Prosthetic Gait Deviations Flashcards
List some possible gait deviations that can be observed in TTA?
- Excessive knee extension
- Knee Instability
- Hip drop
- Lateral thrust
- Wide based gait
- Drop-off/Knee Instability
- Vaulting
- Pistoning
- Uneven Step length
- Circumduction
List gait deviations that are observed in TTA during stance phase?
- Excessive knee extension
- Knee instability
- Hip drop
- Lateral thrust
- Wide based gait
- Drop off/knee instability
describe the gait deviation excessive knee extension (TTA)
knee joint is fully extended at IC, and stays that way through early stance phase
observed in the sagittal plane
what are some causes for the excessive knee extension gait deviation (TTA)
- Prosthetic causes
- socket aligned too far posterior/foot aligned too far anterior
- heel too soft
- insufficient socket flexion
- Patient causes
- weak musculature around knee
- locking knee to prevent fall
describe the gait deviation “knee instability” observed in TTA
knee joint appears unstable duringly early stance phase
view in sagittal plane
might notice shortened stance phase on prosthetic side during gait (don’t confuse this with drop-off)
looks like pt is stepping into a hole
what are some causes of the gait deviation knee instability in TTA?
- Prosthetic causes:
- socket aligned too far anterior/foot aligned too far posterior
- heel too firm
- excessive foot DF
- Patient causes
- weak quads
- knee flexion contracture
describe the gait deviation hip drop observed in TTA
pelvic drop toward prosthetic side during MSt
view in frontal plane
might occur as a compensation to offload a painful area of the residual limb
what are some causes of the gait deviation, hip drop, observed in TTA?
- Prosthetic causes
- prosthesis too short
- Patient causes
- residual limb pain
describe the gait deviation Lateral Thrust, observed in TTA
narrow BOS with lateral thrust of the socket during MSt excessive varus thrust at knee
can be difficult to see - might look like compensated/uncompensated Trendelenburg
look at proximal pylon → will be lateral leaning
pt complains of proximal medial and distolateral skin breakdown/pain
what are some causes of the gait deviation Lateral Thrust observed in TTA?
- Prosthetic causes:
- foot too far inset
- laterally leaning pylon
- Patient causes:
- glute med weakness
- knee ligament insufficiency
what are some causes of the gait deviation Wide Based Gait observed in TTA?
- Prosthetic causes:
- outset foot
- medial leaning pylon
- Patient causes:
- insufficient weight shift
- hip abduction tightness
- patient fear
describe the gait deviation, drop-off/knee instability, observed in TTA
early and excessive knee flexion during TSt
pt appear to be falling off prosthetic at TSt and the knee looks like it buckles during the transition from TSt to ISw
non-prosthetic side might not achieve full IC/LR and instead have foot flat as they are “catching themselves”
what are some causes of the gait deviation, drop-off/knee instability, observed in TTA?
- Prosthetic causes:
- socket aligned too far anterior/foot too far posterior
- inappropriate foot choice
- Patient causes:
- knee flexion contracture
List gait deviations that are observable during swing phase in TTA
- Vaulting
- Pistoning
- Uneven step length
- Circumduction
describe the gait deviation, Vaulting, observed in TTA
excessive PF of sound limb during MSt to clear prosthetic foot
view in frontal plane
essentially doing a calf raise with every step
what are some causes of the gait deviation, Vaulting, observed in TTA?
- Prosthetic causes:
- prosthesis too long
- long toe lever arm
- socket too far posterior
- Patient causes:
- holding knee in extension too long
what is pistoning?
loss of suspension
viewed in sagittal plane (or any plane)
what are some causes of pistoning?
- Prosthetic causes:
- socket too large
- not enough socks
- Patient causes:
- volume changes (decrease in volume throughout the day)
- not enough socks
what are some causes for uneven step length in TTA?
insufficient gait training
decreased patient confidence
describe the gait deviation, Circumduction, observed in TTA
pt swings leg around in abducted position to advance it forward
demonstrated more commonly in TFA
TTA tend to lock out knee making a functionally longer limb that is difficult to progress through gait
what are some causes for the gait deviation, Circumduction, observed in TTA?
- Prosthetic causes:
- poor suspension
- prosthesis too long
- Patient causes:
- feeling of instability
- decreased knee flexion during swing
What are some main takaways from the TTA gait deviation lecture?
- any gait deviation is going to have an impact on gait efficiency and work
- analyze gait from multiple viewpoints to catch deviations
- patients may have a combo of deviations
- recognize when a deviation is out of your control and refer appropriately
- treat impairments when possible
List gait deviations observed in TFA
- Terminal Impact
- Foot slap
- Knee Instability
- Lateral Trunk Bend
- Abducted gait
- Excessive Trunk Extension
- Drop off
- Excessive heel rise
- Circumduction
- Vaulting
- Medial Whip
- Lateral Whip
describe the gait deviation, Terminal Impact, observed in TFA
forceful and excessive knee extension, usually audible
observed in sagittal plane
from IC/LR
what are some causes for the gait deviation Terminal Impact (TFA)?
