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Cut Outs Elaine Echelon

The award-winning Echelon is a waterproof hydraulic ankle that absorbs and damps on impact, self-aligns on rough and sloping surfaces, then remains dorsiflexed at toe-off. These design features help reduce abnormal pressures at the socket interface and other joints, promote comfort and postural symmetry to help reduce the risk of falls and preserve musculoskeletal health.

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Real Life Stories

Elaine’s Story

Unique & Proven Echelon Technology

The Echelon range sits at the heart of our pioneering prosthetic philosophy which makes our products so popular with users around the world. Created with a sharp focus on replicating a natural and safe walking experience, each product in the Echelon Range has a characteristic to suit different users and their requirements, providing confidence in every step.

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  • E-Carbon Foot Spring Technology

    E-Carbon Foot Spring Technology

    This not only provides excellent energy storing and release properties but also works in harmony with the range of movement in the ankle to provide a natural and comfortable walking experience.

  • Natural Motion & Control

    Natural Motion & Control

    When walking up slopes, the additional range allows the body to move forward over the foot, reducing energy requirements by making rollover easier. When walking down slopes, the foot complies with the slope without forcing the leg forward, allowing for a more controlled descent.

  • Hydraulic Ankle Technology

    Hydraulic Ankle Technology

    Hydraulic damping and foot springs produce a visco-elastic response that simulates the behaviour of muscles by storing and releasing energy. When compared to non-hydraulic ankles*, this technology is clinically proven to provide comfort, safety, natural walking, balanced limb loading and overall greater patient satisfaction. *Clinical studies, latest research papers and full references available on our website.

Scientifically Proven

Clinical Compendium Cover 1

Clinical Compendium

Blatchford Biomimetic Hydraulic Technology mimics the dynamic and adaptive qualities of muscle actuation to encourage more natural gait. Multiple independent scientific studies, comparing Blatchford hydraulic ankle-feet to non-hydraulic feet, have shown:

  • Greater comfort, reduced socket pressures
  • Improved safety, reduced risk of trips and falls
  • Smoother, easier and more natural gait
  • More evenly balanced inter-limb loading
  • Greater satisfaction
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Clinical Evidence

Over a decade after challenging conventional wisdom, new scientific evidence continues to be published on the medical advantages of hydraulic ankles. Discover our White Paper ‘A Study of Hydraulic Ankles’.

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*Clinical studies, latest research papers and full references available on our website.

Echelon Clinical Evidence Reference

Improvements in Clinical Outcomes using Echelon compared to ESR feet

  • Safety

    Reduced risk of tripping and falls

    • Increased minimum toe clearance during swing phase1,2

    Improving standing balance on a slope

    • 24-25% reduction in mean inter-limb centre-of-pressure root mean square (COP RMS)3
  • Energy Expenditure

    Reduced energy expenditure during walking

    • Mean 11.8% reduction in energy use on level ground, across all walking speeds4
    • Mean 20.2% reduction in energy use on slopes, across all gradients4
    • Mean 8.3% faster walking speed for the same amount of effort4
  • Mobility

    Improved gait performance

    • Faster self-selected walking speed2,5-7
    • Higher PLUS-M scores than FlexFoot and FlexWalk style feet8

    Improved ground compliance when walking on slopes

    • Increased plantarflexion peak during level walking, fast level walking and cambered walking9
    • Increased dorsiflexion peak during level walking, fast level walking and cambered walking9

    Less of a prosthetic “dead spot” during gait

    • Reduced aggregate negative COP displacement5
    • Centre-of-pressure passes anterior to the shank statistically significantly earlier in stance5
    • Increased minimum instantaneous COM velocity during prosthetic-limb single support phase5
    • Reduced peak negative COP velocity7
    • Reduced COP posterior travel distance7

    Improved ground compliance when walking on slopes

    • Increased plantarflexion range during slope descent10
    • Increased dorsiflexion range during slope ascent10
  • Residual Limb Health

    Helps protect vulnerable limb tissue, reducing likelihood of damage

    • Reduced peak stresses on residual limb11
    • Reduced stress RMS on residual limb11
    • Reduced loading rates on residual limb11
  • Loading symmetry

    Greater contribution of prosthetic limb to support during walking

    • Increased residual knee negative work6

    Reduced reliance on sound limb for support during walking

    • Reduced intact limb peak hip flexion moment6
    • Reduced intact limb peak dorsiflexion moment6
    • Reduced intact ankle negative work and total work6
    • Reduced intact limb total joint work6

    Better symmetry of loading between prosthetic and sound limbs during standing on a slope

