Prosthetic Gait Deviations Flashcards
Content: Terms to Describe Gait Deviation (6)
- Toe lever arm (shoe size)
- Heel lever arm
- Heel/Keel Stiffness
- Socket Flexion
- Socket Rotation
- External foot rotation
Q: How can too short of a toe lever effect gait?
Can cause fall off/fall forward over the toe
Q: How can a anteriorly shifted foot effect gait?
Makes it hard for the ankle to roll over the foot
Q: What gait deviation is socket flexion used to accomodate?
Contractures (hip and knee flexion)
T/F: Socket flexion can effect which areas are under pressure in the socket.
True
Q: What degree of foot ER is normal?
~5 degrees
Defn: Bench Alignment
Bench alignment is were the WB line is in relationship to the foot. Each prothesis has a preset (optimum) bench alignment with multiple components that can be altered by a prothetist
Content: Static Alignment (4)
- Before assessment it is important to be all the way down into the socket
- Height
- Foot Rotation
- Socket Position
Content: Assessing prosthetic height (3)
- “Do you feel level”
- Distance from tibial plateau to floor equal bilaterally
- ASIS symmetrical
Q: Why may a pt. feel unlevel when first trying a prosthesis? (2)
- Not used to WB
- Typically initially feel tall
Q: What question can be asked to assess socket position?
“Do you feel equal weight under your heel and the ball of your foot?”
Q: If the patient feels like they are on their toes, how can you adjust the socket position to achieve flat foot?
Flex the socket
Defn: Dynamic Alignment
The alignment of the prosthesis while the pt. is moving/ambulating
Q: What force do you want to see at the knee during mid stance?
Varus thrust
Q: How can too long of a toe lever affect gait?
Cause the knee to flex/buckle
Q: How would you alter socket flexion to a hip flexion contracture?
Increase socket flexion by 5 degrees
- Allows for the knee to be in proper alignment
- Allows pt. to swing forward
- Increases step length by increases ability for hip to extend back
Q: What is the degree of ER at the foot and knee during stance?
5-7 degrees for both
Q: What is the Foot, Knee and Hip Joint/Pelvis alignment during swing?
Foot - perpendicular to line of progression
Knee - perpendicular to line of progression
Hip Joint/Pelvis - IR 5-7 degrees
Content: Trochanter/Knee/Ankle (TKA) (4)
- Stationary alignment line identifies the relative alignment between center of socket weight, rotation point of knee, rotation point of ankle
- WB line anterior to TKA = stable
- WB line posterior to TKA = buckle
- Socket angled, T moves posterior, knee can’t straighten (move knee posterior)
Content: AKA: Prosthetic Cause of Medial Whip (3)
- ER of the knee
- Tight socket
- Mis-aligned toe break
Content: AKA: Amputee Cause of Medial Whip (2)
- Gait habit
- Socket not put on properly
Content: AKA: Prosthetic Cause of Lateral Whip (3)
- IR of the knee
- Loose socket
- Mis-aligned toe break
Content: AKA: Amputee Cause of Lateral Whip (3)
- Gait habit
- Socket not put on properly
- IR of hip at toe off/hip flexion
Content: AKA: Prosthetic Cause of Abducted Gait (4)
- Prosthesis too long
- Medial wall to high
- Insufficient femoral stability
- Induces medial whip
Q: What question can you ask if you see whip?
“Do you feel like the socket is on right/feels good?”
Content: AKA: Amputee Cause of Abducted Gait (3)
- Poor gait habit
- Abduction contracture
- Pt. insecure and desires wide base in belief it will increase stability
Q: What positions should amputees never be left in?
With pillows under or between their legs (prevent flexion and abd contracture)
Content: AKA: Prosthetic Cause of Circumducted Gait (2)
- Long prosthesis
- Excessive knee friction stability
Content: AKA: Amputee Cause of Circumducted Gait (4)
- Lack of confidence in flexing knee
- Abd contracture
- Weak hip flexors
- Habit, using entire hip and pelvis to initiate gait
Content: AKA: Prosthetic Cause of Vaulting (4)
- Long prosthesis
- Poor suspension
- Excessive PF
- Excessive knee resistance/stability
Content: AKA: Amputee Cause of Vaulting (3)
- Gait habit - fear of catching toe
- Weak hip flexors on residual limb
- Improper initiation of hip flexors on residual limb
T/F: Vaulting gait deviations are easy to fix.
