Pre-gait & Gait activities Flashcards
Gait deviations - Initial contact & Loading response
- Forefoot first
- Rotation
- Excessive knee flexion
- Insufficient knee flexion
Forefoot first
- Prosthetic PF
- Transtibial - knee flexion contracture
- Transfemoral - insufficient clearance/time to achieve knee extension; constant knee friction - knee too high
Rotation
- Prosthesis is too lose in socket (add ply sock to fix)
- Rigid heel (cannot get foot flat fast enough)
Excessive knee flexion
- Prosthetic DF
- Posteriorly set foot
- Rigid heel
- Transfemoral - knee set anterior; lack of socket flexion
Insufficient knee flexion
- Polycentric, single axis knees, weight activated stance control knee should not have flexion in initial contact
- Microprocessor and hydraulic knees have slight flexion at IC
- Anteriorly set foot or flat foot too quickly
- Soft heel
Midstance gait deviations
- Inconsistent progression of knee over foot - inconsistency in dynamic characteristics between heel and toe
- Excessive varus moment
- Insufficient varus moment, valgus moment
- Pelvic elevation
Excessive varus moment
- Should have slight varus moment at midstance
- Abducted socket
- Internally rotated foot
- Poor fit
Insufficient varus moment, valgus moment
- Excessively adducted socket
- Outset or excessively externally rotated foot (force WB over medial aspect of foot)
Pelvic elevation
- Excessive PF
- Anteriorly placed foor
Gait deviations - terminal stance
- Late heel off
- Pelvic drop off
- Early heel off
- Medial/lateral instability
- Lateral trunk flexion
Late heel off
- Soft forefoot
- Excessive DF
Pelvic drop off
- Soft forefoot
- Excessive DF
- Transfemoral - socket placed anterior over foot
- Excessive knee flexion
Early heel off
- Firm forefoot
- Excessive PF
Medial/Lateral instability
Same as midstance
Lateral trunk flexion
- Less demand on glut med and reduces pressure on lateral distal femur
- Wide BOS - abducted socket, outset foot
- Transfemoral - Pain at pubic ramus from high medial wall or bottoming out in socket; femur abducting inside socket
Gait deviations pre-swing
- Toe drag
- Valgus thrust
Toe drag
- Long prosthesis
- Excessive PF
- Poor suspension
Valgus thrust
- Excessively ER foot
Medial whip
- Force pushing heel medially initially then lateral by midswing
- Prosthesis in ER
Lateral whip
- Force pushing heel lateral initially, medially by midswing
- Prosthesis in IR
Lumbar lordosis
- Transfemoral socket with inadequate initial flexion
- Short residual limb
- Weak or contracture hip flexors
Vaulting
- Normally combines w/ circumduction
- Effect of sound side - during swing of prosthesis side, sound side will come up onto toe
- Anything that functionally lengthens prosthesis
- Excessive knee friction
Circumduction
- Anything that would functionally lengthen prostheiss
- Fear of knee instability at initial contact
Terminal impact
- Normally audible
- Many patients will force this so they know that foot is stable when it hits floor
- Inadequate knee friction
- Fear of knee instability at IC
- Should expect from specific prostheses: single axis, polycentric, weight activated stance control
- Deviation before initial contact
Prosthetic gait assessment
- Step width (expected 4 inches)
- Step length (expected 10-12 inches)
- Toe load
- Knee flexion (expected 60 degrees in swing; pre swing 35-40 degrees)
- Pelvic rotation (rotation 5 degrees)
- Trunk rotation (rotation 5 degrees)
