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Lower Extremity III > Week 2- TransTibial > Flashcards

Week 2- TransTibial Flashcards

1
Q

What is considered a very short Transtibial?

A

Less than three inches

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2
Q

What is considered a short Transtibial?

A

3-5 inches

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3
Q

What is considered a normal transtibial?

A

3-7 inches

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4
Q

What is considered a long transtibial?

A

Greater than 7 inches

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5
Q

What is a symes amputation?

A

Removal of the tibia and fibula above the malleoli and covering it with the heel pad.

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6
Q

What is an ankle disarticulation?

A

Does not cut through the periosteum but may adjust the pointiness of the tibia and fibula and wrap the heel pad around it.

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7
Q

What does PTB stand for

A

Patellar Tendon Bearing

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8
Q

What does TSB stand for?

A

Total Surface bearing

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9
Q

What are the pressure intolerant areas of a PTB socket?

A

Patella
Fib head
Distal end of fib and tib
Medial side of Tibial plateau

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10
Q

What are the pressure tolerant areas of a PTB?

A

The Patellar tendon bar

The length of the fibula and tibia

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11
Q

What shape does the PTB create?

A

A triangular shape

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12
Q

What are the indication for a PTB?

A 
Previous wearer
Extreme Atrophy 
Selective Hot Spots 
•  Neuromas 
•  Callusing
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13
Q

Where are the pressures during initial contact?

A

Has greater Distal anterior pressure

Greater Proximal posterior pressure

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14
Q

What are the pressures during Loading Response?

A

less pressure distally

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15
Q

What are the pressures during Terminal Stance?

A

More pressure proximal anterior and distal posterior

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16
Q

What should be the main goal of the socket?

A

Distribute pressures from intolerant areas to tolerant areas

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17
Q

What are the different types of support or interface options for PTB sockets?

A

Lines
Hard
Soft
Air Cushioned

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18
Q

What is an example of a lined interface for a PTB socket?

A

Pelite liner or similar

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19
Q

What is an example of a hard interface for a PTB socket?

A

Hard Plastic

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20
Q

What is an example of a soft interface for a PTB socket?

A

Distal pad

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21
Q

What is an example of a air cushioned interface for a PTB socket?

A

Flexible liner

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22
Q

What are the different types of suspension options for a PTB?

A

Cuff
Side Joint and Thigh Lacer
Supracondylar
Supracondylar/suprapatellar

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23
Q

What are examples of a cuff suspension for a PTB socket?

A

Leather or Dacron

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24
Q

What is an example of a supracondylar suspension for a PTB socket?

A

Supracondylar lateral brim-Fixed or removable medial wedge

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25
Q

What is an example of a supracondylar/suprapatellar suspension for a PTB socket?

A

Supracondylar lateral brim-Suprapatellar anterior brim

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26
Q

What is assumed for a TSB socket?

A

Even distribution of pressures

Total contact fit

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27
Q

What are the indication for a TSB socket?

A

Majority of Patients
Mild to Moderate Atrophy
Patients with Skin Conditions or considerations
Unstable volume or Edema

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28
Q

What does a TSB often involve?

A

A gel liner

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29
Q

Which socket should be used when the patient has a very short fibular compared to Tibia?

A

PTB

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30
Q

Which socket should be used when the patient has a bulbous end?

A

TSB

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31
Q

What is the definition of a flexed socket?

A

The Proximal socket moves anterior in relation to the distal end

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32
Q

What is the definition of an abducted socket?

A

The distal end of the limb is in an abducted position. The lower leg of the prosthesis will compensate.

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33
Q

Where should the foot be in relation to the blumbob line?

A

12mm or 1/2 inch inset or directly under line.

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34
Q

What is the bench alignment for the foot bolt?

A

1 inch anterior to the midline of the lateral brim of the socket

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35
Q

What is the bench alignment of flexion?

A

5-10 degrees of flexion

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36
Q

What is the bench alignment for adduction?

A

2-5 degrees of adduction

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37
Q

What produces a flexion moment of the knee?

A

Force proximal posterior and distal anterior

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38
Q

What produces a varus moment of the knee?

A

Force proximal lateral and distal medial

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39
Q

What produces an extension moment at the knee?

A

Force distal posterior and proximal anterior

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40
Q

What produces a valgus moment at the knee?

A

Force distal lateral and proximal medial

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41
Q

What moment at the knee is desired at midstance?

A

Varus moment at the knee

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42
Q

What is never desired at midstance?

A

A Valgus moment

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43
Q

What influences the amount of force?

A

The distance.

The bigger the distance the greater the force

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44
Q

What is the equation for pressure?

A

Pressure=force/area

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45
Q

What are the forces in the coronal plane of the socket/

A

Fulcrum at MTP
Distal Lateral Forces
Proximal Medial Forces
Loading Pressure Tolerant Areas

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46
Q

What are the forces in the sagittal plane of the socket?

A

Proximal Posterior
Anterior Pre-tibials
Proximal Anterior Patellar Tendon

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47
Q

What are the biomechanical goals for a socket?

