prosthetic gait analysis

Question 1

normal markers of transtibial gait

Answer 1

flexion moment throughout stance
slight varus moment
slight toe out

Knee should be 5-10 degrees of knee flexion to promote weight bearing th

Question 2

main TT gait devations in IC to LR

Answer 2

excessive knee extension
excessive knee flexion (knee instability)

Question 3

prosthetic causes of TT knee excessive extension (IC->LR)

Answer 3

foot too anterior to the socket (too long of a toe lever)
too soft of a heel cushion
excessive PF

Question 4

amputee causes of TT excessive knee extension (ic->lr)

Answer 4

shoe heel height too low
excessive use of knee extensors

Question 5

what might excessive knee extension lead to symptom wise? how can we instruct the patient to improve this?

Answer 5

pt may complain of anterior distal pain
encourage to bend knee slightly to encourage WB

Question 6

How does a soft heel cushion affect tibial advancement?

Answer 6

a soft heel cushion delays the pylon of the prosthetic from going forward, decreasing tibial translation forward

Question 7

prosthetic causes of TT excessive knee flexion (IC-LR)

Answer 7

heel too firm
foot too far posterior
foot too DF

Question 8

amputee causes of TT excessive knee flexion aka knee instability

Answer 8

knee flexion contracture
shoe height too high
weak quads

Question 9

main TT gait deviations in MS

Answer 9

Excessive varus thrust
excessive valgus thrust
lateral trunk bending to prosthetic side

Question 10

TT varus thrust prosthetic causes

there are no TT amputee causes for valgus/varus thrust in midstance

Answer 10

pylon leans laterally
foot too inset
socket too wide

Question 11

TT prosthetic causes for valgus thrust in MS

Answer 11

pylon leans medially
foot too outset
socket too wide

Question 12

prosthetic causes of TT lateral trunk bend in MS

Answer 12

prosthetic too short
abducted socket

Question 13

amputee causes of TT lateral trunk lean in MS

Answer 13

pain of lateral distal aspect of residual limb
weak hip abductors

Question 14

common gait deviations in TT for TSt to PSw

Answer 14

early, abrupt heel off (drop off)
pistoning

Question 15

what is pistoning?

Answer 15

the socket/prostethic is moving around, not secure

Question 16

TT prosthetic causes of early, abrupt heel off

Answer 16

toe lever arm is too short (loss of lever arm)
toe lever is too soft due to excessive posterior position of the foot
foot is excessively dorsiflexed, socket in too much flexion

Question 17

TT amputee causes of drop off

Answer 17

heel height is too high

Question 18

TT prosthetic causes of pistoning

Answer 18

socket too large
suspension inadequate

Question 19

TT amputee causes of pistoning

Answer 19

limb shrinkage

Question 20

common TT gait deviations in Swing phase

Answer 20

Foot whip (medially or laterally)

a whip is named for the direction that the heel is pointing

Question 21

a lateral whip means the knee is rotated how?

Answer 21

knee internally rotated

Question 22

a medial whip means the knee is rotated how?

Answer 22

knee externally rotated

Question 23

TT prosthetic causes of foot whip

Answer 23

inadequate suspension-misaligned

Question 24

TT amputee causes of foot whip

Answer 24

irregular loading at terminal stance
improperly donned prosthesis

Question 25

if you note a gait deviation, what should you do first?

Answer 25

rule out patient-related factors as potential contributors first

Question 26

TF common gait devations in IC

Answer 26

knee instability foot slap

Question 27

TF prosthetic causes of knee instability in IC

Answer 27

knee axis is too far anterior, creates a flexion moment heel cushion is too hard- creating a DF moment at heel strike

Question 28

how does a hard heel cushion affect tibial advancement?

Answer 28

a hard heel cushion thrusts the tibia forward, creating tibial advancement

Question 29

what is more stable- a soft or hard heel cushion?

