Transfemoral Gait Deviations Flashcards
What are the causes of rotation of the prosthetic foot at initial contact? (1 amputee, 2 prosthetic)
Amputee:
1. Too vigorous extension of knee
Prosthetic:
- Heel cushion too firm/ too hard PF bumper
- Loose socket
What are the causes of instability of the prosthetic knee? (3 amputee, 4 prosthetic)
Amputee:
- Weak hip extensors
- Significant flexion contracture
- Lack of gait training
Prosthetic:
- Alignment instability (too far anterior to TKA line)
- Too firm heel cushion/PF bumper
- Insufficient flexion in socket
- Heel too high or excessive dorsiflexion
In what stage of gait are we concerned about instability of the prosthetic knee?
Initial contact to loading response
What are the causes of foot slap?
Amputee:
1. Forceful driving of prosthesis into ground to ensure knee stability
Prosthetic:
1. Posterior bumper too soft
In which stage of gait are we concerned about foot slap?
Initial contact to loading response
What are the causes of ipsilateral bending of the trunk? (5 amputee, 4 prosthetic)
Amputee:
- Very short residual limb
- Habit/fear/poor balance
- Weak abductors
- Abduction contracture
- Habit or poor gait training (inadequate weight shifting)
Prosthetic:
- Too short
- Lateral wall allows too much abduction of femur
- Foot outset
- Distal lateral residual limb pain
What gait deviation does crotch pressure cause?
Contralateral bending of the trunk
In what phase of gait are we concerned about ipsilateral bending of the trunk?
Midstance
What can cause drop-off at the end of stance?
Amputee:
None
Prosthetic:
- Inadequate limitation of dorsiflexion
- Too soft dorsiflexion bumper
- Toe break too far posterior
- Socket too anterior on pylon
- Foot too posterior
What can cause excessive heel rise? (1 amputee, 3 prosthetic)
Amputee:
1. Forcible hip flexion
Prosthetic:
- Insufficient friction at knee
- Inadequate extension aid
- Improper knee selection
When are we concerned about excessive heel rise?
Initial swing
What can cause excessive pistoning?
Amputee:
1. May occur with large, flabby residual limb with poor muscular control
Prosthetic:
1. Patient not seated in socket (socket too big or improperly donned)
What can cause a lateral whip?
Amputee:
1. Improper donning
Prosthetic:
1. Too much IR at knee
What can cause a medial whip?
Amputee:
1. Improper donning
Prosthetic:
- Too much ER at knee
- Too loose socket
In what stage of gait are we concerned about whips?
Initial swing
In what stage of gait are we concerned about pistoning?
Initial swing
What can cause vaulting? (4 amputee, 4 prosthetic)
Amputee:
- Habit
- Poor balance/poor knee control (such as weak hip extensors)
- Fear of stubbing prosthetic toe
- Weak hip flexors or improper gait training for initiation of flexion
Prosthetic:
- Too long
- Inadequate suspension
- Too much knee friction leading to insufficient knee flexion
- Excessive built in knee stability (such as knee joint too far posterior to TKA line)
In what stage of gait are we concerned with vaulting?
Midswing
What can cause circumduction? (3 amputee, 1 prosthetic)
Amputee:
- Habit
- Weak hip extensors
- Insecurity regarding knee control
Prosthetic:
1. Too much stability at knee joint (too much friction or too far posterior to TKA line)
In what stage of gait are we concerned about circumduction?
Midswing
What causes abduction gait? (4 amputee, 3 prosthetic)
Amputee:
- Abduction contracture
- Habit
- Fear (such as from weak hip extensors)
- Residual limb pain “crotch pressure”
Prosthetic:
- Too long
- Too high medial wall
- Too much foot outset or valgus alignment between shank and socket may mimic this
What does an abducted gait cause?
Excessive distal, lateral pressure
In what phase of gait are we concerned with abducted gait?
Midswing
What can cause terminal impact? (2 amputee, 2 prosthetic)
Amputee:
- Intentional to get an audible click
- Too vigorous hip flexion followed by too strong hip extension
Prosthetic:
- Insufficient friction at knee
- Too strong extension aid
In what phase of gait are we concerned with terminal impact?
Terminal swing
What causes uneven timing/short prosthetic stance? ( 3 amputee, 5 prosthetic)
Amputee:
- Weakness/unstable knee
- Poor balance/insecurity
- Pain
Prosthetic:
- Socket fits poorly causing pain
- Alignement instability
- Excessive dorsiflexion
- Poor suspension
- Unaccommodated hip flexion contracture
What causes uneven arm swing?
Amputee:
1. Habit/poor balance/insecurity
Prosthetic:
- Occasionally due to stump pain
- Inadequate suspension
What gait deviations can too firm of a heel cushion cause?
- Rotation of the prosthetic foot during initial contact
2. Instability of prosthetic knee during initial contact
What gait deviations can too hard of a plantarflexion bumper cause?
- Rotation of the prosthetic foot during initial contact
2. Instability of the prosthetic knee during initial contact
What gait deviations can weak hip extensors cause?
- Instability of prosthetic knee during initial contact to loading response
- Vaulting during midswing
- Circumduction during midswing
- Abducted gait during midswing
- Short prosthetic stance/uneven timing
What gait deviations can alignment instability cause?
- Instability of the prosthetic knee during initial contact to loading response
- Short prosthetic stance/uneven timing
What gait deviations can excessive dorsiflexion cause?
- Instability of prosthetic knee during initial contact
- Drop off at terminal stance
- Uneven timing/short prosthetic stance
What gait deviations can habit cause?
- Ipsilateral bending of trunk during midstance
- Vaulting during midswing
- Circumduction during midswing
- Abducted gait during midswing
- Uneven arm swing
What can poor balance cause?
- ipsilateral bending of the trunk during midstance
- Vaulting
- Uneven timing/short prosthetic stance
- Uneven arm swing
What gait deviations can an abduction contracture cause?
- Ipsilateral trunk lean
2. Abducted gait during midswing
What gait deviations can insufficient knee friction cause?
- Excessive heel rise in initial swing
2. Terminal impact in terminal swing
What can improper donning of the socket cause?
- Excessive pistoning during initial swing
- Lateral whip
- Medial whip
What gait deviations can too long of a prosthesis cause?
- Vaulting
- (Circumduction)
- Abducted gait during midswing
What gait deviations can a hip flexion contracture cause?
- Flexion moment of prosthetic knee at initial contact
2. Short prosthetic stance/uneven timing
What gait deviations can inadequate suspension cause?
- Vaulting
- Short prosthetic stance
- Uneven arm swing
What gait deviations can excessive knee friction cause?
- Vaulting
2. Circumduction
What gait deviations can excessive stability of the knee joint cause?
- Vaulting
2. Circumduction
What gait deviations can pain cause?
- Abducted gait during midswing
- Short prosthetic stance/uneven timing
- Uneven arm swing
- Ipsilateral trunk lean
