Prosthetic devices have a long and rich history going from peg legs to complex systems we have today. The first examples of prosthetics and amputation are found by the ancient Egyptians. The ancient Egyptians believed that if a person was amputated in life, it would carry on into the after-life, which made amputation seem worse than death itself. To aid the deceased in the after-life, the ancient Egyptians would bury them with their missing counterparts that were preserved or with a prosthetic device. The earliest example of the prosthetic was uncovered and dated back to the fifteenth century B.C.E.[1] with a “beautifully carved wooden toe prosthesis.”[2] There is also written evidence from a sacred Indian poem dated between 3500 and 1800 B.C.E. The piece tells the story of Warrior-Queen Vishpla, “who lost her leg in battle and was fitted with a prosthesis fabricated in iron to enable her to return to battle.”[3]

Prosthetics history is more apparent in the Greek and Roman civilizations in both writing and archeological evidence. In Herodotus’ historical writings he describes an event in 484 B.C.E. where a Persian soldier escaped from the Greek prison by amputating his leg and later replacing it with a wooden prosthesis.[4] Archeological evidence from this time period includes the Roman Capula Leg from about 300 B.C.E., the time of the Second and Third Samnite Wars, made from copper and wood (Fig. 1). Unfortunately, the Capula leg was burned when the Museum of the Royal College of Surgeons was bombed in World War II.[5]

[1] Roman Capula Leg

The Dark Ages were a relatively slow-period for prosthetic technology, and scientific technology in general. The devices were large and heavy, made of wood, metal, and leather peg legs that remained strikingly similar to those of the Roman and Greek times. Amputees also used early crutches made of wood and leather.[6] Limbs were designed mainly by blacksmiths who built knight’s armor. Blacksmiths designed the devices to look like armor to disguise the knight’s handicap and not as an everyday functioning limb. With the Dark Ages also came more disease cured only by amputation and the use of cannons and gunpowder that greatly changed bodily injuries.[7]

The Renaissance was a period of scientific exploration, which included an increased amount of painful and often deadly amputation surgeries before the advent of anesthesia. If the amputee survived, he or she would be provided with Ambroise Pare’s Leg. Pare lived from 1510 to 1590 and served in the French Army as a master surgeon for Henry II, Francis II, Charles IX, and Henry III. Among his accomplishments is “revolutionizing the management of wounds” from the campaign for Piedmont in 1537 to the battle of Saint-Barthelemy in 1572.[8] He reintroduced linen ligatures, originally used by Hippocrates, and located preferred sites of amputation.[9] He also was an innovator eager to try new techniques. Because of his desire, he designed prosthetics from head to foot, literally artificial eyes to legs.[10] His above-knee prosthetic device included a kneeling peg and a prosthetic foot in a fixed position and a suspension harness, which are still used today, to an extent (Fig. 2). Pare’s Leg was not a preferred prosthetic due to its unwieldy weight and unrealistic price.

[2] Pare’s Leg

The next major prosthetic advancement came with Pieter Andriannszoon Verduyn’s published writing Dissertation epistolaris de nova artuum decur tandorum ratione.[11] In his work, he introduced the first non-locking lower-limb prosthetic device. The Verduyn, sometimes spelled Verduuin, Leg consists of external hinges, wooden foot, and a leather cuff with a copper outer shell to hold the weight of the wearer.[12] In 1674, French Army Surgeon Etienne Morel introduced the tourniquet, which popularized life-saving amputation surgery in Europe and increased the need for artificial limbs. The Verduyn leg fulfilled the needs of many amputees. The leg seemingly disappeared until a surgeon reintroduced it in 1826 and the Verduyn leg remained popular until the 1960’s, with some slight modifications along the way.[13]

