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ESAR + VSP appears to have 1999 [31] positive effect on energy cost, gait efficiency, and relative exercise intensity compared with SACH foot and ESAR during walking and running.
They concluded that subjects with amputation use a hip-extensor dominant strategy on the amputated side during stair ascent, and dynamic response (DR) feet (Flex Foot and Re-Flex VSP [Ossur Inc]) are advantageous over a SACH foot because they reduce the moments and power generation at the hip joint.
Later, the rubber foot, the forerunner of the SACH foot, came into use and eliminated the complicated articulated ankle of the Bly leg.