TFA Chart

Question 1

Knee is too far anterior to TKA line
Increased dorsiflexion
Stiff heel cushion (too hard or too high)
Foot does not have adequate heel rocker
Heel lever too long
Insufficient socket flexion
Suspension too loose or ant/post diameter too small

Answer 1

knee instability

Question 2

Shoe changed (heel too high)
Hip flexion contracture
Weak hip extensors

Answer 2

knee instability

Question 3

Anterior or medial brim pressure
Heel too hard or too high
Too much built in toe out
Socket too loose
Too much pressure over tensor

Answer 3

foot rotation

Question 4

Patient extends limb too forcefully at initial impact
Changed shoe to stiffer heel
Poor residual limb muscle control
Poor pelvic control

Answer 4

foot rotation

Question 5

Too soft heel cushion or bumper
Foot simulation of heel rocker too soft

Answer 5

Foot Slap &
Forceful Impact of heel with floor

Question 6

Patient drives prosthesis into ground too forcefully
Lack of confidence
Inadequate training

Answer 6

Foot Slap &
Forceful Impact of heel with floor

Question 7

Excessive dorsiflexion
Excessive socket flexion

Answer 7

Ball of foot is >1.5” from floor

Question 8

prosthetic stride too long

Answer 8

Ball of foot is >1.5” from floor

Question 9

Prosthesis too long
Foot outset
Medial leaning pylon
Limb not seated into socket
Medial wall too high
Improper relief of femur at distal femur
Pelvic band not proper shape or too far from body

Answer 9

abducted gait

Question 10

Poor midline perception
Sound limb adducted
Too many ply socks or Limb is edematous
Abduction contracture
Insecurity or habit
Poor midline perception
Sound limb adducted
Too many ply socks or Limb is edematous
Abduction contracture
Insecurity or habit
Poor balance
Weak hip extensors or weak hip adductors
Hip flexor contracture

Answer 10

abducted gait

Question 11

Prosthesis too short
Outset foot
Medial-lateral socket diameter too large
Lateral leaning pylon / abducted socket
Too high medial wall / ramus pressure
Improper lateral wall contouring causing pressure

Answer 11

Lateral leaning of trunk towards prosthesis or
Trendelenburg / Duchenne

Question 12

Weak hip abductors/gluteus medius
Fear or habit
Pain / Inability to bear weight
Abducts foot & shifts weight with upper body
Very short residual limb
Hip abduction contracture

Answer 12

Lateral leaning of trunk towards prosthesis or
Trendelenburg / Duchenne

Question 13

Inadequate socket adduction
Lateral leaning pylon / socket abducted
Inadequate support to lateral side esp. distally
Outset foot

Answer 13

excessive drop of pelvis on sound side

Question 14

weak hip abductors

Answer 14

excessive drop of pelvis on sound side

Question 15

Inset foot
Medial leaning pylon / socket adducted
Excessive medial-lateral socket diameter

Answer 15

lateral gapping of socket

Question 16

adducted gait
short residual limb

Answer 16

lateral gapping of socket

Question 17

Abducted socket / lateral leaning pylon
Inverted foot

Answer 17

Walking on lateral border of foot*

Question 18

adducted gait on prosthetic side

Answer 18

walking on lateral border of foot

Question 19

Adducted socket / medial leaning pylon
Everted foot

Answer 19

walking on medial border of foot

Question 20

abducted gait

Answer 20

walking on medial border of foot

Question 21

Pain from socket
Knee bolt is higher or lower than anatomical knee

Answer 21

decreased stance duration

Question 22

Inadequate weight bearing
Poor balance
Bad habit

Answer 22

decreased stance duration

Question 23

Posterior leaning pylon (insufficient socket flexion)
Prosthesis too long
Toe lever too long / Forefoot too stiff
Foot too plantar flexed

Answer 23

pelvic rise

Question 24

Bad habit /does not trust flexing knee
Intentional as patient fears knee flexion
Poor pelvic control
Changed heel height to too low

