Gait Deviations in Amputees Flashcards
In patients with a transtibial prosthesis the socket should be aligned in _ degrees of knee flexion. Explain why…
5
To elongate the quadriceps muscle slightly so that they are better prepared to accept the full weight of the body and to aid in shock absorption during the loading response
In patients with a transtibial prosthesis the socket should be aligned in _ degrees of hip adduction. Explain why…
5
To ensure the foot is sufficiently inset to create the appropriate varus moment during stance; this properly loads the proximomedial and distolateral aspects
What are four goals in prosthetic alignment?
1) facilitate heel strike at initial contact
2) provide adequate single limb stability during stance phase
3) create smooth forward progression (rollover) during the transition from early to late stance phase
4) insure adequate swing phase toe clearance
If the sleeve suspension is not in contact with the skin at least _ inches above the liner pistoning will occur
2
What may be the source of the following gait deviation:
Circumduction
- Extension assist is too strong
- Medial brim of the socket impinges soft tissue during swing phase
- Prosthesis has been excessively lengthened
What may be the source of the following gait deviation:
Lateral Trunk Bending
- Prosthetic foot is excessively outset
- Insufficient prosthetic length
- Attempt to alleviate pain due to bone spur on distal lateral femur
- Weak hip abductors
- Prosthetic is excessively abducted
What may be the source of the following gait deviation:
Limited Heel Rise
- swing friction is too high
- swing flex damping too high
What may be the source of the following gait deviation:
Vaulting
- Prosthesis is too long
- Excessive knee friction
- Inadequate suspension
What may be the source of the following gait deviation:
Lateral Whip
- Prosthesis is excessively IR
- Rectus femoris channel is too large
- Posteromedial wall angle too tight
What may be the source of the following gait deviation:
Medial Whip
- Knee axis of prosthesis is in excessively ER
- Prosthesis is donned in ER
Where should the knee bolt be positioned in order to avoid medial or lateral whip?
In 5 degrees of external rotation, so the limb will track closer to the line of progression
What may be the source of the following gait deviation:
Foot Slap
- Insufficient plantarflexion resistance in the prosthetic foot
- Excessively soft plantarflexion bumper in a foot with an articulated ankle
What may be the source of the following gait deviation:
Excessive Heel Rise
- Inadequate resistance to knee flexion
What may be the source of the following gait deviation:
Pistoning
- Socket is too large
- Suspension is inadequate
What is drop off?
sudden knee flexion during stance
What may be the source of the following gait deviation:
Drop Off
- the keel or tow lever is too soft or too short
- shoe heel height is too high for the prosthetic foot
What may be the source of the following gait deviation:
Knee Hyperextension
- heel cushion is too soft
- ## heel or toe lever arm is too long or too firm
What can help facilitate knee extension?
an articulated ankle
What may be the source of the following gait deviation:
ER of the foot at Heel Contact
- heel durometer of the foot is too firm
- socket is too loose
What may be the source of the following gait deviation:
Excessive Varus Moment
- ML dimension of the socket is too large
- too much inset of the prosthetic foot
- attempts to match the extreme ER of the foot on the “good” leg
- patient has hypermobile LCL
What may be the source of the following gait deviation:
Terminal Impact (audible clunk at the end of terminal swing phase)
- inadequate resistance to knee extension
What may be the source of the following gait deviation:
Unequal step length
- excessive lumbar lordosis
- insufficient socket flexion (5 degrees is preferred, can be increased)
What may be the source of the following gait deviation:
Asymmetrical Shoulder Movement
- leg length discrepancy
What may be the source of the following gait deviation:
Amputee is walking on the lateral aspect of their foot
- socket is in excessive abduction
What may be the source of the following gait deviation:
Amputee is walking on the medial aspect of their foot
- socket is in excessive adduction
What are the disadvantages of excessive heel compression
- lowers the COG
- delays the drop of the forefoot to the floor (which requires increased knee and hip stability muscle firing)
- delays the rate of initial tibial advancement resulting in reduced knee flexion during weight acceptance
What may be the source of the following gait deviation:
Excessive valgus (medial) moment
- insufficient medial displacement of the foot in reference to the socket
- inversion of the foot
- poor integrity of the MCL
What may be the source of the following gait deviation:
Pelvic Elevation/Hip Hike
- prosthesis is too long
- knee does not have enough friction
- excessively strong extension assist
What may be the source of the following gait deviation:
Knee Instability
- socket is too posterior to the trochanter-knee-ankle line
- plantarflexion bumper is too firm
- foot is aligned in excessive dorsiflexion
- short residual limb
- weak hip extensors
What may be the source of the following gait deviation:
Abducted Gait
- excessive pressure on the ramus as it exits the socket medially
- prosthesis is too long
In a transtibial prosthesis what may be the source of the following gait deviation:
Knee is Extended
- Socket to far posterior over foot
- Insufficient knee flexion (socket or patient)
- Soft heel
- Inadequate training
- Weak Quads
In a transtibial prosthesis what may be the source of the following gait deviation:
Knee Instability
- Socket to far forward over foot
- Heel is too hard
3. Too much knee flexion (socket or patient)
4. Higher heeled shoes
In a transtibial prosthesis what may be the source of the following gait deviation:
Excessive hip rise
Prosthesis is too long
In a transtibial prosthesis what may be the source of the following gait deviation:
Excessive hip drop
Prosthesis is too short
In a transtibial prosthesis what may be the source of the following gait deviation:
Wide Based gait
- outset foot
- medial leaning pylon
In a transtibial prosthesis what may be the source of the following gait deviation:
Narrow Based Gait
- inset foot
- lateral leaning pylon
In a transfemoral prosthesis what may be the source of the following gait deviation:
Knee Instability
- line of body weight falls behind the knee
- lack of adequate socket flexion
- heel too hard
- Severe hip flexion contracture not accounted for in the socket
In a transfemoral prosthesis what may be the source of the following gait deviation:
excessive trunk extension
- Lack of initial socket flexion
- Flexion contracture that the prosthesis cannot accommodate
- Weak hip extensors
- Weak abdominals
What will the gait abnormality be if the foot is inset?
