Transtibial Gait Deviations Flashcards
What are causes of a hyperextension moment at the knee? (2 amputee, 5 prosthetic)
Amputee:
- Weak quads
- Too forceful quad contraction
Prosthetic:
- Too soft/too low heel cushion
- Too low a shoe heel
- Posterior leaning pylon
- Foot too anterior=short heel lever
- Foot too plantarflexed
In what part of gait are we concerned about a knee hyperextension moment?
Initial contact to loading response
What are causes of a flexion moment at the knee? (2 amputee, 6 prosthetic)
Amputee:
- Unaccommodated knee flexion contracture
- Weak quads
Prosthetic:
- Too hard heel cushion
- Too high shoe heel
- Anterior leaning pylon (socket flexed greater than 5 to 15 degrees)
- Foot too posterior=long heel lever
- Foot too dorsiflexed
- Excessive Pressure against distal, anterior tibia
In what part of gait are we concerned about a flexion moment in the knee?
Initial contact to loading response
What are the causes of external rotation of the prosthesis? (1 amputee, 2 prosthetic)
Amputee:
1. weak internal rotators
Prosthetic:
- Too hard or too high a heel cushion
- Too much toe out
In what part of stance are we concerned about external rotation of the prosthesis?
Initial contact to loading response
What are the causes of abducted gait? (1 amputee, 2 prosthetic)
Amputee:
1. Habit
Prosthetic:
- Pylon too long
- Outset foot may mimic this
In what phase of gait are we most concerned about abducted gait?
Midstance
What are the causes of a trunk lean? (1 amputee, 4 prosthetic)
Amputee:
1. Weak abductors
Prosthetic:
- Too short or too long
- Outset foot
- Improper socket fit causing pain
- Medial leaning pylon
In what phase of gait are we concerned about a trunk lean?
Midstance
What are the causes of a valgus moment at the knee?
Amputee:
None
Prosthetic:
1. Outset foot
What are the causes of a varus moment at the knee?
Amputee:
None
Prosthetic:
1. Inset foot
In what stage of gait are we concerned about valgus/varus moments at the knee?
Midstance
What causes walking on the lateral border of the foot?
Amputee:
None
Prosthetic:
1. Laterally leaning pylon
What causes walking on the medial border of the foot?
Amputee:
None
Prosthetic:
1. Medially leaning pylon
In what stage of gait are we most concerned with walking on the borders of the foot?
Midstance
What causes decreased stance time? (2 amputee, 1 prosthetic)
Amputee:
- Inadequate weight bearing
- Poor balance
Prosthetic:
1. Pain from socket
What causes a Trendelenburg gait?
Amputee:
- Weak hip abductors
- Poor balance
Prosthetic:
None
in what stage of gait are we concerned about a Trendelenburg gait?
Midstance
What causes a drop-off? (1 amputee, 3 prosthetic)
Amputee:
1. Habit
Prosthetic:
- Toe lever too short (foot too posterior, keel too short)
- Excessive socket flexion
- Excessive dorsiflexion
In what stage of gait are we concerned about a drop-off?
Terminal stance to pre-swing
What causes delayed knee flexion? (2 amputee, 2 prosthetic)
Amputee:
- Poor pelvic control
- Weak knee flexors
Prosthetic:
- Foot too anterior
- Excessive plantarflexion
In what phase of gait are we concerned about delayed knee flexion?
Terminal stance to pre-swing
What can cause a shortened prosthetic stride length/shorter prosthetic swing? ( 1 amputee, 3 prosthetic)
Amputee:
1. Knee flexion contracture
Prosthetic:
- Anterior leaning pylon
- Pylon too short
- Inadequate suspension
What are the causes of inability for the leg to clear the floor?
Amputee:
None
Prosthetic:
- Prosthesis too long
- Inadequate suspension
What are the causes vaulting? (2 amputee, 3 prosthesis)
Amputee:
- Habit or fear of catching toe
- Improper gait training for initiation of hip flexion
Prosthetic:
- Prosthesis too long
- Inadequate suspension
- Excessive plantarflexion
What can cause a lateral whip? (1 amputee, 1 prosthetic)
Amputee:
1. Improperly donned (rotated)
Prosthetic:
1. Internally rotated socket
What can cause a medial whip? (1 amputee, 1 prosthetic)
Amputee:
1. Improperly donned (rotated)
Prosthetic:
1. Externally rotated socket
In what phase of gait are we concerned about lateral and medial whips?
Initial swing to terminal swing
What can cause pistoning?
Amputee:
None
Prosthetic:
- Socket too loose
- Improperly donned
In what stage of gait are we concerned mainly about pistoning?
Swing
What gait deviations can result from too hard or too high of a heel cushion?
- Flexion moment at the knee during Initial contact to loading response
- External rotation of the prosthesis during initial contact to loading response
What gait deviations can result from an anterior leaning pylon?
- Flexion moment at the knee during initial stance to loading response
- Shorted prosthetic stride length/short prosthetic swing
What gait deviations can result from a too far posterior foot?
- Flexion moment at the knee during initial contact to loading response
- Drop-off in terminal stance to preswing
What gait deviations can result from a too far anterior foot?
- Hyperextension moment at the knee during initial contact to loading response
- Delayed knee flexion in terminal stance to preswing
What gait deviations can result from a foot that is too plantarflexed?
- Hyperextension moment of the knee during initial contact to loading response
- Delayed knee flexion in terminal stance to preswing
- Vaulting in swing
What gait deviations can result from a foot that is too dorsiflexed?
- Flexion moment of the knee during initial contact to loading response
- Drop-off in terminal stance to preswing
What gait deviations are related to habit?
- Abducted gait
- Drop off
- Vaulting
What gait deviations are related to a socket with too much initial flexion?
- Flexion moment of the knee during initial stance to loading response
- Drop off in terminal stance to preswing
What gait deviations can result from a pylon/prosthesis that is too long?
- Abducted gait during midstance
- Inability to clear the floor
- Vaulting during swing
- Trunk leaning during midstance
What gait deviations can result from a pylon/prosthesis that is too short?
- Trunk leaning during midstance
2. Shorted prosthetic stride length (short prosthetic swing)
What gait deviations can result from an outset foot?
- Abducted gait appearance during midstance
- Trunk leaning during midstance
- Valgus moment at the knee during midstance
What gait deviations can result from a medially leaning pylon?
- Trunk leaning during midstance
2. Walking on medial border of foot during midstance
What gait deviations can result from poor balance?
- Decreased stance time
2. Trendelenburg gait during midstance
What gait deviations can result from inadequate suspension?
- Vaulting
- Inability to clear the floor
- Shortened prosthetic stride/swing
What gait deviations can result from improperly donning a socket?
- Lateral/medial whip
2. pistoning