Transfemoral Gait Deviations

Question 1

Lateral Trunk Bending

Answer 1

Causes

1. Pain or discomfort in the crotch area (medial brim, adductor roll, skin issue). Attempt to gain relief by moving away from medial brim.
2. Weak or Contracted Hip Abductors
3. Prosthesis too long, difficult to place limb under hip during stance and to clear leg during swing
4. Shank aligned in valgus position with respect to the thigh section.
5. Feeling of insecurity. Amputee compensates by widening his walking base.
6. Mechanical hip joint set so that the socket is abducted

Question 2

Wide Walking Base (Abducted Gait)

Answer 2

Width of walking base is significantly greater than normal range 5 to 10 cm (2 to 4in)

1. Pain or discomfort in the medial brim area.
2. Contracted abductors.
3. Prosthesis too long.
4. Shanked aligned in valgus position with respect to the thigh section.
5. Feeling of insecurity.
6. Mechanical hip joint set so that the socket is abducted

Question 3

Circumduction

Answer 3

Prosthesis follows laterally curved line as it swings.

Causes- basically too long, amputee has to swing it to the side to clear the ground.

1. Prosthesis is too long
2. Insufficient flexion of the knee because of insecurity or fear.
3. Manual knee lock, excessive friction, or tight extension aid preventing the knee from flexing.
4. Inadequate suspension allowing prosthesis to drop (piston)
5. Too small a socket. IT is above its proper location.
6. Foot set in excessive plantarflexion.

Question 4

Vaulting

Answer 4

Amputee raises his entire body by early and excessive plantarflexion of the sound foot.

Causes

1. Insufficient friction in the prosthetic knee. In the normal pattern. Heel rise is excessive, shank takes a longer time to swing forward. Because of time lag, body no longer at maximum elevation as the prosthetic foot is at its lowest point in swinging through. Prosthetic foot would fail to clear the ground unless the amputee gained additional time and clearance by vaulting.
2. Excessive length of the prosthesis. Amputee vaults to gain additional clearance of the prosthetic foot during swing.

Question 5

Swing Phase Whips

Answer 5

Medial whip at toe off, heel moves medially

Lateral whip at toe off, heel moves laterally

Causes

1. Improper alignment of the knee unit in the transverse plane. Medial whip is caused by an externally rotated knee. Lateral whip is caused by internally rotated knee.
2. With a suction socket and no auxillary suspension, whips may be seen because of the following

Question 6

Foot Rotation at Heel Strike

Answer 6

As the heel contacts the ground, foot rotates laterally, sometimes with a voluntary motion

Cause

1. Too hard a heel cushion or plantarflexion bumper

Question 7

Foot Slap

Answer 7

Foot plantarflexes too rapidly and strikes the floor with a slap

Causes

Plantarflexion bumper is too soft and does not offer enough resistance too foot motion as weigh tis transferred to the prosthesis

Question 8

Uneven Heel Rise

Answer 8

Prosthetic heel rises higher than the sound heel

However, prosthetic heel can also rise less than the sound heel

Causes

1. Insufficient friction at the prosthetic knee
2. Insufficient extension assist or absence of an extension aid
3. Forceful hip flexion to ensure that the prosthetic knee will extended fully at heel strike

Question 9

Terminal Impact

Answer 9

Prosthetic shank comes to a sudden stop with a visible and audible impact as the knee reaches full extension

Causes

Insufficient friction at the prosthetic knee

Excessive extension assist

Absent or worn resilient extension bumper in the knee unit

Patient habit, fear of buckling causes him/her to extend the hip abruptly as knee reaches full extension, impact and sound provides feed back to amputee assuring them that knee is fully extended and will be stable for weight bearing

Question 10

Uneven step length

Answer 10

Prosthetic step length differs from the lenght of the step taken with the sound leg

Causes

Pain or insecurity causing the amputee to transfer quickly from the prosthesis to his sound leg

Hip flexion contracture or insufficient socket flexion. Restriction of hip extension range will be reflected by shorter step length on the sound side.

Insufficient or excessive friction in the prosthetic knee

Question 11

Exaggerated Lordosis

Answer 11

Lumbar lordosis is exaggerated when the prosthesis is in stance phase

Causes

1. Hip Flexion Contracture. Pelvis tilt forward because shortened
2. Insufficient socket flexion
3. Insufficient support form the anterior socket brim
4. Weak Hip Extensors. Extensors help restrain tendency of pelvis to tilt forward.
5. Weak Abdominal muscles