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Prosthetic Exam > Gait Deviations/ Troubleshooting > Flashcards

Gait Deviations/ Troubleshooting Flashcards

1
Q

What causes knee instability in a prosthesis?

A

Knee too anterior
Excessive resistance to PF
Shoe heel height increased
Insufficient socket flexion

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2
Q

Unequal step length

A

Painful socket
Unstable knee
Patient insecurity
Insufficient initial socket flexion to accommodate contracture

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3
Q

Foot slap

A

PF bumper or heel cushion to soft
Patient forces heel compression to ensure knee instability
Insufficient PF resistance in the px foot

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4
Q

How to correct knee instability in a prosthesis?

A

Reduce the degree of dorsiflexion or anterior translation of the socket over the foot.

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5
Q

What deviations occur at loading response?

A 
External foot rotation 
Knee flexion is not smooth 
Knee flexion is abrupt and uncontrolled 
Knee remains extended; rides heel> midstance 
Pistoning
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6
Q

What gait deviations occur at mid stance?

A

Abducted gait
Lateral trunk bending
Toe rotation does not match sound side

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7
Q

What is external foot rotation caused by?

A

PF bumper or heel cushion too firm
Excessive toe out
Socket rotation -loose fit
Socket rotation- tight medial/posterior wall

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8
Q

Knee flexion is not smooth what is the cause

A

Weak quads

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9
Q

The knee remains extended and patient rides the heel through to midstance?

A 
Foot too anterior 
Insufficient socket flexion 
Foot plantarflexed 
Sach heel too soft (if more than 3/8" comp)
Heel on shoe too low 
Excessive use of knee extensors
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10
Q

Knee flexion is abrupt and uncontrolled?

A

Foot too posterior
Socket too flexed
Foot excessively dorsiflexed
Heel on shoe too high
Plantarflexion bumper or heel wedge too firm
Shoe does not allow heel cushion to compress sufficiently

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11
Q

What causes pistoning?

A

Patient dropping too deeply into socket

Suspension too loose
Not enough prosthetic socks
Poor modifications - not enough support under medial tibial flare or patellar tendon

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12
Q

Abducted gait

A 
Pubic ramus pressure 
Pain at distal lateral femur 
Lateral wall not shaped to provide adequate femur support 
Prosthesis too long 
Excessive abduction built in 
Pelvic band too far from ilium 
Patient has weak/contracted abductors 
Patient insecurity
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13
Q

Lateral trunk bending

A 
Prosthesis is too short 
Excessive outset 
Insufficient socket adduction 
Wide ML
Lateral wall not shaped to provide adequate femur support 
Pubic Ramus pressure 
Pain at distal lateral femur
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14
Q

Toe rotation does not match sound side is caused by?

A

Improper foot rotation alignment

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15
Q

What gait deviations occur at terminal stance?

A

Pelvic rise
Drop off
Excessive lumbar lordosis

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16
Q

What causes pelvic rise (hill climbing) hip hiking

A

Toe lever too long
Prosthesis that is too long
Prosthetic knee with Insufficient friction

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17
Q

What causes drop off (excessive pelvic drop with forward progression

A

Toe lever too short
Keel or toe level is soft
Heel height is too high

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18
Q

What causes excessive lumbar lordosis?

A

Insufficient initial socket flexion
Improper shaped posterior wall causing painful ischium weight
Hip flexion contracture

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19
Q

What gait deviations occur at preswing?

A 
Medial whip 
Lateral whip 
Socket drops pistoning 
Inadequate or delayed knee flexion 
Uneven heel rise
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20
Q

Medial whip

A

Knee axis is in external rotation

Socket donned in external rotation

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21
Q

Lateral whip

A

Knee axis in internal rotation

Socket donned in internal rotation

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22
Q

Socket drops (pistoning)

A

Inadequate suspension

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23
Q

Inadequate or delayed knee flexion

A

Excessive mechanical resistance to knee flexion

Prosthesis Aligned with too much stability

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24
Q

Uneven heel rise

A

Incorrect resistance to knee flexion

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25
Q

What gait deviations occur at initial contact?

A

Knee instability
Unequal step length
Foot slap

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26
Q

What gait deviations occur in terminal swing?

A

Excessive terminal impact

Unequal step length

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27
Q

Terminal impact

A 
Caused by:
Insufficient knee friction 
Extension bias too strong 
Warn or absent extension bumper 
Patient deliberately extends
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28
Q

Circumduction is caused?