- Prosthetic cause
- inadequate knee friction
- Patient cause
- fear of knee giving way
- forceful hip flexion
describe the gait deviation, Foot Slap, observed in TFA
accelerated PF at heel strike resulting in the foot getting flat to the floor too soon
IC/LR
observed in sagittal plane
what are some causes for the gait deviation Foot Slap (TFA)
- Prosthetic causes:
- PF bumper too soft
- Patient causes
- increased hip extension force at IC
describe the gait deviation, knee instability, observed in TFA
knee giving way in early stance phase
observed in IC/LR in sagittal plane
what are some potential causes of the gait devitation, Knee Instability observed in TFA
- Prosthetic causes
- knee axis too far anterior
- socket too far posterior
- lack of socket flexion
- Patient causes
- inadequate hip extension ROM
- hip flexion contracture
what are some causes of the gait deviation lateral trunk bend observed in TFA?
- Prosthetic causes
- socket too abducted
- prosthesis too short
- medial socket wall too high
- Patient causes
- pain
- glute med weakness
- decreased balance
- adductor roll
describe the gait deviation, Lateral Trunk Bend, observed in TFA
excessive lateral lean during stance phase
might have a decrease in contact with lateral wall of the socket which will decrease the ability of the glute to stabilize the pelvis
observed in MSt, in frontal plane
describe the gait deviation, abducted gait, observed in TFA
excessive hip abduction during stance leading to a wide based gait pattern
observed in MSt in the frontal plane
what are some causes of abducted gait?
- Prosthetic causes
- foot/leg too far outset
- prosthesis too long
- medial socket wall too high
- lateral wall not adducted enough
- Patient causes
- abduction contracture
- lateral-distal RL pain
- decreased balance/trying to incr BOS
- adductor roll
describe the gait deviation, Excessive Trunk Extension, observed in TFA
excessive lumbar lordosis during stance or a posterior trunk lean
observed in MSt in sagittal plane
what are some causes of excessive trunk extension?
- Prosthetic causes
- increased socket extension
- not enough flexion build into socket
- Patient causes
- weak hip extensors
- weak abdominals
- hip flexion contracture
describe the gait deviation drop off (TFA)
sudden and excessive knee flexion during late stance phase
observed in TSt in sagittal plane
what are some causes of the gait deviation drop off?
- Prosthetic causes
- short toe lever
- socket set too posterior to knee axis
- Patient causes
- N/A
describe the gait deviation excessive heel raise (TFA)
prosthetic heel rises excessively (both in distance and velocity)
observed in PSw → Sw in sagittal plane
what are some causes for the gait deviation excessive heel raise?
- Prosthetic causes:
- insufficient knee friction
- Patient causes:
- early forceful hip flexion
describe the gait deviation Circumduction (TFA)
user swings leg in a circular motion laterally to advance it during swing
observed in Sw in frontal plane
what are some potential causes of the gait deviation circumduction (TFA)?
- Prosthetic cause
- prosthesis too long
- inadequate suspension
- excessive knee friction
- Patient cause
- hip flexor weakness
- hip abduction contracture
- fear
describe the gait deviation Vaulting observed in TFA
excessive PF of the sound limb to clear the prosthetic limb
observed in Sw in frontal plane
looks like they are doing a calf raise with every step
what are some potential causes of the gait deviation: Vaulting
- Prosthetic cause
- Prosthesis too long
- inadequate suspension
- excessive knee friction
- Patient cause
- hip flexor weakness
- hip abduction contracture
- fear
describe the gait deviation Medial Whip (TFA)
medially directed whipping motion of the prosthesis
observed in Sw in frontal/transverse plane
what are some potential causes of the gait deviation Medial Whipping?
- Prosthetic causes
- ER of knee compartment
- improper alignment of knee bit
- Patient causes
- improper donning
describe the gait deviation, Lateral Whip (TFA)
laterally directed whipping motion of the prosthesis
observed in Sw in frontal/transverse plane
what are some potential causes of the gait deviation Lateral Whip?
- Prosthetic cause
- IR of knee component
- improper alignment of knee bit
- Patient cause
- improper donning
What TFA gait deviations are observed in stance phase?
- Terminal Impact
- foot slap
- knee instability
- lateral trunk bend
- abducted gait
- excessive trunk extension
- drop off
- excessive heel raise
what TFA gait deviations are observed in swing phase?
- circumduction
- vaulting
- medial whip
- lateral whip
what is the relationship between # of prosthetic components and deviations?
more components = increased likelihood of deviations