A

Maximize the weight-bearing capacity of the
residual limb
Provide ML stability at Mid-Stance on the prosthetic side
Encourage knee flexion throughout stance phase

48
Q

How do you maximize weight-bearing capacity?

A 
Even distribution of forces
Inclination of forces 
•  Loads pressure tolerant anterior surface 
•  Encourages knee flexion at heel strike 
•  Prevents knee hyperextension
Total contact 
•  Minimize edema 
•  Increase proprioception 
•  Improve weight bearing
49
Q

How do you provide ML stability at Mid-stance?

A

Floor reaction line is medial to the knee joint (NHL)
Varus moment at mid-stance (NHL)
•  Prosthetic Alignment: Foot initially inset at 12mm (medial)
•  Excessive Varus Moment:
•  Increased distal-lateral and proximal-medial pressure
Insufficient Varus Moment:
•  Valgus moment produced
•  Proximal-lateral and distal-medial pressure

50
Q

What occurs when distal-lateral and proximal-medial are loaded?

A

Base of support is narrowed
•  Decrease in energy expenditure
•  Loads pressure tolerant areas and relieved pressure sensitive areas

51
Q

What happens to the force when mass is increased?

A

Force increases on the limb

52
Q

What happens to the force when the foot is excessively inset?

A

Increase force on the limb

53
Q

What happens to the force when the limb is lengthened or long?

A

decrease force on the limb

54
Q

What happens to the force when the trimlines are increased?

A

decrease force on the limb

55
Q

How do you encourage knee flexion throughout stance phase?

A 
Prosthetic Alignment: 
•  Initial foot placement at 37mm posterior to ankle bolt 
•  Foot is dorsiflexed 
•  Socket aligned with 10o flexion 
•  Proper heel stiffness
56
Q

What could be the problem when there is excessive knee flexion at early stance?

A

heel too firm, foot too DF, excessive socket
flexion, foot too far posterior, heel too high,
shoe too tight, keel too soft

57
Q

What could be the problem when the knee is too hyperextended at late stance?

A

Foot too far anterior, foot too PF, inadequate flexion of socket, heel too soft, keel too stiff

58
Q

What could be the problem when there is Premature loss of anterior support at late stance (drop off)?

A

Foot too far posterior, foot size too small, keel too soft.

59
Q

What are the different modes of suspension?

A 
Joint and Corset Suspension 
Belt or Cuff Suspension 
Compression Sleeve Suspension 
Anatomical 
•  Supra-Condylar (SC) 
•  Supra-Condylar, Supra-Patellar (SCSP) 
Suction/Expulsion Valve Suspension 
Elevated Vacuum
60
Q

What are the indications for using a joint and corset suspension?

A

Incorporates thigh weight bearing-for patients who cannot weight bear on limb
Improves ML stability
Heavy duty user
Patient preference
Hyperextension problems- has back check to encourage flexion

61
Q

What are the advantages of joint and corset suspension?

A

Increases weight bearing surface
Unloads the residual limb
Increases ML stability
Knee extension control

62
Q

What are the disadvantages of the joint and corset suspension?

A

Heavy, un-cosmetic, inherent pistoning

63
Q

What are the contraindications for using a joint and corset suspension?

A

New users- combersom and can cause atrophy of the thigh

64
Q

What are the indications for Supracondylar cuff?

A

Many of TT users prefer
Patients with stable ligaments
Juvenile patients-easily adjustable
Long residual limbs

65
Q

What are the contraindications for the supracondylar cuff?

A

Unstable ligaments- suspension can exacerbate the problem by allowing more movement at the knee

66
Q

What are the advantages of the supracondylar cuff?

A

Provides good suspension over patella
Adjustable
Can be used in combination with waist belt

67
Q

What are the disadvantages of the supracondylar cuff?

A

Can be restrictive

Does not increase ML stability, un-cosmetic

68
Q

What can be used instead of the suspension cuff?

A

A figure 8 strap

69
Q

What are the materials that can be used for a sleeve suspension?

A

Silicone

Neoprene sleeve

70
Q

What are the indications for a sleeve suspension?

A

Many of TT users prefer
Patients with stable ligaments
Juvenile patients
Long residual limbs

71
Q

What are the advantages of the sleeve suspension?

A

Provides excellent suspension
Conceals trim lines
Variety of materials available

72
Q

What are the disadvantages of the sleeve suspension?

A

Can cause skin problems
Can increase perspiration, hard to don
May not be indicated for vascular patients

73
Q

Where does the sleeve suspension have to be touching in order to suspend?

A

The patients skin posteriorly

The socket distally

74
Q

What are the contraindications for sleeve suspension?

A

Upper extremity involvement

Poor circulation-can compress and cause further circulation problems

75
Q

What are the indications for the supracondylar/patellar?

A

Patients with very short residual limbs
Patients requiring ML stability
Patients who want less straps

76
Q

What are the advantages of the supracondylar/patellar?

A

Increase weight bearing surface
Improved ML stability
Improves cosmesis

77
Q

What are the disadvantages of the supracondylar/patellar?

A

Can inhibit some motion and activity
Difficult to use on obese or muscular
Difficult to kneel on

78
Q

What is the trimline for the patella on a supracondylar/patellar?