A 
Excessive mechanical resistance to knee flexion 
Aligned w/too much knee stability 
Prosthesis too long 
Medial brim pressures
Inadequate suspensions
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29
Q

Vaulting

A

Prosthesis too long
Excessive mechanical resistance to knee flexion
Aligned in too much stability
Inadequate suspension

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30
Q

Patient is having pain or redness on distal end of RL and or redness on distal Patella

A

Not enough socks allows RL to “bottom out”

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31
Q

Patient is having redness on distal aspect of fibula head and distal patella is caused by?

A

Not enough socks allows RL to drop too far into socket

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32
Q

Patient is having redness on tibial tubercle and or proximal fibular head. May also show signs of verrucose hyperplasia why?

A

Too many socks being used causes lack of distal contact.

RL volume reduced and they are wearing proper ply but socks cause too much tightness proximally: adding padding posterior, medial tibial flare and lateral tibial flare (pre tibs) *reduce sock ply

33
Q

Pressures on distal lateral and proximal medial is caused by?

A

Alignment issue:
Excessive varus
Excessive foot inset
Too much socket adduction

34
Q

Discomfort on anterior proximal patella and posterior distal RL

Can occur @initial contact or preswing - initial swing

A 
Patient switched to lower height shoe 
Foot too anterior (toe lever too long) 
Heel cushion or plantar flexion bumper too soft 
Plantarflexed foot 
Posterior leaning pylon 
Excessively extended socket
  • All these can cause excessive extension in stance phase
35
Q

Discomfort on anterior distal tibia and posterior proximal RL near hamstring tendons

Can occur @initial contact or preswing to initial swing

A 
Patient switched to higher heel height 
Foot too posterior (toe lever short)
Heel or plantarflexion bumper too firm
Dorsi flexed foot 
Heel too short or soft 
Anterior leaning pylon
Excessive socket flexion

*All of these can cause excessive flexion in stance

36
Q

Patient is having all over redness or irritation

A

Could be improper hygiene or allergic

37
Q

Proper sock ply is being used with proper alignment but there is irritation present over a bony prominence

A

Check for distal contact with clay or flexible steel probe. If RL is seated properly bony prominence needs to be relieved by heating, grinding, or distraction pads.

38
Q

Patient complains of discomfort while ambulating but is comfortable while standing

A

Mostly pistoning:
Assess w patient weight bearing you hold prosthesis in place and have patient lift RL. If RL motion more than 1cm of patella than pistoning is occurring.

  • -faulty suspension
  • -loose socket fit
  • -not enough socks
39
Q

Pylon leans medially

A

Too much socket adduction

Foot outset

40
Q

Pylon leans laterally

A

Not enough socket adduction

Foot inset

41
Q

State one cause and one correction for:

Anterior distal and posterior pressure?

A

Cause: shoe change
Correction: heel wedge to correct height

42
Q

State one cause and one correction for:

AK distal lateral pressure, socket fit good

A

Cause: too much adduction built into socket
Correction: remove adduction

43
Q

State one cause and one correction for:

BK distal end pressure with blisters “I’m just pulling it on”

A

Cause: incorrect donning of liner causing void at distal end
Correction: re educate on rolling on Liner

44
Q

State one cause and one correction for:

BK distal pressure cuff suspension- self adjust, tight, gained 20lbs, putty test?

A

Cause: lack of distal contact
Correction: remake socket

45
Q

State one cause and one correction for:

Pediatric Symes: fib head, tibial tuberosity, lateral distal pressure

A

Caused: gained weight
Correction: remake socket

46
Q

State one cause and one correction for:

Pediatric exoskeleton Symes - distal lateral pressure

A

Cause: bone spur
Correction: distraction pad until can remake socket

47
Q

State one cause and one correction for:

AK medial brim pressure

A

Cause: weight loss
Correction: add socks

48
Q

State one cause and one correction for:

BK redness on distal Patella and anterior distal tibia

A

Cause: patient is shrink
Correction: add sock

49
Q

State one cause and one correction for:

Knee disarticulation- medial window. Medial pain and Proximal fit?

A

Cause: not enough socks
Correction: distraction pads

  • alignment (too much abduction)
  • check proximal stability
50
Q

State one cause and one correction for:

BK redness on all bony landmarks. Traditional suction socket

A

Cause: pistoning
Correction:
Leak in suction - replace vacuum pump, check for leak in sleeve

51
Q

State one cause and one correction for:

TR- patient could not open TD completely. Rubber hands

A

Cause: force vs excursion problem
Correction:

52
Q

State one cause and one correction for:

TH TD opens prematurely

A

Cause: EFT too proximal
Correction: move EFT distal

53
Q

If patient is having a problem with the prosthesis what questions must you ask to determine the cause?

