Gait Deviations Flashcards
Circumducted Gait
Prosthesis swings laterally in a wide area during swing phase
Prosthetic Causes: Circumducted Gait
Prosthesis is too long
Too much alignment stability/friction in the knee making it difficult to bend knee in swing through
Patient Causes: Circumducted Gait
Abduction contracture
lack of confidence to flex prosthetic b/c muscle weakness or fear of stubbing toe
Habit
Vaulting
Rising on the toe of the sound foot to swing prosthesis through with little knee flexion.
Prosthetic Causes: Vaulting
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.
Patient Causes: Vaulting
Fairly frequent habit pattern
Fear of stubbing toe
Discomfort in residual limb
Rotation of prosthesis upon heel strike
Prosthesis rotates on initial contact
Prosthetic Causes: Rotation on heel strike
Too much resistance to PF by PF bumper/heel wedge
Too much toe out built into prosthesis
Socket too loose
Patient Causes: Rotation on heel strike
Extend residual limb too vigorously at heel strike (kick too hard into extension)
Poor muscle control of residual limb
Uneven arm swing
Arm on prosthetic side is held close to body during locomotion
Patient Causes: Uneven arm swing
No prosthetic causes.
Poor Balance
Fear and Insecurity (with uneven timing)
Habit pattern
Uneven timing
Unequal duration steps with usually a very short stance phase on the prosthetic side.
Prosthetic Causes: Uneven Timing
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
Patient Causes: Uneven timing
Weak residual limb
Poor Balance
Fear and Insecurity
Long prosthetic Step
Individual takes a longer step with the prosthesis than with the uninvolved LE.
Prosthetic Causes: Long prosthetic Step
Initial flexion in socket is insufficient is insufficient, when an irreducible flexion contracture is present.
Patient Causes: Long prosthetic Step
Flexion contracture that cannot be accommodated prosthetically.
Excessive trunk extension
Individual creates an active lumbar lordosis during stand phase
Prosthetic Causes: Excessive trunk extension
Improperly shaped posterior wall causing forward rotation of pelvis to avoid full WB on ischium
Insufficient initial flexion built into socket
Patient Causes: Excessive trunk extension
Hip flexor tightness Weak hip extensors (substitue with ES) Habit Move shoulders backward in effort to obtain better balance Weak abdominals
Uneven Heel Rise
Prosthetic heel rises quite markedly and rapidly when the knee if flexed at beginning of swing phase
Prosthetic Causes: Uneven Heel Rise
Insufficient knee joint friction
Inadequate extension aid
Patient Causes: Uneven Heel Rise
Use more power than necessary to force the knee into flexion
Terminal Swing Impact
Rapid forward movement of the shin piece allows the knee to reach maximum extension with too much force before heel strike
Prosthetic Causes: Terminal Swing Impact
Insufficient knee joint friction
Too strong extension aid
Patient Causes: Terminal Swing Impact
Deliberate, forceful extension of residual limb to ensure knee in full flexion
Instability of prosthetic knee
Unstable knee creates danger of falling when flexing
Prosthetic Causes: Instability of prosthetic knee
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
Patient Causes: Instability of prosthetic knee
Hip extensor weakness
severe hip flexion contracture
Medial or Lateral Whips
Observed posterior to pt.
Medial whip = heel traveling medially on initial flexion & beginning of swing phase
Lateral = when it moves laterally
Prosthetic Causes: Medial or Lateral Whips
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.
Foot Slap
Too rapid descent of the anterior portion of the prosthetic foot
Prosthetic Causes: Foot Slap
PF resistance too soft
Patient Causes: Foot Slap
Drive prosthesis into walking surface too forcible to assure extension of the knee
Drop-off at the end of stance phase
Downward movement of the trunk as the body moves over prosthesis.
Prosthetic Causes: Drop-off at the end of stance phase
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.
Lateral Bending of trunk
Excessive bending occurs laterally from midline, generally to prosthetic side
Prosthetic Causes: Lateral Bending of trunk
Prosthesis too short
Improperly shaped lateral wall failing to support femur
Prosthetic aligned in Abduction, causing wide BOS.
Patient causes: Lateral Bending of trunk
Inadequate balance ABduction contracture Oversensitive/painful residual limb Very short residual limb, failing to provide adequate lever arm Habit
ABducted Gait
Very wide based gait with prosthesis held away from the midline at all times
Prosthetic Causes: ABducted Gait
Prosthesis too long
Too much adduction built in
High medial wall causing ramus pressure
Improperly shaped lateral wall failing to support femur
Patient causes: ABducted Gait
ABduction contracture
Habit pattern
