A PROPOSED NOMENCLATURE
FOR LIMB PROSTHETICS
This report reflects decisions made at two 1974
meetings of the Task Force on Standardization of
Prosthetic-Orthotic Terminology, one on Feb
ruary 21 at Rancho Los Amigos Hospital, Inc., in
Downey, California, and the other on July 9 at
the Rehabilitation Institute of Chicago, Illinois.
Jacquelin Perry, M.D., is the General Chairman
of the Task Force; Paul R. Meyer, Jr., M.D., and
Robert G. Thompson, M.D., were Acting Chair
men, respectively, at the two sessions under dis
cussion, which dealt primarily with prosthetics
matters. Present at both meetings were Task
Force members; liaison representatives from the
prosthetics education institutions; the American
Academy of Orthotists and Prosthetists; the
American Board for Certification in Orthotics
and Prosthetics, Inc.; the American Orthotic and
Prosthetic Association; and the Veterans Ad
ministration. A list of participants is appended to
this report.
T h e T a s k F o r c e o n S t a n d a r d i z a t i o n of
Prosthetic-Orthotic T e r m i n o l o g y , established by
the C o m m i t t e e o n Prosthetic-Orthotic E d u c a t i o n
( C P O E ) , N a t i o n a l A c a d e m y of S c i e n c e s
N a t i o n a l R e s e a r c h C o u n c i l , with J a c q u e l i n
Perry as C h a i r m a n met on J a n u a r y 2 1 , 1971. At
this initial meeting both H e r b e r t W . W a r b u r t o n ,
on behalf of the A m e r i c a n Orthotic and Prosthet
ic A s s o c i a t i o n A m e r i c a n B o a r d for Certifica
tion ( A O P A - A B C ) , and A n t h o n y Staros for t h e
V e t e r a n s Administration presented r e a s o n s for
the d e v e l o p m e n t of a standardized prosthetics
1Assistant Executive Director, Committees on
Prosthetics Research and Development and
Prosthetic-Orthotic Education (CPRD-CPOE), Na
tional Academy of Sciences, Washington, D.C. 20418.
H e c t o r W . Kay
and orthotics n o m e n c l a t u r e . S o m e of the n e e d s
advanced were:
T h e establishment of bases for prices of de
vices in c o n n e c t i o n with M e d i c a r e , Medicaid,
and similar p r o g r a m s . P r o p o s e d c o m p u t e r i z a t i o n
of g o v e r n m e n t billing information reinforced the
need in this area.
T h e elimination of p r o b l e m s resulting from
inconsistencies in n o m e n c l a t u r e as they affect
examinations for certification of prosthetists and
orthotists.
C o n s i s t e n c y in the use of orthotics t e r m s in
the field, in clinical and educational situations,
a n d in Volume 1 of the Orthopaedic Appliances
Atlas now being rewritten.
D e v e l o p m e n t of a glossary of prosthetics
and orthotics t e r m s in r e s p o n s e to a suggestion
made by the International Society for Prosthetics
and Orthotics (ISPO). T h e p r o p o s e d glossary
should lend itself to translation into o t h e r lan
guages, m a k e m a x i m u m use of Latin and G r e e k
t e r m s , and avoid " A m e r i c a n i s m s . "
Completion of a VA project to s t a n d a r d i z e
n o m e n c l a t u r e for preparation of c o n t r a c t s , for
control of statistical information, and for use in
coding, filing, and retrieving n u m e r o u s docu
ments and o t h e r types of literature stored by the
V e t e r a n s Administration.
T h e T a s k F o r c e has met on a continuing basis,
usually once or twice a year, and has m a d e major
progress in the a r e a of o r t h o t i c s n o m e n c l a t u r e .
As a result of the T a s k F o r c e ' s efforts a new set of
termsactually a c r o n y m s h a s been d e v e l o p e d ,
and this language is already being used exten
s i v e l y . T h e b a s i c p r i n c i p l e of t h e o r t h o t i c s
n o m e n c l a t u r e is essentially simple, being that of
categorizing o r t h o s e s by the joints they e n c o m
p a s s . T h u s , an " F O " (foot orthosis) is one which
pertains to the joints of the foot; an " A F O "
(ankle-foot orthosis) e n c o m p a s s e s the ankle as
well as the foot; and a " K A F O " (knee-ankle-foot
orthosis) spans the knee as well as the ankle and
foot, e t c . This new orthotics n o m e n c l a t u r e has
now been incorporated into technical analysis
forms for the u p p e r and lower limbs and the
spine; a prescription p r o c e d u r e ; and com
puterized billing p r o c e d u r e s . The n o m e n c l a t u r e
is also being included in the revision of Volume 1
of the Orthopaedic Appliances Atlas now in pro
c e s s , o n e of its applications being to provide a
basis for the description of orthotic c o m p o n e n t s
and s y s t e m s for the u p p e r limb, lower limb, and
spine. Cognizance of the new system is also t a k e n
in the revision of d e s c r i p t o r s , o r key w o r d s , for
the Winnipeg Information Retrieval S y s t e m . A
c o m p r e h e n s i v e report covering the applications
of the new orthotics n o m e n c l a t u r e is in prepara
tion and will be published in the near future.
Despite the m a r k e d progress m a d e with the
standardization of orthotics n o m e n c l a t u r e , very
little progress w a s m a d e with regard to the stan
dardization of prosthetics t e r m s . T h e reasons for
the lack of progress in t h e prosthetics a s p e c t of
the Task F o r c e ' s assignment probably w e r e :
P r o s t h e t i c s n o m e n c l a t u r e w a s m u c h less
confusing than was the c a s e in orthotics w h e n the