A

Is it physical problems (ROM, weaknes)
Fit issues with the socket (volume)
Alignment issues with the prosthesis

54
Q

What Are the causes if patient is unable to flex knee, difficult rolling over toe

A

Too rigid of toe lever (too plantarflexed)
Prosthetic knee is too stiff
Not fully shifting weight over knee, pelvic rotation
Not putting enough weight through the prosthesis

55
Q

What Are the solutions/corrections if patient is unable to flex knee, difficult rolling over toe

A

Prosthesis alignment GRF

Gait training, trusting prosthesis

56
Q

What are similar causes of circumduction, abducted, and hip hiking gait ?

A

Clearance of prosthesis- height and PF ankle
Pain
Insufficient suspension
Trouble bending knee

57
Q

What are similar corrections of circumduction, abducted, and hip hiking gait ?

A

Check volume add/ remove sock
Check suspension
Gait training- weight through prosthesis
Foot placement BOS

58
Q

What are the causes of toe dragging in a BK prosthesis?

A

Prosthesis height
Foot too PF
Suspension inadequate
Patient habit/inadequate knee flexion

59
Q

How to correct toe dragging in a BK prosthesis?

A 
Gait training (strengthen muscles) 
If patient has a liner/sleeve on over knee, increases stiffness - remind pt to intentionally flex their knee 
Alignment
60
Q

What are possible causes of excessive varus thrust (BK)

A

Socket too loose in ML
Improper foot placement at unitized contact
Foot too inset
Foot “toed” in too much

61
Q

What are some solutions to excessive varus thirst in a BK

A

Volume issue/ add socks
Gait training
Prosthetic alignment change (outset foot)
Rotate socket or change toe out

62
Q

What are prosthetic causes of drop off?

A

Short toe lever
Excessive socket flexion
Excessive dorsiflexion
Incorrect foot type

63
Q

What are amputee causes of drop off?

A

Bad gait habit, strength, short residual limb

Internal rotation of hip at toe off / hip flexion

64
Q

Patient complains of feeling like they are walking uphill what is the cause?

A

A long prosthesis

65
Q

Patient complains of feeling like they are stepping into a hole what is the cause?

A

A short prosthesis

66
Q

What are some thing to do before messing with alignment?

A

Check fit of sock ply (try too many socks then decrease per ply)
Check AP dimension (use corset stays/probe or inside calipers)
Check ML dimension (use corset stays, probe or inside calipers)

67
Q

If patient has AP dimension issues you correct by?

A

Add popliteal pad
Check patella tendon bar
Look for sock marks in the weight tolerant areas
Check popliteal shelf (make sure no impingement on hamstrings for comfort)

68
Q

What happens if the posterior shelf is lowered excessively?

A

Lowering the shelf excessively will loose the AP and the limb will bottom out.

69
Q

If patient has ML dimension issues you correct by?

A

Adding padding to medial or lateral walls and medial flare: be careful of fibular head
Within range of 1/4 to anatomical measurements

70
Q

What happens if the length of the socket is too long?

A

No distal contact, patient may experience varicose hyperplasia (scaling or hardening of distal end)

71
Q

How correct socket if the length of the socket is too long?

A

Apply foam pad to distal end to create total contact

Have patient wear Shrinker sock sung to reduce condition without wearing socket.

72
Q

What happens if a patient has a knee flexion contracture?

A

They may need to be fit with a preparatory socket/ copolymer until the contracture is reduced by stretching through PT

73
Q

What is bell clapping and how do you fix or check for it?

A

Socket would be loose distally allowing the limb to move in the AP direction without total contact.

BAby powder mAy be helpful tool to determine where the limb is not making contact with the socket

Use probe to check Area
Recheck measurements
Add pad on wallet hollow for TF
Add pad in the gastrocnemius and pretib areas for TT

74
Q

Hammocking of socks- patient feels like they are bottoming out but are not actually at the bottom of the socket.

A

Test with ball of putty to see actual pressure

Check socks marks distally and proximal to distal cut bone

75
Q

What is the solution for Hammocking of socks- patient feels like they are bottoming out but are not actually at the bottom of the socket.

A

Reduce sock ply
Heat relieves socket in specific area to decrease Hammocking effect
Compare current measurements to previous measurements.

76
Q

How to correct pistoning if pt has too many layers of socks

A 
Reduce to 3 or 5 ply 
Reduce ply fit with adding pads 
Check suspension 
May need to add pad to existing sc pad 
Check cuff strap 
 Check fit of sleeve, corset or gel liner
77
Q

How to determine the length of socket?

A

Check either mid patella tendon or medial Tibial plateau to distal end.

78
Q

True or false too many (8-10) sock ply will raise the limb out the socket

A

True
Too many socks will cause pistoning and rotation of the socket
Solution : pad the weight tolerant Areas to reduce the ply fit or global reaction of the negative cast/model

Prosthetic Exam (3 decks)

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