[3] Verduyn leg

The nineteenth century brought innovation to prosthetic devices. The Anglesey Leg was invented by London’s James Potts in 1800 and patented in 1805 (Fig. 4). The prosthetic was named after the brave Henry William, Lord Paget, the second Earl of Uxbridge, and the first Earl of Anglesey, who was shot and immediately had his leg amputated, without anesthetics, at the Battle of Waterloo. James Potts fitted his prosthetic leg consisting of a wooden shaft and socket, steel knee joint, and an articulated foot with artificial cords or catgut tendons that connected knee flexion with foot flexion. The tendon system caused the first incorporation of dorsiflextion and plantar flexion of the foot with accordance to knee movement, an aspect of prosthetic feet production that is used and desirable today.[14] The Anglesey Leg technology was transferred to the United States of America by William Selpho in 1839 and it was renamed the American Leg. During the Civil War, J.E. Hanger (a veteran amputee) and other American prosthetists modified Pott’s invention by replacing the tendons or cords with rubber bumpers on both sides of the ankle joint, a technique used in many articulated prosthetic feet today.[15]

[4] Anglesey or American Leg

In 1858, Doctor Douglas Bly of Rochester, New York invented and patented a prosthetic leg with an articulated ankle made of an ivory ball in a vulcanized rubber socket. The articulated ankle allowed for inversion and eversion, the movement that brings the sole of the foot inward and outward.[16] Dr. Bly admitted that his prosthetic leg had its flaws when compared to an anatomical leg: “Though the perfection of my anatomical leg is truly wonderful, I do not want every awkward, big fatted or gamble-shanked person who always strided of shuffled along in a slouching manner with both his natural legs to think that one of these must necessarily transform him or his movements into specimens of symmetry or beauty as if by magic.”[17]

The American Civil War (1861-1865) produced about 30,000 amputees, thus creating a lot of demand for prosthetic devices. Also, the federal and state government agreed to pay for prosthetic devices for war veterans in hope they can return to an independent life, which added competition into the prosthetic limb market.[18] Radical claims were made by inventors and manufacturers about new developments to attract government contracts.[19] Even with the demand and “new” claims, there were little prosthetic improvements past the modifications on the Anglesey “American” Leg and Dr. Bly’s Leg. At the same time, surgical techniques, medicines, and procedures improved greatly, as well as treatment and development of amputation stumps.[20]

World War I and the Great Depression did not yield much advancement in prosthetic technology. In Europe, prosthetists were seen as “ambulance chasers” unconcerned with the needs of their patient, but interested in self-promotion and greed. This pushed surgeons away from business with most prosthetists.[21] An interesting turning point in the field of prosthetics occurred in the 1920’s when a surgeon and prosthetists duo, Thomas and Haddan, proposed that prosthetists and physicians should work together to create and fit artificial limbs. Also, in World War I, the American amputation casualties reached 4,403, which is incomparable to the European 100,000 with 42,000 of those being British.[22] As a result, the American Orthotic and Prosthetic Association was formed to aid the American amputees, address medical ethics, increase relations between all medical professionals, educational programs, and to advance prosthetic technology.

Physically, the introduction of lightweight materials during this time, such as aluminum, lessened the weight of the prosthetic but did not affect the design. The design appeared like the Anglesey Leg and the weight of the wearer and various impact forces were pressed onto an inflexible and solid outer shell. The weight and force distribution made the prosthetic leg painful to the amputation site leaving bruises or irritation.[23]

In the beginning and middle of American entrance into World War II, the United States lagged behind in prosthetic technology when compared to Europe. Prosthetics remained basically unchanged for more than a century. In response, Surgeon General Normal Kirk sent a request to the National Academy of Sciences to evaluate and improve the prosthetic field. The investigations lead to technology and personnel transfer from Europe to the United States, but no significant innovations.[24]

Large prosthetic improvements occurred with the large number of amputee veterans from both World Wars, government funding, influx of research, and material innovation. In the time between 1945 and the 1960s prosthetic devices varied greatly while scientists experimented, veterans added input, and industries manufactured artificial materials.[25]

In 1956, the SACH foot, the most recent antecedent and competition to the Seattle Foot, was invented at the University of California.