Answer 29

soft

Question 30

TF amputee causes of knee instability in IC

Answer 30

hip flexion contracture hip extensor weakness change in heel height

Question 31

in TF, what muscles to activate to stabilize the knee

Answer 31

**hip extensors**

Question 32

TF prosthetic causes of foot slap in IC

Answer 32

insufficient PF resistance in the foot heel cushion is too soft for weight/activity | too soft = delayed tibial advancement, so could cause excess PF

Question 33

common gait deviation for TF IC-LR

Answer 33

external rotation of the prosthetic foot

Question 34

TF prosthetic causes of ER of prosthetic foot

Answer 34

excessively firm heel cushion inappropriate toe-out alignment

Question 35

TF amputee causes of ER of prosthetic foot

Answer 35

poor muscle control (compensates and keeps hip in ER) limb shrinkage

Question 36

what is a quick solution to limb shrinkage

Answer 36

add socks!!

Question 37

common TF gait deviations in MS

Answer 37

abducted gait excessive lateral trunk bend

Question 38

TF prosthetic causes for abducted gait

Answer 38

medial brim of socket too high prosethetic too long insufficient femur support by lateral wall socket is too abducted

Question 39

TF amputee causes of abducted gait

Answer 39

increased limb volume excess pressure on pubic ramus pain at lateral distal femur contracted hip abductors insecurity.habit

Question 40

TF prosthetic causes for excessive lateral trunk bend

Answer 40

prosthesis too short excessively outset foot medial wall of socket too high adduction of socket inadequate

Question 41

TF amputee causes of excessive lateral trunk bend

Answer 41

weak abductors pain limb shrinkage- now is too deep in socket

Question 42

common TF ait deviations in TS

Answer 42

pelvic rise drop off excessive lumbar lordosis

Question 43

how do patients describe pelvic rise

Answer 43

"feels like walking uphill all the time"

Question 44

prosthetic causes of TF pelvic rise | no patient causes

Answer 44

toe lever is too long foot place too anterior with respect to knee excessively plantarflexed foot | functionally longer prosthetic leg, stiff leg

Question 45

TF prosthetic causes of drop off | no patient causes

Answer 45

toe lever too short foot too dorsiflexed

Question 46

TF prosthetic causes of excess lumbar lordosis

Answer 46

insufficient socket flexion( causes the patient to extend lumbar spine to have knee extension) improperly shaped posterior wall, painful ischial WB

Question 47

TF amputee causes of excessive lumbar lordosis

Answer 47

weak hip extensors weak abdominals hip flexion contracture that cannot be accomodated pain from ischial WB

Question 48

TF common gait deviations in PSw

Answer 48

medial or lateral whip inadequate/delayed knee flexion

Question 49

TF prosthetic and pt causs of medial or lateral whip

Answer 49

medial whip: prosthetic knee aligned in excess ER, or amputee donned with too much ER lateral whip: prosthetic knee aligned with excess IR, or amputee donned with too much IR

Question 50

TF prosthetic causes of inadequate knee flexion

Answer 50

excess mechanical resistance to knee flexion prosthesis aligned with too much stability

Question 51

TF patient causes of inadequate/delayed knee flexion

Answer 51

poor gait mechanics- patient is not trusting the knee, walking on it locked | this pattern could cause circumduction or vaulting = leg longer

Question 52

common TF gait deviations in initial and midswing

Answer 52

circumducted gait, vaulting

Question 53

TF prosthetic causes of circumduction or vaulting

Answer 53

knee locked in extension, excess resistance to flexion, too long prosthesis vaulting: all of the above + inadequate socket suspension

Question 54

TF pt causes for vaulting and circumduction

Answer 54

both: **fear of flexion or catching toe** circumduction: inadequate hip flexion, pain in high medial brim vaulting: habit

Question 55

common TF deviations in TSw

Answer 55

excessive terminal impact unequal step length

Question 56

what is excessive terminal impact

Answer 56

shin of prosthesis moves forward so fast the the extended position is reached **early**, with **audible or visible impact**

Question 57

prosthetic causes of excessive terminal impact

Answer 57

insufficient resistance to extension

Question 58

pt causes of excessive terminal impact

Answer 58

forceful hip flexion in initial swing to build momentum to extension forceful extension in prep for IC | usually have weak hamstrings

Question 59

unequal step length usually means a longer ____ side step

Answer 59

longer prosthetic side step

Question 60

TF prosthetic causes for unequal step length

Answer 60

insufficient initial socket flexion to accomodate for hip flexion contracture

Question 61

amputee causes of a unequal side step

Answer 61

hip flexion contracture fear of falling pain | focus on that excessive hip flexion will cause unequal step length