Gait Deviations

Question 1

Circumducted Gait

Answer 1

Prosthesis swings laterally in a wide area during swing phase

Question 2

Prosthetic Causes: Circumducted Gait

Answer 2

Prosthesis is too long

Too much alignment stability/friction in the knee making it difficult to bend knee in swing through

Question 3

Patient Causes: Circumducted Gait

Answer 3

Abduction contracture
lack of confidence to flex prosthetic b/c muscle weakness or fear of stubbing toe
Habit

Question 4

Vaulting

Answer 4

Rising on the toe of the sound foot to swing prosthesis through with little knee flexion.

Question 5

Prosthetic Causes: Vaulting

Answer 5

Prosthesis is too long
Inadequate socket suspension
Excessive stability in the alignment or another limitation in knee flexion like knee lock or strong extension aid.

Question 6

Patient Causes: Vaulting

Answer 6

Fairly frequent habit pattern
Fear of stubbing toe
Discomfort in residual limb

Question 7

Rotation of prosthesis upon heel strike

Answer 7

Prosthesis rotates on initial contact

Question 8

Prosthetic Causes: Rotation on heel strike

Answer 8

Too much resistance to PF by PF bumper/heel wedge
Too much toe out built into prosthesis
Socket too loose

Question 9

Patient Causes: Rotation on heel strike

Answer 9

Extend residual limb too vigorously at heel strike (kick too hard into extension)
Poor muscle control of residual limb

Question 10

Uneven arm swing

Answer 10

Arm on prosthetic side is held close to body during locomotion

Question 11

Patient Causes: Uneven arm swing

Answer 11

No prosthetic causes.
Poor Balance
Fear and Insecurity (with uneven timing)
Habit pattern

Question 12

Uneven timing

Answer 12

Unequal duration steps with usually a very short stance phase on the prosthetic side.

Question 13

Prosthetic Causes: Uneven Timing

Answer 13

Improperly fitting socket may cause pain and desire to shorten stance phase
Weak extension air or insufficient friction in prosthetic knee causing excessive heel rise with prolonged swing through

Question 14

Patient Causes: Uneven timing

Answer 14

Weak residual limb
Poor Balance
Fear and Insecurity

Question 15

Long prosthetic Step

Answer 15

Individual takes a longer step with the prosthesis than with the uninvolved LE.

Question 16

Prosthetic Causes: Long prosthetic Step

Answer 16

Initial flexion in socket is insufficient is insufficient, when an irreducible flexion contracture is present.

Question 17

Patient Causes: Long prosthetic Step

Answer 17

Flexion contracture that cannot be accommodated prosthetically.

Question 18

Excessive trunk extension

Answer 18

Individual creates an active lumbar lordosis during stand phase

Question 19

Prosthetic Causes: Excessive trunk extension

Answer 19

Improperly shaped posterior wall causing forward rotation of pelvis to avoid full WB on ischium
Insufficient initial flexion built into socket

Question 20

Patient Causes: Excessive trunk extension

Answer 20

Hip flexor tightness
Weak hip extensors (substitue with ES)
Habit
Move shoulders backward in effort to obtain better balance
Weak abdominals

Question 21

Uneven Heel Rise

Answer 21

Prosthetic heel rises quite markedly and rapidly when the knee if flexed at beginning of swing phase

Question 22

Prosthetic Causes: Uneven Heel Rise

Answer 22

Insufficient knee joint friction

Inadequate extension aid

Question 23

Patient Causes: Uneven Heel Rise

Answer 23

Use more power than necessary to force the knee into flexion

Question 24

Terminal Swing Impact

Answer 24

Rapid forward movement of the shin piece allows the knee to reach maximum extension with too much force before heel strike

Question 25

Prosthetic Causes: Terminal Swing Impact

Answer 25

Insufficient knee joint friction | Too strong extension aid

Question 26

Patient Causes: Terminal Swing Impact

Answer 26

Deliberate, forceful extension of residual limb to ensure knee in full flexion

Question 27

Instability of prosthetic knee

Answer 27

Unstable knee creates danger of falling when flexing

Question 28

Prosthetic Causes: Instability of prosthetic knee

Answer 28

Knee joint too far anterior of TKA line Insufficient initial flexion built in PF resistance too great causing knee to buckle at heel strike Failure to limit DF leading to incomplete knee control

Question 29

Patient Causes: Instability of prosthetic knee

Answer 29

Hip extensor weakness | severe hip flexion contracture

Question 30

Medial or Lateral Whips

Answer 30

Observed posterior to pt. Medial whip = heel traveling medially on initial flexion & beginning of swing phase Lateral = when it moves laterally

Question 31

Prosthetic Causes: Medial or Lateral Whips

Answer 31

``` Medial: excessive ER of prosthetic Lateral: excessive IR of prosthetic Overly tight socket Excessive valgus in prosthetic Toe break in conventional foot malaligned, causing twisting on toe off. No pt causes. ```

Question 32

Foot Slap

Answer 32

Too rapid descent of the anterior portion of the prosthetic foot

Question 33

Prosthetic Causes: Foot Slap

Answer 33

PF resistance too soft

Question 34

Patient Causes: Foot Slap

Answer 34

Drive prosthesis into walking surface too forcible to assure extension of the knee

Question 35

Drop-off at the end of stance phase

Answer 35

Downward movement of the trunk as the body moves over prosthesis.

Question 36

Prosthetic Causes: Drop-off at the end of stance phase

Answer 36

Inadequate limitation of DF in prosthetic foot Too short heel in SACH type foot or toe break of conventional foot too posterior No patient causes.

Question 37

Lateral Bending of trunk

Answer 37

Excessive bending occurs laterally from midline, generally to prosthetic side

Question 38

Prosthetic Causes: Lateral Bending of trunk

Answer 38

Prosthesis too short Improperly shaped lateral wall failing to support femur Prosthetic aligned in Abduction, causing wide BOS.

Question 39

Patient causes: Lateral Bending of trunk

Answer 39

``` Inadequate balance ABduction contracture Oversensitive/painful residual limb Very short residual limb, failing to provide adequate lever arm Habit ```

Question 40

ABducted Gait

Answer 40

Very wide based gait with prosthesis held away from the midline at all times

Question 41

Prosthetic Causes: ABducted Gait

Answer 41

Prosthesis too long Too much adduction built in High medial wall causing ramus pressure Improperly shaped lateral wall failing to support femur

Question 42

Patient causes: ABducted Gait

Answer 42

ABduction contracture | Habit pattern