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Fancy footwork by Canadians brings smiles
to mine victims

By Steve Sandford
THE GLOBE AND MAIL
January 2, 2003

ARANYAPRATHET, THAILAND - The morning sun slowly rises over lush paddy fields as a woman swings her hoe into the red earth. Chua-buakam Sriprapai moves spryly, cutting through the lettuce patch to gather food for breakfast. Mobility and endurance are prerequisites for farming the rugged terrain along the Thai-Cambodian border. For decades, land mines planted during Cambodia's civil war have robbed the area's people of these. Ms. Chua-buakam lost her right leg below the knee.

But that is changing, thanks to a Canadian invention that has restored Ms. Chua-buakam's agility and her ability to feed her family. The Niagara Foot, a revolutionary new prosthesis, is helping her and 14 other land-mine victims take steady steps toward regaining self-worth and productivity. "I feel like I have a real leg now," Ms. Chua-buakam said. "It is much more comfortable and gives me more energy to spend with my family. My good hip is less sore at the end of the day." Simple tasks, such as walking to a nearby shop, can be painful for those with artificial limbs; hauling a 20-kilogram sack of rice can be unbearable. But the Niagara Foot's energy-return design helps relieve the fatigue and pain.

A clinical team from Queen's University and a St. Catharines, Ont., prosthesis-maker, Niagara Prosthetics and Orthopedics, is in the border region completing tests on 15 land-mine victims aged 29 to 72. "We wanted to improve conditions by providing a foot that would withstand rugged conditions, was affordable and did not need to be replaced," designer Rob Gabourie said.

The Niagara Foot uses Dupont Delrin, a special polyacetyl plastic that is unique in its combination of elasticity and toughness. Researchers tested the foot at Queen's for three years before moving from the cyclical fatigue laboratory to the Thai-Cambodia border, a region with a distressingly high number of potential test subjects.

The area is one of the most heavily mined in the world because of the Cambodian war, which began in the early 1970s and ended only with the final collapse of the Khmer Rouge in the late 1990s. Millions of land mines are still in the ground in Cambodia, and the border area is no exception: Even the Thai army laid them to prevent the conflict from spreading across the frontier.

Some amputees make do by fashioning a crude homemade prosthesis, but many are fitted with a device known as the solid ankle cushion heel (SACH), commonly used for amputations above the knee. While the SACH prosthesis is relatively cheap, a bonus for subsistence farmers, Mr. Gabourie said the design also causes fatigue. "Most SACH feet are not much more than rubber on a stick."

The Niagara Foot, however, with its inverted S-shaped heel design, provides a spring action that gives a push to propel the wearer forward when the foot contacts the ground.

Patients have reported less exhaustion and more comfort on the opposite limb during testing, which has been partly funded by the Department of National Defence's Canadian Centre for Mine Action Technologies.

The biggest complaint about the Niagara Foot has been its space-age design. Already stigmatized by the loss of a limb, some patients were distressed by the added burden of a strange plastic prosthesis. Researchers solved the problem by adding a life-like cover for the foot.

A larger concern is price. At $35, it is far more expensive than SACH feet, which cost about $5. However, Mr. Gabourie pointed out, SACH feet typically break and need to be replaced six to eight times a year, a frailty that undermines the foot's usefulness.

"When someone breaks one of the other replacement feet, they will usually keep it stored in the house and whittle a peg to hop around with," rather than travel to Aranyaprathet for a replacement, said Dave McCracken, a former Canadian military engineer who is now a technical adviser for the Thailand Mine Action Committee. "The Niagara Foot just keeps going and going."

Kamkem Thongdee, who lost his left leg after stepping on a land mine in 1979 and has tried the Niagara Foot, believes it will be eagerly adopted by other amputees.

"I had to make my first leg by myself. No one had help for me," the 46-year-old rice farmer said, proudly holding up a crude wooden device held together by chicken wire and rusty nails.

"With the new energy, I feel better. My wife is happy now that I can work. But many other people have the same problem. I hope that some day they will also be able to use it."