Gait Deviations/ Troubleshooting Flashcards Preview

Prosthetic Exam > Gait Deviations/ Troubleshooting > Flashcards

Flashcards in Gait Deviations/ Troubleshooting Deck (78):
1

What causes knee instability in a prosthesis?

Knee too anterior
Excessive resistance to PF
Shoe heel height increased
Insufficient socket flexion

2

Unequal step length

Painful socket
Unstable knee
Patient insecurity
Insufficient initial socket flexion to accommodate contracture

3

Foot slap

PF bumper or heel cushion to soft
Patient forces heel compression to ensure knee instability
Insufficient PF resistance in the px foot

4

How to correct knee instability in a prosthesis?

Reduce the degree of dorsiflexion or anterior translation of the socket over the foot.

5

What deviations occur at loading response?

External foot rotation
Knee flexion is not smooth
Knee flexion is abrupt and uncontrolled
Knee remains extended; rides heel> midstance
Pistoning

6

What gait deviations occur at mid stance?

Abducted gait
Lateral trunk bending
Toe rotation does not match sound side

7

What is external foot rotation caused by?

PF bumper or heel cushion too firm
Excessive toe out
Socket rotation -loose fit
Socket rotation- tight medial/posterior wall

8

Knee flexion is not smooth what is the cause

Weak quads

9

The knee remains extended and patient rides the heel through to midstance?

Foot too anterior
Insufficient socket flexion
Foot plantarflexed
Sach heel too soft (if more than 3/8" comp)
Heel on shoe too low
Excessive use of knee extensors

10

Knee flexion is abrupt and uncontrolled?

Foot too posterior
Socket too flexed
Foot excessively dorsiflexed
Heel on shoe too high
Plantarflexion bumper or heel wedge too firm
Shoe does not allow heel cushion to compress sufficiently

11

What causes pistoning?

Patient dropping too deeply into socket

Suspension too loose
Not enough prosthetic socks
Poor modifications - not enough support under medial tibial flare or patellar tendon

12

Abducted gait

Pubic ramus pressure
Pain at distal lateral femur
Lateral wall not shaped to provide adequate femur support
Prosthesis too long
Excessive abduction built in
Pelvic band too far from ilium
Patient has weak/contracted abductors
Patient insecurity

13

Lateral trunk bending

Prosthesis is too short
Excessive outset
Insufficient socket adduction
Wide ML
Lateral wall not shaped to provide adequate femur support
Pubic Ramus pressure
Pain at distal lateral femur

14

Toe rotation does not match sound side is caused by?

Improper foot rotation alignment

15

What gait deviations occur at terminal stance?

Pelvic rise
Drop off
Excessive lumbar lordosis

16

What causes pelvic rise (hill climbing) hip hiking

Toe lever too long
Prosthesis that is too long
Prosthetic knee with Insufficient friction

17

What causes drop off (excessive pelvic drop with forward progression

Toe lever too short
Keel or toe level is soft
Heel height is too high

18

What causes excessive lumbar lordosis?

Insufficient initial socket flexion
Improper shaped posterior wall causing painful ischium weight
Hip flexion contracture

19

What gait deviations occur at preswing?

Medial whip
Lateral whip
Socket drops pistoning
Inadequate or delayed knee flexion
Uneven heel rise

20

Medial whip

Knee axis is in external rotation
Socket donned in external rotation

21

Lateral whip

Knee axis in internal rotation
Socket donned in internal rotation

22

Socket drops (pistoning)

Inadequate suspension

23

Inadequate or delayed knee flexion

Excessive mechanical resistance to knee flexion
Prosthesis Aligned with too much stability

24

Uneven heel rise

Incorrect resistance to knee flexion

25

What gait deviations occur at initial contact?

Knee instability
Unequal step length
Foot slap

26

What gait deviations occur in terminal swing?

Excessive terminal impact
Unequal step length

27

Terminal impact

Caused by:
Insufficient knee friction
Extension bias too strong
Warn or absent extension bumper
Patient deliberately extends

28

Circumduction is caused?

Excessive mechanical resistance to knee flexion
Aligned w/too much knee stability
Prosthesis too long
Medial brim pressures
Inadequate suspensions

29

Vaulting

Prosthesis too long
Excessive mechanical resistance to knee flexion
Aligned in too much stability
Inadequate suspension

30

Patient is having pain or redness on distal end of RL and or redness on distal Patella

Not enough socks allows RL to "bottom out"

31

Patient is having redness on distal aspect of fibula head and distal patella is caused by?

