Ch 6 - Prosthetic and Orthotics: Complications and Gait Deviations Flashcards
What is Follicullitis?
Hair root infection resulting from poor hygiene, sweating, poor socket fit, or pistoning
How should Follicullitis be treated?
Antiseptic cleanser
Oral antibiotics
How should boils and abscesses be treated?
Limited prosthetic use
I&D
Oral antibiotics
What causes epidermoid cysts?
Sebaceous glands are plugged by keratin
What causes Choke syndrome?
Proximal prosthetic socket being too tight and lack of total contact between residual limb and the socket leads to impairment of venous return
What is seen on exam in acute Choke syndrome?
Well-circumscribed indurated area
Weeping/blistering of the skin
Tender to palpation
Prone to cellulitis
What is seen on exam in Chronic Choke syndrome?
Skin becomes thickened and hyperpigmented due to hemosiderin accumulation
What is the treatment of Choke syndrome?
Relieve proximal constriction
Reduce # of socks
Modify distal end pad
New total contact socket
What is Verrucous hyperplasia?
Wartlike skin overgrowth from inadequate socket wall contact with subsequent edema formation
How much is gait speed decreased with a Symes amputation?
32%
What causes increased knee flexion at initial contact?
- ↑ Ankle dorsiflexion
- Excessive anterior displacement of the socket over the foot
- Excessive posterior displacement of the foot in relation to the socket
- Too hard heel cushion
- Knee flexion contracture
What causes increased knee extension at initial contact?
- ↑ Ankle plantar flexion
- Excessive posterior displacement of the socket over the foot
- Excessive anterior displacement of the foot in relation to the socket
- Too soft heel cushion
- Quad weakness
What causes Delayed, abrupt, and limited knee flexion after heel-strike in a Transtibial amputee?
Heel wedge is too soft
Foot is too far anterior
What causes Extended knee throughout stance phase in a Transtibial amputee?
Too much plantar flexion
What causes the toes to stay off the floor after heel-strike in a Transtibial amputee?
Heel wedge too stiff
Foot too anterior
Too much dorsiflexion
What causes “Hill-climbing” sensation toward end of stance phase in a Transtibial amputee?
Foot too anterior
Too much plantar flexion
What causes High pressure against patella throughout most of stance phase in a Transtibial amputee?
Too much plantar flexion
What causes the knee to be too forcefully and rapidly flexed after heel strike or high pressure against anterodistal tibia at heel-strike in a Transtibial amputee?
Heel wedge too stiff
Foot too far posterior
Foot too dorsiflexed
What causes Hips level, but prosthesis seems short in a Transtibial amputee?
Foot too far posterior
Foot too dorsiflexed
What causes Drop-off at end of stance phase in a Transtibial amputee?
Foot too far posterior
What causes Toe off of floor as patient stands or knee flexed too much in a Transtibial amputee?
Foot too dorsiflexed
What causes valgus knee during stance phase, pressure on distal medial limb and proximal lateral surface of knee in a Transtibial amputee?
Foot too outset
What causes varus knee during stance phase, pressure on lateral distal limb knee in a Transtibial amputee?
Mediolateral dimension of socket too large
Foot too inset
What causes Lateral bending of trunk in a Transfemoral amputee?
- Prosthesis too short
- High medial wall
- Prosthesis in abduction causing wide-based gait
What causes Abducted gait in a Transfemoral amputee?
- Prosthesis too long
- Too much adduction
- High medial wall
- Improperly shaped lateral wall
- Pelvic band may be positioned too far away from patient’s body
What causes Circumducted gait in a Transfemoral amputee?
- Prosthesis too long
* Prosthesis too much alignment stability or friction in knee, making it difficult to bend knee in swing-through
What causes Vaulting gait in a Transfemoral amputee?
- Prosthesis too long
- Socket suspension inadequate
- Excessive stability in alignment or some limitation of knee flexion
What causes Medial whip in a Transfemoral amputee?
Excessive external rotation of knee
What causes Lateral whip in a Transfemoral amputee?
Excessive internal rotation of knee
What causes Foot rotation at heel strike in a Transfemoral amputee?
Too hard heel cushion or plantar flexion bumper
What causes Foot slap in a Transfemoral amputee?
Plantar flexion bumper is too soft
What causes Uneven heel rise in a Transfemoral amputee?
- Knee joint may have insufficient friction
* Extension aid may be inadequate
What causes Terminal swing impact in a Transfemoral amputee?
- Knee friction is insufficient
* Knee extension aid may be too strong
What causes Uneven step length in a Transfemoral amputee?
- Insufficient socket flexion
* Insufficient friction at the prosthetic knee or too loose an extension aid
What causes Exaggerated lordosis in a Transfemoral amputee?
- Insufficient socket flexion
* Insufficient support from the anterior socket brim
What causes Instability of the prosthetic knee in a Transfemoral amputee?
- Knee too far ahead of trochanter-knee-ankle (TKA) line
- Socket w/ excess flexion
- Plantar flexion resistance
- Failure to limit dorsiflexion
What causes Drop-off at end of stance phase in a Transfemoral amputee?
- Limitation of dorsiflexion of prosthetic foot
- Heel of SACH-type too short
- Toe break of a conventional foot too far posterior
- Socket too far anterior to foot
How often will pediatric amputees need prosthesis or sockets replaced?
<5 yo: yearly
5-12 yo: 18 mo
12-21 yo: ~2 years
In which amputation population is bony overgrowth MC seen?
Acquired amputations in children more than in adults