A

Patella is enclosed in trimline

79
Q

What are the indications for a supracondylar suspension?

A

Patients with very short residual limbs
Patients requiring ML stability
Patients who want less straps

80
Q

What are the advantages of the supracondylar supsension?

A

Less restrictive than PTB-SC

Improved cosmesis

81
Q

What are the disadvantages of the supracondylar supsension?

A

Loss of rigid hyperextension stop

Difficult to use on obese or muscular

82
Q

What are the indications for the silicon suction?

A

Patients with good subcutaneous tissue
Full function of upper extremities
Want less straps

83
Q

What are the advantages of the silicon suction?

A

Excellent suspension
Eliminates pistoning
Increased proprioception
Good torque absorption

84
Q

What are the disadvantages of the silicon suction?

A

Can be difficult to don

Good hygiene is required-can have bacterial problems in not cleaned properly

85
Q

What are the indications for the vacuum and suction suspension?

A

Patients with good subcutaneous tissue
Patients who want less straps
Patients who can’t tolerate distal pulling from a lock and pin

86
Q

What are the advantages of the vacuum and suction suspension?

A

Excellent suspension
Eliminates pistoning
Increased proprioception

87
Q

What are the disadvantages of the vacuum and suction suspension?

A

Maintenance is required
Can loose vacuum
Can be complicated to use for some

88
Q

What are the different components involved with Transtibials?

A 
Socket 
•  PTB, TSB 
•  Endo, Exo 
Suspension 
•  Joint and corset, cuff, sleeve, silicone suction, vacuum 
Interface 
•  Dependent on socket design 
Pylon 
Ankle 
Feet
89
Q

What are three examples of ankle components?

A

DAS MARS
OWW Earthwalk
Multi-flex Ankle

90
Q

What are the indication for ankle components?

A

Torque absorption is needed
Special situations
Accommodation to various surfaces

91
Q

What are the indications for Shock Absorbers and Rotational Units?

A

Torque absorption
Active users
Special situations and activities

92
Q

What are the different prosthetic feet avaliable?

A 
SACH 
Single Axis 
Multi-Axis 
Dynamic Response/Energy Storing 
Multi-Axis Dynamic Response 
External Power
93
Q

What are the indications for SACH feet?

A

Many lower limb users

Juveniles

94
Q

What are the contraindications for SACH feet?

A

Active individuals
When inversion/eversion is required
When knee stability is required

95
Q

What are the advantages of SACH feet?

A

Cosmetic, quiet, little maintenance

96
Q

What are the disadvantages of SACH feet?

A

Deterioration of soft materials

No torque absorption

97
Q

What’s the indications for single axis feet?

A

Patients needing knee stability

98
Q

What are the contraindications for single axis feet?

A

Many lower limb users
Active users
When torque, inversion or eversion is needed

99
Q

What are the advantages of the single axis feet?

A

More shock absorption

•  Promotes knee stability

100
Q

What are the disadvantages of the single axis feet?

A

No torque absorption

Requires bumper replacement

101
Q

What are the indications for multi-axis feet?

A

Torque absorption needed
Special activities
Need for in/eversion

102
Q

What are the contraindications for multi-axis feet?

A

When other components can be used

103
Q

What are the advantages of the multi-axis feet?

A

Absorbs torque, shock

Foot conforms to surfaces

104
Q

What are the disadvantages of the multi-axis feet?

A

Cosmesis, increased weight

Increased maintenance

105
Q

What are the indications for dynamic response feet?

A

Active ambulators

Community ambulators

106
Q

What are the contraindications for dynamic response feet?

A

One speed ambulators

107
Q

What are the advantages of the dynamic response feet?

A

Smoother gait, less energy expenditure

Light weight, cosmetic, energy storing

108
Q

What are the disadvantages of the dynamic response feet?

A

Material durability, limited sizes, expense

109
Q

What are the indications for the MULTI-AXIS DYNAMIC RESPONSE feet?

A

Active users, Varying cadence ambulators

Community ambulators, Athletes

110
Q

What are the contraindications for the MULTI-AXIS DYNAMIC RESPONSE feet?

A

Single speed ambulators

111
Q

What are the advantages of the MULTI-AXIS DYNAMIC RESPONSE feet?

A

Multi-axial capabilities, dynamic response

Energy storing capabilities

112
Q

What are the disadvantages of the MULTI-AXIS DYNAMIC RESPONSE feet?

A

Expense

Maintenance

113
Q

What are the indications for the externally powered feet?

A

Potentially, all mildly active ambulators

114
Q

What are the contraindications for the externally powered feet?

A

K1 level ambulators

Wet or corrosive environments

115
Q

What are the advantages of the externally powered feet?

A

Anatomical power and propulsion

Anatomical limits for PF and DF

116
Q

What are the disadvantages of the externally powered feet?

A

Batteries, weight, cost
Processing speed
Limited environment use

117
Q

What are the basic gait deviations for transtibials?

A 
Inadequate flexion or extension 
Medial or lateral leaning pylon 
Drop off 
Erratic movement 
Heel lever and Toe lever 
Whip(s)

Lower Extremity III (9 decks)

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