False: Hard to get rid of
Content: AKA: Prosthetic Cause of Heel Rise (3)
- Inadequate extension aid
- Insufficient knee friction
- Improper knee selection
Content: AKA: Amputee Cause of Heel Rise
Excessive use of hip flexors to initiate swing phase, overpowering knee unit
Content: AKA: Prosthetic Cause of Knee Instability (4)
- Excessive DF
- Knee aligned in unstable position
- Insufficient socket flexion
- Mal-alignment of foot
Content: AKA: Amputee Cause of Knee Instability (2)
- Weak hip extensors
- Hip flexion contracture
Q: What is one thing pts. can do that can effect their gait?
Change their shoes - altered heel height
Q: Which leg should an amputee start their gait with?
Sound leg
The prosthesis is like a pendulum, its easier to start a pendulum from a pulled back position as opposed to the bottom of the swing
Q: What are two types of uneven timing?
- Short Prosthetic Step
- Long Prosthetic Step
Content: AKA: Prosthetic Cause of Short Prosthetic Step (5)
- Socket Pain
- Weak extension aid
- Unstable knee
- Excessive DF
- Poor suspension
Content: AKA: Amputee Cause of Short Prosthetic Step (3)
- Patient Insecurity
- Weak hip muscles
- Poor balance
Content: AKA: Prosthetic Cause of Long Prosthetic Step (3)
- Excessive PF
- Insufficient initial socket flexion
- Long toe lever arm
Content: AKA: Amputee Cause of Long Prosthetic Step (3)
- Flexion contracture
- Patient insecurity
- Pain on sound side
Content: AKA: Prosthetic Cause of Lateral Shift (2)
- Prosthetic foot too far inset
- Excessive socket adduction
Content: AKA: Amputee Cause of Lateral Shift (2)
- Weak hip abductors
- Narrow gait base
Content: AKA: Prosthetic Cause of Lateral Trunk Bend (4)
- Foot too far outset
- Ineffective lateral socket containment
- High medial wall
- Aligned in Abd
Content: AKA: Amputree Cause of Lateral Trunk Bend (4)
- Habit
- Inadequate balance
- Abd contracture
- Short residual limb
Content: AKA: Prosthetic Cause of Toe Drag (3)
- Long prosthesis
- Excessive PF
- Excessive knee friction
Content: AKA: Amputree Cause of Toe Drag (4)
- Weak hip flexors
- Weak hip abd on sound side
- Poor posture
- Poor gait habits
Q: What are the 4 factors of Gait?
- Patient
- Prosthetic alignment
- Socket fit
- Rehab teamwork
Q: When are patients typically fit for prosthetics?
anywhere from 4 (early) to 8 wks, sometimes 12 wks
Content: BKA: Prosthetic Causes of Drop Off (with excess knee flexion) (4)
- Short toe lever
- Excessive socket flexion - throws torso forward
- Excessive DF
- Incorrect foot type (ex. keel not firm enough)
Content: BKA: Amputee Cause of Drop Off (with excess knee flexion) (3)
- Gait Habit
- Weak Quads
- Knee Flexion Contracture
Content: BKA: Prosthetic Cause of Vaulting (4)
- Long prosthesis
- Poor suspension
- Excessive PF
- Excessive knee resistance/stability
Content: BKA: Amputee Cause of Vaulting (3)
- Gait habit - fear of catching toe
- Weak hip flexors on residual limb
- Improper initiation of hip flexors on residual limb
Content: BKA: Prosthetic Cause of Wide Gait (2)
- Prosthetic foot too far outset
- Excessive socket adduction
Content: BKA: Amputee Cause of Wide Gait (3)
- Gait Habit
- Insecurity, wants to widen base in attempt to increase stability
- Weak ML knee control
Content: BKA: Prosthetic Cause of Lateral Shift (3)
- Foot too far inset
- Insufficient socket adduction
- Short prosthesis
Content: BKA: Amputee Cause of Lateral Shift (3)
- Inadequate balance
- Weak knee
- Narrow gait base
Content: BKA: Long Prosthesis (5)
- LBP
- Feel like walking up a hill
- Noticeable rise and drop of shld on effected side
- Hesitation in gait timing from prosthetic mid-stance to sound side heel strike
- Pain in hip on amputated side - taking more pressure
Content: BKA: Short Prosthesis (6)
- LBP
- Feel like stepping in a hole
- Noticeable rise and drop of shld on the sound side
- Uneven arm motion to accommodate uneven stride length
- Appears like patient may be vaulting
- Hip pain on sound side
Content: BKA: External Foot Rotation (7)
- Pt. wants foot to match sound side
- IR of knee at toe off
- Induces “medial whip”
- Drop off at end of stance phase
- LBP
- Skin irritation due to rotational stress in socket
- Mid stance falling over foot (valgus thrust)
