Chapter 3

Question 1

For TT patient, WB on pressure tolerant areas. What are those areas?

Answer 1

patellar tendon,
pretibials
posterior distal aspect of the stump (gastrocs)
popliteal fossa, lateral fibula (not fibular head) and the tibial flares.

Question 2

PTB total contact sockets help to do what?

Answer 2

1. Ensure good venous return

2. Help prevent distal pooling

Question 3

Why is the foot 1/2” medial to center of the socket in bench alingment?

Answer 3

brings them to a normal amount of varus at the knee

Question 4

Why must valgus at the knee not occur?

Answer 4

This to ensure that there are minimal forces on the popliteal nerve as it courses behind the fibular head.

Question 5

Why is the knee flexed to about 5 degrees in the socket?

Answer 5

enhanced patellar tendon weight bearing

decrease lumbar lordosis

Question 6

If the socket is too far anterior (foot too far posterior), where will there be excessive pressures?

Answer 6

anterodistal and posteroproximal pressures

Question 7

If the socket is too far posterior (foot too far anterior), what will occur at the knee?

Answer 7

hyperextension = knee instability

Question 8

What will the head, arms, and trunk do for foot stability during stance phase of gait?

Answer 8

Move the body over the foot for stability

Question 9

If the foot is too far anterior (socket too far posterior), where will there be excessive pressures?

Answer 9

anteroproximal and posterior distal pressures

Question 10

Where is breakdown more common in a TF amputee?

Answer 10

groin, hamstring tendons, adductor longus tendon

Question 11

If you see heal strike into midstance and flexion, what direction should you move the foot?

Answer 11

More anterior

Question 12

If you see hyperextension through gait stance, what direction should you move the foot?

Answer 12

posterior

Question 13

What is TT foot outset? How do you correct it?

Answer 13

1. Foot too far lateral - pressure at lateral proximal and medial distal areas
2. Correction: translation medially of the foot, laterally of the residual limb

Question 14

What is TT foot inset? How do you correct it?

Answer 14

1. Foot too far medial - Pressure proximal medial and pressure distal laterally
2. Correction: slide foot more lateral or socket more medial

Question 15

What type of stability is the most important for a TF amputee?

Answer 15

Knee stability

Question 16

Minimize rotation of the prosthesis for a TF amputee by doing what 3 things?

Answer 16

1. maintain pelvis in a posterior tilt on the posterior rim
2. incorporate ischial/gluteal weightbearing/ containment
3. the adductor longus tendon is secured in a groove in the socket

Question 17

Without a good lateral wall support, what type of gait will you see for a TF amputee?

Answer 17

likely ambulate with a trendelenburg-type gait and expend significantly more energy

Question 18

TF socket designed to do what 3 things for good lateral wall support?

Answer 18

1. provide abductor contact with socket
2. provide points of force in a proximomedial direction and distolateral direction to prevent lateral shifting of the prosthesis
3. place the center of the heel under or slightly lateral to the ischial tuberosity to promote a slight valgus at the hip for increased stability

Question 19

If the foot is placed too far medially, where will there be excessive pressure?

Answer 19

in the groin and distal lateral aspect of the residuum.

Question 20

Alignment of a TF amputee in the sagittal planes helps ensure what?

Answer 20

helps to ensure that the knee will not buckle during stance phase and weight bearing

Question 21

5 degrees of flexion (floor reaction force anterior to knee joint) is built into TF amputees the do what 2 things?

Answer 21

1. enhance the firing of the gluteal muscles

2. allow the person to extend the hip without having to go into a hyperlordotic posture

Question 22

If the foot is placed too far laterally, where will there be excessive pressure?

Answer 22

excessive pressure proximolateral and distomedial

Question 23

What basic fit principles are you looking for in a static checkout?

Answer 23

1. Soles of feet flat (no dorsi or plantar flexion)
2. Socket fit well (put playdough into socket and make sure they make full contact so there is no edema)
3. User comfortable
4. Is suspension adequate
5. Are bony landmarks level
6. Vertical pylon in stance
7. Are tissue rolls minimal
8. Gapping between leg and socket
9. Does residuum have distal contact
10. Normal heel center spacing (2-4 in quiet stance)
11. Is knee stable in stance