Answer 24

pelvic rise

Question 25

Anterior leaning pylon (Too much socket flexion) Toe lever too short / forefoot too soft Foot too dorsiflexed Knee too anterior on TKA line

Answer 25

drop off

Question 26

Hip &/or knee flexion contracture Heel height too high Hip &/or knee extensor weakness Sound side stride length too long

Answer 26

drop off

Question 27

loose suspension

Answer 27

early piston action

Question 28

Improper donning Too few ply socks / decreased volume of limb

Answer 28

early piston action

Question 29

foot too plantar flexed

Answer 29

early heel rise

Question 30

knee and/or hip flexion contracture

Answer 30

early heel rise

Question 31

Knee too posterior on TKA line Posterior leaning pylon Knee friction too strong

Answer 31

inadequate knee flexion

Question 32

Fear Decreased hip ROM

Answer 32

inadequate knee flexion

Question 33

Knee friction too soft / low Insufficient socket flexion Foot set in too much plantar flexion

Answer 33

early heel rise with excessive knee flexion

Question 34

Hip flexion contracture Sound side stride length too long Excessive hip flexion to initiate swing

Answer 34

early heel rise with excessive knee flexion

Question 35

Foot set in dorsiflexion Forefoot too soft Knee is too posterior to TKA line Hydraulic knee too viscous or friction too strong Toe lever too long

Answer 35

late heel rise delay in initation of swing phase

Question 36

Sound side stride length too short No pelvic rotation to initiate swing

Answer 36

late heel rise delay in initiation of swing phase

Question 37

insufficient knee friction

Answer 37

excessive heel rise

Question 38

too strong hip flexioncontracture

Answer 38

excessive heel rise

Question 39

excessive knee friction

Answer 39

insufficient heel rise

Question 40

insecurity/fear habit

Answer 40

insufficient heel rise

Question 41

inadequate suspension socket too large

Answer 41

excessive piston action

Question 42

too few ply socks Improper donning / suspension too loose Non-muscular (flabby) limb Poor muscle control

Answer 42

excessive piston action

Question 43

insufficient knee friction

Answer 43

terminal impact

Question 44

Too vigorous hip flexion followed by strong hip extension Patient uses as cue to know knee is extended

Answer 44

terminal impact

Question 45

Prosthesis too long Inadequate suspension / pistoning Inadequate socket flexion / posterior leaning pylon Foot is too plantarflexed Too much friction leading to inadequate knee flexion Toe lever too long so does not flex knee Medial wall pressure / pain

Answer 45

Vaulting Circumduction Toe drag or stubbing Hip Hiking

Question 46

Improper donning Limb not seated in socket / too many ply socks Weak hip flexion Inadequate knee &/or hip flexion Bad habit Walking faster than friction of knee unit No pelvic rotation to initiate swing Gluteus medius weakness on non-amputated side Fear of stubbing toe or ability to control knee

Answer 46

Vaulting Circumduction Toe drag or stubbing Hip Hiking

Question 47

Medial: Knee bolt too externally rotated Varus knee alignment Lateral: Knee bolt internally rotated Valgus knee alignment Inadequate suspension Socket too tight / not seated in socket

Answer 47

lateral or medial whip

Question 48

Improperly donned socket Inadequate ply socks Bad habit Selesian belt too tight Poor muscle control Flabby, non-muscular limb

Answer 48

lateral or medial whip

Question 49

Prosthesis too short Anterior leaning pylon

Answer 49

prosthetic stride length is too short

Question 50

Heel height too high Hip flexion contracture on contralateral side Pelvic retraction

Answer 50

prosthetic stride length is too short

Question 51

Prosthesis too long Posterior leaning pylon

Answer 51

prosthetic stride length is too long

Question 52

Heel height too low Knee flexion contracture on contralateral side Hip flexion contracture on amputated side Stance phase too short duration Prosthesis too long (could be too many ply socks)

Answer 52

prosthetic stride length is too long

Question 53

improper socket design causing pain

Answer 53

uneven arm swing

Question 54

Bad habit / fear Insecurity in Weight bearing Uneven timing Unequal stride length Poor balance

Answer 54

uneven arm swing