Improving Transtibial Amputee Gait

Question 1

Bench Alignment

Answer 1

A/P Alignment: Socket center to slightly anterior of ankle bolt

Socket Tilt: 5–10° flexion (add 5° if contracture is present)

M/L Alignment: Foot inset ~½ inch, 2–5° adduction

Foot Rotation: Externally rotated 5–7° during midstance

Question 2

Static Alignment

Answer 2

Patient standing; check height, symmetry, comfort

Question 3

Dynamic Alignment

Answer 3

Adjustments based on gait observation during ambulation

Question 4

drop off

Answer 4

prosthetic cause: Short toe lever, excessive DF or socket flexion

amputee cause: Internal hip rotation, gait habit

Question 5

vaulting

Answer 5

prosthetic cause: Long limb, poor suspension, PF foot, stiff knee

amputee cause: Fear of toe catch, weak hip flexors

Question 6

circumduction

Answer 6

prosthetic cause: Long prosthesis, poor suspension, PF

amputee cause: Abduction contracture, hip flexor weakness

Question 7

trendelenburg gait

Answer 7

prosthetic cause: Short prosthesis, pylon inset/socket outset, socket fit issues

amputee cause: Weak hip abductors (glute med/min)

Question 8

short step

Answer 8

prosthetic cause: Socket pain, excessive PF, long toe lever

amputee cause: Hip contracture, lack of confidence

Question 9

heel rise

Answer 9

prosthetic cause: Excessive PF, poor socket flexion/suspension

amputee cause: Fear of catching toe

Question 10

lateral (varus) moment

Answer 10

prosthetic cause: Foot too far inset, short prosthesis

amputee cause: Weak knee, narrow base

Question 11

valgus moment

Answer 11

prosthetic cause: Foot too far outset, excess socket adduction

amputee cause: Wide base from insecurity

Question 12

toe drag

Answer 12

prosthetic cause: Long limb, PF foot, poor socket flexion/suspension

amputee cause: Weak hip extensors/abductors, posture

Question 13

foot rotation (IR/ER)

Answer 13

prosthetic cause: Alignment or socket issues

amputee cause: Hip weakness, rotation habit

Question 14

excessive PF

Answer 14

prosthetic cause: PF foot, inadequate socket flexion

amputee cause: New shoes with low heel height

Question 15

Therapy Goals & Interventions

Primary Focus:

Answer 15

Strength (hip flexors/extensors/abductors)

Flexibility (contracture management)

Balance & proprioception

Gait retraining

Fall prevention & energy conservation

Proper donning/doffing for consistent alignment

Question 16

Therapy Goals & Interventions

ADL Modifications:

Answer 16

Reduce compensatory movement patterns

Improve functional independence