Base of support is too narrow b/c prosthetic foot is aligned too close to the intact foot during midstance
What will the gait abnormality be if the foot is outset?
Base of support is too wide b/c prosthetic foot is aligned too far from the intact foot during midstance
What will the gait abnormality be if the heel is too hard?
Knee instability during weight acceptance b/c the heel does not function to absorb any shock, so the knee has to absorb more force which results in some level of instability, i.e. it may look like a ‘wobbly’ knee
What will the gait abnormality be if the heel is too soft?
The knee will be extended during weight acceptance because the heel is absorbing too much force and the patient will need to “stiffen” the leg/knee to prevent the leg from buckling as it accepts the body weight during this early phase of stance
What will the gait abnormality be if the foot is aligned in too much ER?
Prosthetic foot will be externally rotated which contributes to a less efficient gait, may reflect alignment of the prosthesis OR alignment of the intact hip OR external rotation/torsion of the tibia/fibula of the residual limb
What will the gait abnormality be if the pylon leans laterally?
a narrow base of support during midstance similar to the base of support you observed with an inset foot
What will the gait abnormality be if the pylon leans medially?
You will observe a wide base of support during midstance similar to the base of support you observed with an outset foot
What will the gait abnormality be if the socket is too far posterior?
The knee will be extended during weight acceptance phase of gait and the gait pattern may look “stiff” b/c the patient is having difficulty with trying to absorb the weight force
What will the gait abnormality be if the socket is too far anterior?
The knee will be flexed too much during weight acceptance phase of gait – also known as knee instability. This is b/c the knee will flex too much as the patient works to get their body weight over the foot. This problem will also be observable during terminal stance and you will most likely see knee instability and will promote a lack of confidence in the prosthetic leg
What will the gait abnormality be if the socket does not allow for enough knee flexion?
The knee will be extended rather than flexed during the weight acceptance phase of stance & the patient may report that they feel like they are walking uphill and the gait will look “stiff”
What will the gait abnormality be if the socket allows for too much knee flexion?
The knee will appear unstable during the weight acceptance phase of stance b/c of the tendency this creates for the knee and prosthetic leg to buckle & the patient will develop a lack of confidence over time in the prosthetic leg
What will the gait abnormality be if the socket is too big?
The prosthetic leg will piston, i.e. move up and down on the residual limb during swing which will also contribute to gait instability, uneven step and stride lengths & a lack of trust in the prosthetic leg by the patient
What will the gait abnormality be if the prosthetic knee flexes too much?
The prosthetic leg will buckle from initial contact to midstance. This will look like knee/LE instability due to too much knee flexion during stance
What will the gait abnormality be if the prosthetic knee is aligned in too much extension?
You may observe a circumducted gait during swing, vaulting to clear the prosthetic leg during swing, or excessive pelvic rise/hip hike on the prosthetic leg side during swing of the prosthetic leg, you may also observe a wide base of support or an abducted gait pattern
What will the gait abnormality be if the prosthetic knee is IR too much?
You will observe a lateral whip of the prosthetic leg during swing as the patient attempts to bring the prosthetic leg into a good position for stance
What will the gait abnormality be if the prosthetic knee is ER too much?
You will observe a medial whip of the prosthetic leg during swing as the patient attempts to bring the prosthetic leg into a good position for stance
What will the gait abnormality be if the prosthetic socket is too loose?
You will most likely observe an externally rotated foot or prosthetic leg that looks like it is hard to control, vaulting may occur b/c a poor socket fit will lead to inadequate suspension of the prosthesis
What will the gait abnormality be if the prosthetic socket is too tight?
You will observe excessive soft tissue or an adductor roll during stance – either quiet stance or during the stance phase of gait, the patient may complain of pain or burning sensation and most likely will walk with an abducted gait b/c they will be trying to relieve that medial pressure, and you may see either a medial or lateral whip of the prosthetic leg during swing
What will the gait abnormality be if the prosthetic socket does not allow for initial hip flexion?
You may observe ‘active lumbar lordosis’ b/c the patient will be hyperextending h/her lumbar spine to keep h/her center of gravity within the base of support in an A-P direction
What will the gait abnormality be if the prosthetic socket is not adducted enough or the medial wall is too high?
You will observe lateral trunk bending during midstance towards the side of the prosthetic leg
Also, with a high medial wall you may observe an abducted gait b/c the patient will be trying to unload that pressure on their pubic ramus
What will the gait abnormality be if the toe lever arm is too short in a transfemoral prosthesis?
pelvic drop off during terminal stance if this is present