T A B L E I. AMPUTATION LEVELSUPPER LIMB

1To identify the level when the amputation was close to a joint, it was agreed that the epiphyseal growth plate or
scar would be the reference line, e.g., an amputation at or above the proximal humeral growth plate would be
"arm, complete"; one a little lower than this would be "arm, partial (or upper 1/3)."
2
" Partial arm" would be the new general term for above-elbow (AE); "partial forearm" for below-elbow (BE).
T a s k F o r c e began its meetings. T h u s , there has
been less incentive or urgency to c h a n g e the cur
rent terminology, which many people find quite
acceptable.
Following the success achieved in the revi
sion of the orthotics n o m e n c l a t u r e , an a t t e m p t
was m a d e to follow the same organizational pat
tern in prosthetics. It took two or t h r e e unpro
ductive trials t o convince the g r o u p that the ap
proach used in orthotics was not applicable to
prosthetics.
C o n v e r s e l y , n u m e r o u s individuals c o n t i n u e d
to be disturbed by the fact that such terms as
Fig. 1. An Arm, complete amputation (shoulder dis
articulation).
" k n e e disarticulation," " k n e e exarticulation,"
"through knee," "Gritti-Stokes," and
" S t o k e s - G r i t t i " were all applied to a m p u t a t i o n s
which were or appeared to be essentially the
same from a functional standpoint. M o r e o v e r ,
the needs of the V e t e r a n s Administration and
other purchasers of prosthetic devices and ser
vices for a n o m e n c l a t u r e which described c o m
ponents in functional t e r m s rather than brand
n a m e s continued to exist, and so the search for a
standardized prosthetics nomenclature con
tinued.
At t h e F e b r u a r y 1974 meeting of the g r o u p a
Fig. 2. An Fo, complete amputation (elbow disarticu
lation).
fresh a p p r o a c h to the problem w a s m a d e along
two lines:
Amputation Levels and Prosthesis T y p e s
Here the incentive was a report on a new ter
minology for the classification of congenital limb
deficiencies developed at an international work
s h o p held in D u n d e e , S c o t l a n d , in J u n e 1973. It
a p p e a r e d likely that this new terminology would
be a c c e p t e d internationally. In the new s y s t e m
for the classification of limb deficiencies, all de
fects were classified u n d e r one or two major
Fig. 3. A Ca, complete amputation (wrist disarticula
tion).
categoriestransverse or longitudinal. The
t r a n s v e r s e deficiencies present as amputation
like s t u m p s , and prosthetics m a n a g e m e n t is e s
sentially the same as with surgical a m p u t a t i o n s
deriving from t r a u m a or disease. After extensive
consideration and discussion, therefore, the T a s k
Force decided to adopt the n o m e n c l a t u r e for
t r a n s v e r s e congenital defects in designating am
putation levels for non-congenital a m p u t a t i o n s .
T h e present report describes this p r o p o s e d new
n o m e n c l a t u r e . It has been designated as Part I of
the T a s k F o r c e ' s r e c o m m e n d a t i o n s on prosthet
ics n o m e n c l a t u r e .
Fig. 4. An Arm, partial or upper 1/3 amputation
(short above-elbow).
 T e r m i n o l o g y of P r o s t h e t i c Components
Based o n Function
H e r e the T a s k F o r c e simply took each c o m p o
nent of a p r o s t h e s i s s o c k e t , knee joint, ankle
joint, e t c . a n d a t t e m p t e d to classify each in
functional yet relatively simple t e r m s . T h e out
c o m e of this work is being written up as Part II of
the T a s k F o r c e ' s prosthetics report.
T h e e s s e n c e of the new s y s t e m for naming
t r a n s v e r s e congenital deficiencies or surgical
a m p u t a t i o n s is that the n a m e designates the level
at which the limb terminates (or the most proxi
Fig. 5. An F o , partial or lower 1/3 amputation (long
below-elbow).
mal segment that is missing). It is u n d e r s t o o d that
all elements distal to the level n a m e d are also
a b s e n t . F o r e x a m p l e , a short below-elbow a m p u
tation would be identified as a " f o r e a r m , upper
1/3." An elbow disarticulation or through-elbow
a m p u t a t i o n would be n a m e d " f o r e a r m , c o m
plete," thus indicating the most proximal missing
portion (Table 1 and Figs. 1-5).
T h e n e w terminology for lower-limb amputa
tions (with a b b r e v i a t i o n s ) and the equivalent
levels in current terms as s h o w n in Table II and
illustrated in Figures 6-10 are in conformity with
the format previously presented for u p p e r limbs.
Fig. 6. A Th, complete amputation (hip disarticula
tion).
 TABLE II. AMPUTATION LEVELSLOWER LIMB

