Gait Deviations in Amputees Flashcards
2 causes for a medial whip during gait
Knee axis is at excessive external rotation.
Also occurs if prosthesis is donned in external rotation.
Cause of lateral whip during gait. Name phase of gait in which lateral whip occurs
Knee axis is at excessive internal rotation.
Heel moves laterally at beginning of swing phase.
Define lateral trunk bending, the phase of which it is seen during gait, and its causes
Significant leaning of torso towards prosthetic side. Occurs at midstance. Compensation reduces pressure on the lateral distal femur. Can occur when prosthetic foot is excessively outset and/or socket is abducted. May also be an antalgic gait due to a bone spur on the distal lateral femur. Weakened hip abductors is another cause.
Cause of knee instability and when it occurs during gait
Knee flexes uncontrollably at loading response. Typically occurs when socket is too far posterior to Trochanter-knee-ankle (TKA) line. May also occur in early stance phase when excessive resistance to plantar flexion is caused by a heel durometer or plantar flexion bumper that is too firm. Short lever arm of residual limb and weaknesses in hip extensors also attributed.
Cause of excessive heel rise and when it occurs during gait
Results from inadequate resistance to knee flexion. Heel moves abnormally high during initial swing. Delays swing phase and reduces gait velocity.
Causes of external rotation of foot at heel contact
Lateral movement of forefoot at beginning of stance phase. May result when heel durometer is too firm, insufficient space in socket for muscle expansion, or if socket is too tight in conjunction w/ loose soft tissue.
Cause of abducted gait
Results in a wide BOS. Common prosthetic cause= excessive pressure on ramus as it exits the socket medially.
Circumduction of leg
Occurs if knee flexion resistance is extreme, prosthesis is too long and/or extension assist is too strong. One may also circumduct due to pain from impingment of tissues at medial brim of prosthetic.
Cause of terminal impact
Inadequate resistance to knee extension causes audible “clunk” at terminal swing phase. Knee unit reaches full extension without resistance; will wear out the knee quickly over time.
Causes of unequal step length
Associated w/ excessive lumbar lordosis. Sound limb step length is shorter than prosthetic step length. Solution: flexing socket 5 deg assists w/ increasing step length.
Flexion contracture at hip = greater flexion needed at socket.
Negative affects of pistoning or bell-clapping
Translates into a decrease in control over prosthesis and it results in discomfort (blistering from shear forces).
Normal Gait knee flexes smoothly 8-10 d from heel contact to midstance. This helps to absorb shock and reduce energy requirements of gait. List potential causes of an extended knee w/ transtibial prosthesis:
- Too long of a lever arm
- Socket to far posterior over foot
- Insufficient knee flexion (socket or patient)
- Soft heel
- Inadequate training
- Weak quads
More causes of knee instability w/ transtibial prostheses which may shorten stance phase on prosthetic side:
- Socket too far forward over foot
- Heel is too hard
- Too much knee flexion (socket or patient)
- Higher heeled shoes
- Too short of toe lever
Results of excessive rise/drop of hip w/ transtibial prostheses.
Excessive Rise or Drop of the Hip
Causes:
Rise = Prosthesis is too long.
Drop = Prosthesis is too short.
What are the 3 things you need to observe when observing gait analysis?
- Sitting (static)
- Standing (static)
- Gait (dynamic)
What are the 3 areas you need to observe when evaluating a transtibial amputee in a general static position?
- Residual limb - Does the skin have any sores, abrasions, cuts, or other problems?
- Prosthesis - What is the overall/general condition of the prosthesis?
- Liner - Does it fit with the socket?
For a transtibial amputee (eval in general static position), what are the potential issues with their residual limb?
Some areas might not tolerate socket pressure and cause abrasions, cuts, sores, etc.
For a transtibial amputee (eval in general static position), what are potential issue with the condition of their prosthesis?
Any changes, broken components, wear and tear
For a transtibial amputee (eval in general static position), what are potential issues with their liner?
Improper fit that can cause pain, skin breakdown, and gait deviations
What is priority #1 when observing a transtibial amputee in static?
observe and check the skin to make sure it’s not broken
What are the three areas you need to observe when evaluating a transtibial amputee in sitting?
- Seated posture - Knees flex to 90 deg? feet flat on floor?
- Posterior Flaring - Pressure on HS when seated?
- Residual Limb Position - Stump rise out of socket when seated?
For a transtibial amputee (eval in sitting), what are potential issues with their overall seated posture?
If pressure on the knee or bony prominences, the pt may keep leg extended
For a transtibial amputee (eval in sitting), what are the potential issues with posterior flaring?
pt will keep leg extended or report pain if there is pressure applied to HS
For a transtibial amputee (eval in sitting), what are potential issues with residual limb position?
Socket may be too small or the pt may be wearing too many socks