People with lower-limb amputation in low- and middle-income countries (LMICs) lack access to adequate prosthetic devices that would restore their mobility and increase their quality of life. This is largely due to the cost and durability of existing devices. Single-keel energy storing and return (ESR) prosthetic feet have recently been developed using the lower leg trajectory error (LLTE) design framework to provide improved walking benefits at an affordable cost in LMICs. The LLTE framework optimizes the stiffness and geometry of a user's prosthesis to match a target walking pattern by minimizing the LLTE value, a measure of how closely a prosthetic foot replicates a target walking pattern. However, these low-cost single-keel prostheses do not provide the required durability to fulfill international standards organization (ISO) testing, preventing their widespread use and adoption. Here, we developed a multi-keel foot parametric model, and extended the LLTE framework to include the multi-keel architecture and durability requirements. Multi-keel designs were shown to provide 76% lower LLTE values, compared with single-keel designs while withstanding ISO fatigue and static tests, validating their durability. Given their single-part 2D extruded geometries, multi-keel feet designed with the extended LLTE framework could be cost-effectively manufactured, providing affordable and durable high-performance prostheses that improve the mobility of LMIC users.

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