Not enough socks allows RL to drop too far into socket

32

Patient is having redness on tibial tubercle and or proximal fibular head. May also show signs of verrucose hyperplasia why?

Too many socks being used causes lack of distal contact.

RL volume reduced and they are wearing proper ply but socks cause too much tightness proximally: adding padding posterior, medial tibial flare and lateral tibial flare (pre tibs) *reduce sock ply

33

Pressures on distal lateral and proximal medial is caused by?

Alignment issue:
Excessive varus
Excessive foot inset
Too much socket adduction

34

Discomfort on anterior proximal patella and posterior distal RL

Can occur @initial contact or preswing - initial swing

Patient switched to lower height shoe
Foot too anterior (toe lever too long)
Heel cushion or plantar flexion bumper too soft
Plantarflexed foot
Posterior leaning pylon
Excessively extended socket

* All these can cause excessive extension in stance phase

35

Discomfort on anterior distal tibia and posterior proximal RL near hamstring tendons

Can occur @initial contact or preswing to initial swing

Patient switched to higher heel height
Foot too posterior (toe lever short)
Heel or plantarflexion bumper too firm
Dorsi flexed foot
Heel too short or soft
Anterior leaning pylon
Excessive socket flexion


*All of these can cause excessive flexion in stance

36

Patient is having all over redness or irritation

Could be improper hygiene or allergic

37

Proper sock ply is being used with proper alignment but there is irritation present over a bony prominence

Check for distal contact with clay or flexible steel probe. If RL is seated properly bony prominence needs to be relieved by heating, grinding, or distraction pads.

38

Patient complains of discomfort while ambulating but is comfortable while standing

Mostly pistoning:
Assess w patient weight bearing you hold prosthesis in place and have patient lift RL. If RL motion more than 1cm of patella than pistoning is occurring.

--faulty suspension
--loose socket fit
--not enough socks

39

Pylon leans medially

Too much socket adduction
Foot outset

40

Pylon leans laterally

Not enough socket adduction
Foot inset

41

State one cause and one correction for:
Anterior distal and posterior pressure?

Cause: shoe change
Correction: heel wedge to correct height

42

State one cause and one correction for:
AK distal lateral pressure, socket fit good

Cause: too much adduction built into socket
Correction: remove adduction

43

State one cause and one correction for:
BK distal end pressure with blisters "I'm just pulling it on"

Cause: incorrect donning of liner causing void at distal end
Correction: re educate on rolling on Liner

44

State one cause and one correction for:
BK distal pressure cuff suspension- self adjust, tight, gained 20lbs, putty test?

Cause: lack of distal contact
Correction: remake socket

45

State one cause and one correction for:
Pediatric Symes: fib head, tibial tuberosity, lateral distal pressure

Caused: gained weight
Correction: remake socket

46

State one cause and one correction for:
Pediatric exoskeleton Symes - distal lateral pressure

Cause: bone spur
Correction: distraction pad until can remake socket

47

State one cause and one correction for:
AK medial brim pressure

Cause: weight loss
Correction: add socks

48

State one cause and one correction for:
BK redness on distal Patella and anterior distal tibia

Cause: patient is shrink
Correction: add sock

49

State one cause and one correction for:
Knee disarticulation- medial window. Medial pain and Proximal fit?

Cause: not enough socks
Correction: distraction pads

- alignment (too much abduction)
- check proximal stability

50

State one cause and one correction for:
BK redness on all bony landmarks. Traditional suction socket

Cause: pistoning
Correction:
Leak in suction - replace vacuum pump, check for leak in sleeve

51

State one cause and one correction for:
TR- patient could not open TD completely. Rubber hands

Cause: force vs excursion problem
Correction:

52

State one cause and one correction for:
TH TD opens prematurely

Cause: EFT too proximal
Correction: move EFT distal

53

If patient is having a problem with the prosthesis what questions must you ask to determine the cause?

