Pre-gait & Gait activities

Question 1

Gait deviations - Initial contact & Loading response

Answer 1

• Forefoot first
• Rotation
• Excessive knee flexion
• Insufficient knee flexion

Question 2

Forefoot first

Answer 2

• Prosthetic PF
• Transtibial - knee flexion contracture
• Transfemoral - insufficient clearance/time to achieve knee extension; constant knee friction - knee too high

Question 3

Rotation

Answer 3

• Prosthesis is too lose in socket (add ply sock to fix)

- Rigid heel (cannot get foot flat fast enough)

Question 4

Excessive knee flexion

Answer 4

• Prosthetic DF
• Posteriorly set foot
• Rigid heel
• Transfemoral - knee set anterior; lack of socket flexion

Question 5

Insufficient knee flexion

Answer 5

• 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

Question 6

Midstance gait deviations

Answer 6

• Inconsistent progression of knee over foot - inconsistency in dynamic characteristics between heel and toe
• Excessive varus moment
• Insufficient varus moment, valgus moment
• Pelvic elevation

Question 7

Excessive varus moment

Answer 7

• Should have slight varus moment at midstance
• Abducted socket
• Internally rotated foot
• Poor fit

Question 8

Insufficient varus moment, valgus moment

Answer 8

• Excessively adducted socket

- Outset or excessively externally rotated foot (force WB over medial aspect of foot)

Question 9

Pelvic elevation

Answer 9

• Excessive PF

- Anteriorly placed foor

Question 10

Gait deviations - terminal stance

Answer 10

• Late heel off
• Pelvic drop off
• Early heel off
• Medial/lateral instability
• Lateral trunk flexion

Question 11

Late heel off

Answer 11

• Soft forefoot

- Excessive DF

Question 12

Pelvic drop off

Answer 12

• Soft forefoot
• Excessive DF
• Transfemoral - socket placed anterior over foot
• Excessive knee flexion

Question 13

Early heel off

Answer 13

• Firm forefoot

- Excessive PF

Question 14

Medial/Lateral instability

Answer 14

Same as midstance

Question 15

Lateral trunk flexion

Answer 15

• 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

Question 16

Gait deviations pre-swing

Answer 16

• Toe drag

- Valgus thrust

Question 17

Toe drag

Answer 17

• Long prosthesis
• Excessive PF
• Poor suspension

Question 18

Valgus thrust

Answer 18

• Excessively ER foot

Question 19

Medial whip

Answer 19

• Force pushing heel medially initially then lateral by midswing
• Prosthesis in ER

Question 20

Lateral whip

Answer 20

• Force pushing heel lateral initially, medially by midswing

- Prosthesis in IR

Question 21

Lumbar lordosis

Answer 21

• Transfemoral socket with inadequate initial flexion
• Short residual limb
• Weak or contracture hip flexors

Question 22

Vaulting

Answer 22

• 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

Question 23

Circumduction

Answer 23

• Anything that would functionally lengthen prostheiss

- Fear of knee instability at initial contact

Question 24

Terminal impact

Answer 24

• 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

Question 25

Prosthetic gait assessment

Answer 25

1. Step width (expected 4 inches)
2. Step length (expected 10-12 inches)
3. Toe load
4. Knee flexion (expected 60 degrees in swing; pre swing 35-40 degrees)
5. Pelvic rotation (rotation 5 degrees)
6. Trunk rotation (rotation 5 degrees)