1When the amputation was close to a joint, the epiphyseal growth plate or scar would be the reference line, e.g.,
an amputation just above the level of the distal femoral growth scar would be "Th, partial (or lower 1/3)"; one at the
scar or between the scar and joint would be "leg, complete."
2
"Partial thigh" would be the new general term for above-knee (AK); and "partial leg" for below knee (BK).
 PROSTHETICS TYPES NEXT STEPS

During the c o u r s e of the discussion on nomen
clature to describe amputation levels, it b e c a m e
a p p a r e n t that t h e same n o m e n c l a t u r e should be
used to identify the prostheses which would be
fitted to these levels. F o r e x a m p l e , a c o m p l e t e leg
prosthesis would be fitted to a " l e g , c o m p l e t e "
(or k n e e disarticulation) a m p u t a t i o n (Figs.
11-13).
AMPUTATION LEVELS
Following adoption of the new n o m e n c l a t u r e
to d e s i g n a t e a m p u t a t i o n levels a n d t y p e s of
p r o s t h e s e s , the T a s k F o r c e m a d e three additional
recommendations:
T h a t an article describing the new n o m e n
clature be d e v e l o p e d for possible publication in
3
Orthotics and Prosthetics and o t h e r j o u r n a l s .

Fig. 7. A Leg, complete amputation (knee disarticu Fig. 8. A Ta, complete amputation (ankle disarticula-
lation).

3
This document was prepared in response to this
request.
 That from six to ten prosthetics facilities FUNCTIONAL DESCRIPTIONS
with large case loads be a s k e d to field-test the
Similarly it was r e c o m m e n d e d that the T a s k
new prosthetics n o m e n c l a t u r e . (This r e c o m m e n
F o r c e ' s work on the functional description of
dation is now being implemented and the results
prosthetic c o m p o n e n t s be written for publica
will be reported at a later date.)
tion, field-tested, and referred to the ISPO S u b
T h a t the article describing the new n o m e n
c o m m i t t e e on O r t h o t i c s and P r o s t h e t i c s
c l a t u r e for a m p u t a t i o n levels and p r o s t h e s i s
N o m e n c l a t u r e . Implementation of these recom
types (and the results of the field study when
mendations is now under way (see the following
available) be transmitted to the International Soc
article by E . E . Harris).
iety for Prosthetics and Orthotics for considera
tion by that b o d y ' s S u b c o m m i t t e e on Orthotics
and Prosthetics N o m e n c l a t u r e at its meeting in SUMMARY
O c t o b e r 1974. In the c o u r s e of t w o meetings held in 1974, the
T a s k F o r c e on Standardization of Prosthetic-
Orthotic Terminology of C P R D - C P O E e n d o r s e d
a new prosthetics n o m e n c l a t u r e to designate 1)

