Researchers, charities and prosthetics professionals have proposed new standards for assessing used prosthetic feet before they are donated to low- and middle-income countries, in a move that could improve device quality and reduce waste in global prosthetic provision.
The work, led by King’s College London, focused on the donation of lower-limb prosthetic feet from countries such as the UK, France and the US for use in settings including Uganda. The research team developed a structured visual quality checklist to help determine whether donated prosthetic feet were safe and suitable for reuse. According to the report, the introduction of these checks reduced unusable donated prosthetic feet from 16% to 5%.
For the global O&P community, this is an important development. It addresses a long-standing ethical problem in medical donation: devices that are not suitable for use in high-income countries should not automatically be treated as acceptable for patients in the Global South.
Prosthetic components may be replaced because of warranty rules, routine maintenance, patient changes or prescription updates, even when they are still functional. In systems such as the NHS, these components are often treated as single-patient multi-use devices and may not be reused for another patient locally. As a result, “like new” prosthetic components can be discarded rather than redeployed.
This creates both a waste problem and a donation opportunity. Charities have worked for years to rescue high-quality components from landfill and redirect them to people who need prosthetic care. However, without clear standards, donation systems risk sending damaged, degraded or unsuitable components into settings that already face limited clinical resources.
The research highlights examples of feet becoming unusable through polymer degradation, cracks, discoloration, excessive flexibility or sticky degraded surfaces. These issues may not always be obvious without a structured inspection process.
The key lesson from the study is that prosthetic donation must be governed by quality, not simply generosity.
The research team developed inspection guidelines covering the mechanical integrity and cosmetic condition of prosthetic feet. In a sample of 366 donated prosthetic feet, those processed after the checklist was introduced were 94% usable, compared with 83% usable before the checklist.
That improvement matters. For a patient receiving a donated prosthetic foot, quality is not a secondary issue. A poor-quality component can affect safety, gait, confidence, durability and clinical outcomes. For local CPOs, receiving unusable components also creates extra workload and contributes to the “medical equipment graveyard” problem.
The prosthetics charity STAND, formerly Legs4Africa, was a key partner in the project. Its CEO, Tom Williams OBE, said the charity has rescued more than 67 tons of high-quality prosthetic components from landfill and supported almost 6,000 people with limb differences to walk again.
This shows the value of responsible reuse when it is properly managed. Prosthetic recycling can reduce waste, lower costs and expand access, but it must be linked to clinical judgement, quality checks, local fitting expertise and ethical donation principles.
For CPOs across India, the Middle East and Africa, the article raises a practical question: how can donation systems support local rehabilitation without undermining quality standards?
Used prosthetic components can be valuable in many low-resource settings, especially where patients cannot afford new components or where supply chains are limited. But donations should never become a way to export waste. A donated prosthetic foot must be clinically appropriate, mechanically sound and suitable for the user’s environment.
For IMEA clinics and NGOs, responsible donation pathways should include:
The study also points toward a wider opportunity: a circular economy for prosthetics. Instead of discarding components that are still usable, health systems could develop safe processes for testing, grading and redirecting devices.
The authors suggest that future systems may include MOT-style tests for second-hand prosthetic components. This could support better donation quality internationally and help health systems reduce unnecessary production, waste and cost.
For the NHS, this is also linked to sustainability. The article notes that the NHS has legally binding targets to reduce its carbon footprint by 80% by 2032 and reach net zero by 2040, making waste reduction in clinical services increasingly important.
For IMEA CPO, the message is clear: prosthetic reuse can be ethical, sustainable and clinically valuable, but only when standards come first.
The old model of sending surplus equipment without rigorous assessment is no longer acceptable. Patients in Uganda, India, Nigeria, Yemen, Palestine or any other lower-resource setting deserve the same respect for safety and quality as patients in Europe or North America.
The future should not be “good enough for donation.” It should be “safe, suitable and clinically appropriate for reuse.”
If adopted widely, standards for used prosthetic feet could help reduce waste, support responsible donation, strengthen local prosthetic services and ensure that donated devices improve lives rather than create new burdens.