    • Degree of asymmetry closer to zero for 5/5 amputees3

    Reduced residual and sound joint moments during standing of a slope

    • Significant reductions in both prosthetic and sound support moments12

    Less pressure on the sole of the contralateral foot

    • Peak plantar-pressure13

    Improved gait symmetry

    • Reduced stance phase timing asymmetry14
  • User satisfaction

    Patient reported outcome measures indicate improvements

    • Mean improvement across all Prosthesis Evaluation Questionnaire domains15
    • Bilateral patients showed highest mean improvement in satisfaction15

    Subjective user preference for hydraulic ankle

    • 13/13 participants preferred hydraulic ankle13

*Maximum user weight 100kg and always use one higher spring rate category than shown in the Spring Set Selection table.
**Component weight shown is for a size 26cm without foot shell.

References

  • Full Reference Listing
    1. Riveras M, Ravera E, Ewins D, Shaheen AF, Catalfamo-Formento P.

      Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait & Posture. 2020 Sep 1;81:41-8.

    2. Johnson L, De Asha AR, Munjal R, et al.

      Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429.

    3. McGrath M, Laszczak P, Zahedi S, et al.

      Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396.

    4. Askew GN, McFarlane LA, Minetti AE, et al.

      Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39.

    5. De Asha AR, Munjal R, Kulkarni J, et al.

      Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734.

    6. De Asha AR, Munjal R, Kulkarni J, et al.

      Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1.

    7. De Asha AR, Johnson L, Munjal R, et al.

      Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224.

    8. Wurdeman SR, Stevens PM, Campbell JH.

      Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784.

    9. Bai X, Ewins D, Crocombe AD, et al.

      Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836.

    10. Bai X, Ewins D, Crocombe AD, et al.

      A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093.

    11. Portnoy S, Kristal A, Gefen A, et al.

      Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125.

    12. McGrath M, Davies KC, Laszczak P, et al.

      The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Can Prosthet Orthot J; 2.

    13. Moore R.

      Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70.

    14. Moore R.

      Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48.

    15. Sedki I, Moore R.

      Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254.

Echelon Documentation

  • Product Information
  • Datasheet
  • References
    • Johnson L, De Asha AR, Munjal R, et al.
      Toe clearance when walking in people with unilateral transtibial amputation: effects of passive hydraulic ankle. J Rehabil Res Dev 2014; 51: 429.
    • McGrath M, Laszczak P, Zahedi S, et al.
      Microprocessor knees with “standing support” and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing. J Rehabil Assist Technol Eng 2018; 5: 2055668318795396.
    • Askew GN, McFarlane LA, Minetti AE, et al.
      Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid ‘ankle’: insights from body centre of mass dynamics. J NeuroEngineering Rehabil 2019; 16: 39.
    • De Asha AR, Munjal R, Kulkarni J, et al.
      Impact on the biomechanics of overground gait of using an ‘Echelon’hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees. Clin Biomech 2014; 29: 728–734.
    • De Asha AR, Munjal R, Kulkarni J, et al.
      Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic’ankle’damping. J Neuroengineering Rehabil 2013; 10: 1.
    • De Asha AR, Johnson L, Munjal R, et al.
      Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment. Clin Biomech 2013; 28: 218–224.
    • Wurdeman SR, Stevens PM, Campbell JH.
      Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6: 2055668318820784.
    • Bai X, Ewins D, Crocombe AD, et al.
      Kinematic and biomimetic assessment of a hydraulic ankle/foot in level ground and camber walking. PLOS ONE 2017; 12: e0180836.
    • Bai X, Ewins D, Crocombe AD, et al.
      A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLOS ONE 2018; 13: e0205093.
    • Portnoy S, Kristal A, Gefen A, et al.
      Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet. Gait Posture 2012; 35: 121–125.
    • Moore R.
      Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation. JPO J Prosthet Orthot 2018; 30: 165–70.
    • Moore R.
      Effect on Stance Phase Timing Asymmetry in Individuals with Amputation Using Hydraulic Ankle Units. JPO J Prosthet Orthot 2016; 28: 44–48.
    • Sedki I, Moore R.
      Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int 2013; 37: 250–254.
  • Other downloads
    • Echelon - Ankle Alignment Wedge
    • Echelon - Sandal Toe Foot Range Information
    • Echelon - 838221465 Hydraulic Ankle Technology Brochure Iss1 US AW Web Pages
    • Echelon PDAC Verification Letter
      Suggested L-Codes: L5981, L5968
    • Blatchford Product L Codes January 2024

The PDAC-Approved badge denotes a product that has been approved by the Pricing, Data Analysis and Coding (PDAC) contractor for one or more of the prior authorization codes as specified in the Healthcare Common Procedure Coding System (HCPCS) codes.