Fig. 9. A Th, partial or middle 1/3 amputation Fig. 10. A Leg, partial or upper 1/3 amputation (short
(medium above-knee). below-knee).
a m p u t a t i o n l e v e l s . 2) p r o s t h e s i s t y p e s , a n d 3) t h e
functional description of c o m p o n e n t s .
In t h e f i r s t t w o c a t e g o r i e s t h e n e w n o m e n c l a
t u r e ( a s d e s c r i b e d in t h i s r e p o r t ) is e s s e n t i a l l y
identical with the terminology d e v e l o p e d by the
ISPO Subcommittee on N o m e n c l a t u r e and Clas
s i f i c a t i o n in C o n g e n i t a l L i m b D e f i c i e n c y f o r t h e
classification of c h i l d r e n ' s t r a n s v e r s e congenital
deficiencies. The recommended new nomencla
t u r e is b e i n g f i e l d - t e s t e d in s e l e c t e d f a c i l i t i e s in
North America.
A detailed report on the T a s k F o r c e ' s recom
m e n d a t i o n s concerning the functional descrip
tion of p r o s t h e t i c c o m p o n e n t s has b e e n p r e p a r e d
a n d is p u b l i s h e d in t h i s i s s u e o f Orthotics and
Prosthetics.

Fig. 12. A T a r s a l , c o m p l e t e , p r o s t h e s i s for a c o m p l e t e

tarsal a m p u t a t i o n .

