Almost everyone in Japan normally wears shoes outdoors, but does not use any kind of foot-wear except for socks or Japanese “tabi” socks inside his home. Not only is the temperature very high in Japan during summer, but it is also very humid. Therefore, there is need for special lower extremity prosthesis which is more suitable for the Japanese in their daily life. Research on foot-ankle assemblies is being carried out as our initial work.
1. Commercially available foot-ankle assemblies which are made in both foreign countries and Japan were listed and evaluated. Almost all foot-ankle assemblies made in foreign countries are good in quality, but they are not suitable for walking on ;“tatami mat;”; whereas, the domestically produced assemblies do not fit shoes snugly and are also poor in overall quality compared to the imported assemblies. No foot-ankle assemblies which are considered suitable for Japanese A. D. L. could be found among both the foreign and domestically assemblies.
2. A survey was made on 159 lower extremity amputees who are receiving pension in the Kansai area. Among the many different types of foot-ankle assemblies in use, the conventional single axis assemblies are most extensively used in Japan, numbering about 87%. The SACH foot is used somewhat less extensively which is only almost 5%. Most of the amputees have complaints in using their foot-ankle assemblies, which included trouble with the single axis joint, excessive noise, etc. Most female amputees want to wear shoes with high heels.
3. The above survey shows that lower extremity amputees in Japan need foot-ankle assemblies which are suitable for walking with both shoes (high heels in case of women) and barefoot. We are now making two kinds of experimental foot-ankle assemblies which will be most suitable for the Japanese. One of them has an adjustable coupling for variable ankle angle fitting both shoes and barefoot. The other has a connector for various prosthetic feet which completely fits with any types of footwear. Both of them incorporate the SACH foot.

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The authors studied Activities of Daily Living (A. D. L.) of 33 upper extremity amputees (25 unilateral, 8 bilateral) by interview in order to know, firstly, the dimension of their disability, secondly, the usefulness of the prosthesis.
For each of 126 activities (personal hygiene, eating, dressing, communication, use of tools), the interviewer scored specially designed questionnaire, from which following results were obtained.
1. Upper extremity amputees are essentially independent in A.D.L. (97% of test activities). However, “hidden disabilities”, such as slowness of performance (11% of independent activities), change of motion patterns (41%), use of self help devices (3%) and avoidance of performance (1% of necessary activities) were noted.
2. Dressing activities, especially knotting, use of cuff buttons, are the most difficult among 5 categories of A. D. L.
3. Unilateral amputees use active prosthesis rarely (12% of cases) and their A. D. L. are accomplished by residual function (remaining hand, mouth, foot, etc.). 40% of unilateral amputees use routinely some type of prosthesis.
4. Bilateral amputees tend to use exclusively either active prosthesis or their prehensile stumps (Krukenberg stump or cleft partial hand). Bilateral amputees except for one bilateral above-elbow amputee live within sufficient level of independence, but they avoid to perform more activities than unilateral ones.

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