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Osteoarthritis is a time related joint degenerative condition, the incidence rising rapidly with age, making it the commonest arthritic condition in the world. It develops in various joints in the human body and in some people it particularly affects the large weight-bearing joints of the hip and the knee. As the joint surfaces deteriorate the joint becomes painful, crunches, loses range of motion and becomes difficult to walk on. When conservative measures are not helpful, such as physiotherapy, analgesics, walking aids and weight loss, then knee replacement is considered.

The foot’s design is complex and specialised to manage the forces generated by bearing the weight of the body and by the need to propel the body in gait. The talus is at the apex of the main longitudinal foot arch and is held firmly by the ankle mortise. The largest arch is the lengthways or medial arch of the foot which manages the forces involved in moving the body and standing, the spring ligament contributing to this by storing and releasing the energies involved. The outside or lateral arch is less obvious as is the transverse arch at the front of the foot.

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Lower limb amputation is a major undertaking and greatly affects the life of the individual, adding psychological stresses to the physical efforts of rehabilitation, fitting for a new limb and learning the skills of walking again. The surgeon will plan the process so that the patient can manage the prosthesis easily, participate as soon as possible in rehabilitation and expend the lowest levels of energy in gait. The patient has to learn a large number of new skills – putting the prosthesis on and taking it off, monitoring the skin for areas of excessive pressure, walking on even and uneven surfaces and getting around when they are not wearing the artificial limb.