Fig. 11. A L e g , c o m p l e t e , prosthesis for a c o m p l e t e leg Fig. 13. A Thigh, middle 1/3, prosthesis for a middle
amputation. 1/3 thigh a m p u t a t i o n .
 ACKNOWLEDGMENTS
T h e T a s k F o r c e w a s initially established by the
C o m m i t t e e on P r o s t h e t i c - O r t h o t i c E d u c a t i o n
( C P O E ) , and is now jointly s p o n s o r e d by C P O E
and the C o m m i t t e e on Prosthetics R e s e a r c h and
Development (CPRD). The joint committees
c o n d u c t their activities u n d e r C o n t r a c t V101
(134) P-75 b e t w e e n t h e V e t e r a n s Administration
and the National A c a d e m y of Sciences, and Con
tract N o . S R S 72-6 b e t w e e n the Social and R e
habilitation Service, D e p a r t m e n t of Health, E d u
cation, and Welfare, and t h e National A c a d e m y
of Sciences.
A p p r e c i a t i o n is e x p r e s s e d to M r s . J u n e D .
N e w m a n , C P R D - C P O E staff, for her valuable
assistance in t h e preparation of this report.
LITERATURE CITED
1. American Academy of Orthopaedic Surgeons,
Orthopaedic Appliances Atlas, Vol.1, J. W. Edwards,
Ann Arbor, Mich., 1952.
2. Committee on Prosthetic-Orthotic Education,
Report of First Workshop-Standardization of Prosthet
ic and Orthotic Terminology. Dallas, Texas, March
28-30, 1971, National Academy of Sciences.
3. Committee on Prosthetic-Orthotic Education,
Report on Second Workshop-Task Force on Standar
dization of Prosthetic-Orthotic Terminology. Washing
ton, D . C , September9-11, 1971, National Academy of
Sciences.
4. Harris, E . E . , A new orthotics terminology: a
guide to its use for prescription and fee schedules. Orth.
and Pros. 27:2:6-19, June 1973.
5. Kay, Hector W., When information is needed.
Inter-Clinic Inform. Bull. 13:3, December 1973.
6. McCollough, Newton C , III, Charles M. Fryer,
and John Glancy, A new approach to patient analysis
for orthotic prescriptionpart I: the lower extremity.
Artif. Limbs 14:2:68-80, Autumn 1970.
7. Working G r o u p , International Society for
Prosthetics and Orthotics, A proposed international
terminology for the classification of congenital limb
deficiencies, (prepared by Hector W. Kay). Orth. and
Pros. 28:2:33-48, June 1974.
PARTICIPANTS
(In one or both of the 1974 Meetings of the Task Force
Nelson, Peter J., Project Engineer, Library,
on Standardization of Prosthetic-Orthotic Terminol
Prosthetic-Orthotic Research and Development
ogy.) Unit, Health Sciences Centre, Winnipeg, Canada.
Perry, Jacquelin, M.D. (Chairman), Chief, Research Peizer, Edward, Ph. D., Assistant Director, Veterans
and Development Group, Kinesiology Service, Rancho Los Amigos
Administration
Prosthetics
York.
Meyer, Paul R., Jr. M.D.. (Acting Chairman), Assistant
Professor of Orthopaedic Surgery, Northwestern
University Medical School, Chicago, Illinois.
Thompson, Robert G., M.D. (Acting Chairman), As
sociate Professor of Orthopaedic Surgery, North
western University Medical School, Chicago, Il
linois.
Billock, John N., Research Prosthetist, Prosthetic Re
search L a b o r a t o r y , N o r t h w e s t e r n University
Prosthetic-Orthotic Center, Chicago, Illinois.
Bray, John J., Director, Training Program in
Prosthetics-Orthotics Education, University of
California at Los Angeles Rehabilitation Center, Los
Angeles, California.
Compere, Clinton L., M.D., Program Chairman,
N o r t h w e s t e r n University Prosthetic-Orthotic
Center, and Professor of Orthopaedic Surgery,
Northwestern University Medical School, Chicago,
Illinois.
Cortright, Everett S., Staff Assistant, Prosthetics Re
search and Development, Department of Medicine
and Surgery, Veterans Administration, Washington,
D.C.
Fannin, Robert E., Columbus Orthopaedic Appliance
Co., Columbus, Ohio.
Fryer, Charles M., Director, Prosthetic-Orthotic
Center, Northwestern University Medical School,
Chicago, Illinois.
Harris, E.E., M.R.C.S., Staff Surgeon, Committees on
Prosthetics Research and Development and
Prosthetic-Orthotic Education (CPRD-CPOE), Na
tional Research Council, Washington, D . C .
Hayes, Robert F., President, Starkey Artificial Limb
Co., Inc., West Springfield, Massachusetts.
Kay, Hector W., Assistant Executive Director, Com
mittees on Prosthetics Research and Development
and Prosthetic-Orthotic Education (CPRD-CPOE),
National Research Council, Washington, D . C .
Kolanowski, Stanley J., Technical Information
Specialist, Research Center for Prosthetics, Veter
ans Administration, New York, New York.
Lewis, Earl A., Assistant Director, Research Center
for Prosthetics, Veterans Administration, New
York, New York.
McCollough, Newton C , III, M.D., Director of Re
habilitation, Department of Orthopaedics and Re
habilitation, University of Miami School of
Medicine, Miami, Florida.
Murphy, Eugene F., Ph. D., Director, Research Center
for Prosthetics, Veterans Administration, New
York, New York.
Hospital,
Inc., Downey,
Center, California.
New York, New
Pellicore, Raymond, M.D., Clinical Assistant Profes
sor of Orthopaedic Surgery, Abraham Lincoln
School of Medicine, University of Illinois, Chicago,
Illinois.
Simons, Bernard C , Director, Prosthetics and Orthot
ics Division, Rehabilitation Medicine, University
Hospital, University of Washington, Seattle,
Washington.
Snell, Ralph R., Snell's Limbs and Braces, Memphis,
Tennessee.
Springer, Warren, Assistant Coordinator, Prosthetics
and Orthotics, New York University Post-Graduate
Medical School, New York, New York.
Staros, Anthony, Director, Veterans Administration
Prosthetics Center, New York, New York.
Storrs, Ralph A., General Manager, Pope Brace Com
pany, Kankakee, Illinois.
Zettl, Joseph H., Director, Prosthetics Research
Study, University of Washington, Seattle, Washing
ton.