increased contralateral limb loading.
In
the future studies, careful consideration for confounders, including
preexisting arthritis in multiple joints and cardiovascular status is
warranted. Since we cannot rule out that biomechanical changes in
ipsilateral limb are consequence of those in contralateral limb,
determining the causal relationship is also needed. Once the causal
relationship of the lacked push-off in ipsilateral limb and mechanical
overloading with subsequent comorbidities in contralateral limb is
verified, rehabilitation and gait retraining are of interest to improve
the production capacity of plantar flexor torque during the ipsilateral
terminal stance20.