Is it physical problems (ROM, weaknes)
Fit issues with the socket (volume)
Alignment issues with the prosthesis

54

What Are the causes if patient is unable to flex knee, difficult rolling over toe

Too rigid of toe lever (too plantarflexed)
Prosthetic knee is too stiff
Not fully shifting weight over knee, pelvic rotation
Not putting enough weight through the prosthesis

55

What Are the solutions/corrections if patient is unable to flex knee, difficult rolling over toe

Prosthesis alignment GRF
Gait training, trusting prosthesis

56

What are similar causes of circumduction, abducted, and hip hiking gait ?

Clearance of prosthesis- height and PF ankle
Pain
Insufficient suspension
Trouble bending knee

57

What are similar corrections of circumduction, abducted, and hip hiking gait ?

Check volume add/ remove sock
Check suspension
Gait training- weight through prosthesis
Foot placement BOS

58

What are the causes of toe dragging in a BK prosthesis?

Prosthesis height
Foot too PF
Suspension inadequate
Patient habit/inadequate knee flexion

59

How to correct toe dragging in a BK prosthesis?

Gait training (strengthen muscles)
If patient has a liner/sleeve on over knee, increases stiffness - remind pt to intentionally flex their knee
Alignment

60

What are possible causes of excessive varus thrust (BK)

Socket too loose in ML
Improper foot placement at unitized contact
Foot too inset
Foot "toed" in too much

61

What are some solutions to excessive varus thirst in a BK

Volume issue/ add socks
Gait training
Prosthetic alignment change (outset foot)
Rotate socket or change toe out

62

What are prosthetic causes of drop off?

Short toe lever
Excessive socket flexion
Excessive dorsiflexion
Incorrect foot type

63

What are amputee causes of drop off?

Bad gait habit, strength, short residual limb
Internal rotation of hip at toe off / hip flexion

64

Patient complains of feeling like they are walking uphill what is the cause?

A long prosthesis

65

Patient complains of feeling like they are stepping into a hole what is the cause?

A short prosthesis

66

What are some thing to do before messing with alignment?

Check fit of sock ply (try too many socks then decrease per ply)
Check AP dimension (use corset stays/probe or inside calipers)
Check ML dimension (use corset stays, probe or inside calipers)

67

If patient has AP dimension issues you correct by?

Add popliteal pad
Check patella tendon bar
Look for sock marks in the weight tolerant areas
Check popliteal shelf (make sure no impingement on hamstrings for comfort)

68

What happens if the posterior shelf is lowered excessively?

Lowering the shelf excessively will loose the AP and the limb will bottom out.

69

If patient has ML dimension issues you correct by?

Adding padding to medial or lateral walls and medial flare: be careful of fibular head
Within range of 1/4 to anatomical measurements

70

What happens if the length of the socket is too long?

No distal contact, patient may experience varicose hyperplasia (scaling or hardening of distal end)

71

How correct socket if the length of the socket is too long?

Apply foam pad to distal end to create total contact
Have patient wear Shrinker sock sung to reduce condition without wearing socket.

72

What happens if a patient has a knee flexion contracture?

They may need to be fit with a preparatory socket/ copolymer until the contracture is reduced by stretching through PT

73

What is bell clapping and how do you fix or check for it?

Socket would be loose distally allowing the limb to move in the AP direction without total contact.

BAby powder mAy be helpful tool to determine where the limb is not making contact with the socket

Use probe to check Area
Recheck measurements
Add pad on wallet hollow for TF
Add pad in the gastrocnemius and pretib areas for TT

74

Hammocking of socks- patient feels like they are bottoming out but are not actually at the bottom of the socket.

Test with ball of putty to see actual pressure
Check socks marks distally and proximal to distal cut bone

75

What is the solution for Hammocking of socks- patient feels like they are bottoming out but are not actually at the bottom of the socket.

Reduce sock ply
Heat relieves socket in specific area to decrease Hammocking effect
Compare current measurements to previous measurements.

76

How to correct pistoning if pt has too many layers of socks

Reduce to 3 or 5 ply
Reduce ply fit with adding pads
Check suspension
May need to add pad to existing sc pad
Check cuff strap
Check fit of sleeve, corset or gel liner

77

How to determine the length of socket?

Check either mid patella tendon or medial Tibial plateau to distal end.

78

True or false too many (8-10) sock ply will raise the limb out the socket

True
Too many socks will cause pistoning and rotation of the socket
Solution : pad the weight tolerant Areas to reduce the ply fit or global reaction of the negative cast/model