Transtibial Gait

Question 1

What may be the prosthetic cause of excessive knee extension?

Answer 1

• socket aligned too far posterior or foot aligned too far anterior
• heel too soft
• insufficient socket flexion

Question 2

What may be the patient cause of excessive knee extension?

Answer 2

• weak musculature around knee (weak quads)

- locking knee to prevent fall

Question 3

What may be the prosthetic cause to knee instability in early stance phase?

Answer 3

• socket aligned too far anterior or foot aligned too far posterior
• heel to firm (if foot is too firm, the only way to get foot to the ground is to flex the knee)
• excessive foot DF

Question 4

What may be the patient cause to knee instability in early stance phase?

Answer 4

• weak quads (knee doesn’t extend all the way)

- knee flexion contracture

Question 5

What may be the prosthetic cause of lateral thrust during midstance? What does this cause at the knee?

Answer 5

• foot too far inset
• laterally leaning pylon (proximal part leaning out)

causes excessive varus thrust at the knee

Question 6

What may be the patient cause of lateral thrust during midstance? What does this cause at the knee?

Answer 6

• glute med weakness (contralateral side hip drop)

- knee ligament insufficiency (LCL issues because of varus thrust)

Question 7

What may be the prosthetic cause to a wide based gait? What does this cause at the knee? Where is the pressure located?

Answer 7

• outset foot
• medial leaning pylon

causes valgus at the knee

pressure is proximal lateral and distal medial

Question 8

What may be the prosthetic causes of drop off in terminal stance?

Answer 8

• socket aligned too far anterior or foot too far posterior

- inappropriate foot choice (keel too short which causes toe break too early)

Question 9

What may be the patient causes of drop off in terminal stance?

Answer 9

• knee flexion contracture

Question 10

What may be the prosthetic cause to vaulting during swing phase?

Answer 10

• prosthesis too long
• long toe lever arm (long keel)
• socket too far posterior (foot too far anterior)
• poor fitting prosthetic or poor sock management

Question 11

What may be the patient cause to vaulting during swing phase?

Answer 11

holding knee in extension for too long

Question 12

What is the only issue that will be seen on the sound side?

Answer 12

vaulting

Question 13

What should you look for in the residual limb if you suspect pistoning?

Answer 13

redness on the distal end of RL due to patient bottoming out

Question 14

What may be the prosthetic cause of pistoning?

Answer 14

• socket too large
• not enough socks
• poor suspension mechanism

Question 15

What may be the patient cause of pistoning?

Answer 15

• volume changes

- not enough socks

Question 16

What may be the prosthetic cause to circumduction?

Answer 16

• poor suspension

- prosthesis too long

Question 17

What may be the patient cause to circumduction?

Answer 17

• feeling of instability

- decreased knee flexion during swing