PROSTHETIC GAIT DEVIATIONS

Question 1

TT

transtibial normal 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 through the patella

Question 2

TT

transtibial gait deviations: what are 2 causes?

Answer 2

1. cause of the prosthesis
2. cause from the individual
   *its usually the individual

Question 3

TT

what are causes from the individual for general transtibial gait deviations?

Answer 3

• mm weakness
• mm tightness
• limb size (shrinker, weight changes, edema, meds etc)
• shoe wear (heel height)

Question 4

TT

what are major TT (transtibial) gait deviations in weight acceptance?

Answer 4

1. too much knee
   extension
2. too much knee flexion AKA knee instability

Question 5

TT

What can cause too much knee extension in weight acceptance?
PROSTHETIC CAUSE

Answer 5

1. foot is too anterior to socket “too long” –>
2. heel too soft (delayed tibial translation)
3. too much plantarflexion of the foot (PF/knee extension couple)

Question 6

TT

What can cause too much knee extension in weight acceptance?
AMPUTEE CAUSE

Answer 6

1. shoe heel height too low (tibia is too far back)
2. excessive quad use (extended!)

Question 7

TT

If TT patient has excessive knee extension during weight acceptance, where might they feel pain?

Answer 7

anterior distal pain on residual limb

*encourage a SOFT KNEE

Question 8

Where should a person with transtibial amputation weight bear?
what about transfemoral?

Answer 8

TT: patellar tendon!

TF: isch tub!

Question 9

TT

What can cause too much knee flexion in weight acceptance for transtibial?
PROSTHETIC CAUSE

Answer 9

1. heel too firm
   (fast tibial translation –> knee bends too quick)
2. foot is too posterior relative to socket = short foot
3. foot is too dorsiflexed = tibia tipped too forward!

Question 10

TT

What can cause too much knee flexion in weight acceptance for transtibial?
AMPUTEE CAUSE

Answer 10

1. knee flexion contracture
2. heel height is too high
3. weak quadriceps

Question 11

if heel wedge is too high (high heels), what happens to the knee?

Answer 11

knee flexion at weight acceptance

Question 12

What are gait deviations for transtibial amputations in midstance

Answer 12

1. varus thrust + narrow based gait
2. valgus thrust + wide based gait
3. lateral trunk bend to prosthetic side

Question 13

TT

what causes excess varus thrust in transtibial gait?

Answer 13

1. the pylon leans laterally
2. foot is too inset –> like supination! your knees will go out
3. socket too wide

Question 14

TT

what causes excessive valgus thrust in transtibial gait?

Answer 14

prosthetic:
1. pylon leans medially
2. foot too outset
3. socket too wide

Question 15

TT

what causes lateral trunk bend to prosthetic side in transtibial gait?

Answer 15

prosthetic causes:
1. prosthetic too short
2. abducted socket

amputee causes:
1.weak hip abductors
2. pain on lateral distal aspect of limb –> lean towards it so that pressure is directed more centrally/medially!

Question 16

In terminal stance/preswing, what are the main transtibial gait deviations?

Answer 16

1. early/abrupt heel off (DROP OFF)
2. pistoning

Question 17

transtibial gait deviations: what causes drop off?

Answer 17

1. toe is too short or too soft (foot is too posterior to socket! –> quick heel off)
2. foot too DF (DF/knee flexor couple! socket goes in too much flexion –> early heel off)

amputee cause:
heel height too high –> knee goes in too much flexion in preswing

Question 18

What are 2 results of transtibial gait if foot is too posterior to the socket? (too short)

Answer 18

1. excessive knee flexion (in WA)
2. drop off (in TSt/preswing)

Question 19

what causes pistoning in transtibial gait? (TSt/preswing)

Answer 19

1. socket too big (prosthetic or amputee –> limb shrinkage)
2. bad suspension (if they don’t have a pin lock)

Question 20

What are swing phase transtibial gait deviations?

Answer 20

foot whip!
1. foot whip medially (knee ER)
2. foot whip laterally (knee IR)

Question 21

what are causes of foot whip?
*transtibial swing phase deviation

Answer 21

prosthetically:
* inadequate suspension (misaligned!)
amputee:
* donned incorrectly
* irregular loading at terminal stance

Question 22

What are the main causes for transfemoral gait deviations?

Answer 22

1. limb volume changes
2. # of socks
3. footwear
4. improper donning
5. inadeq suspension

Question 23

What are the main transfemoral gait deviations in weight acceptance?

Answer 23

• knee instability
• foot slap
• ER of prosthetic foot

Question 24

What are the transfemoral gait deviations in midstance?

Answer 24

1. abducted gait
2. lateral trunk bending

Question 25

What are the main Transfemoral gait deviations in terminal stance?

Answer 25

1. pelvic rise 2. drop off 3. lumbar lordosis

Question 26

What are the main Transfemoral gait deviations in preswing?

Answer 26

1. medial or lateral whip 2. inadequate or delayed knee flexion

Question 27

What are the main Transfemoral gait deviations in initial/midswing?

Answer 27

1. circumducted gait 2. vaulting

Question 28

What are the main Transfemoral gait deviations in terminal swing?

Answer 28

1. excessive terminal impact (fling) 2. unequal step length

Question 29

What are the causes for knee instability? (transfemoral gait deviaton in IC)

Answer 29

prosthetic: 1. **knee axis too anterior** --> knee flexion moment 2. **heel cushion too hard** --> knee flexion moment) amputee: 1. hip flexion contracture 2. weak hip extensors 3. change in heel height

Question 30

What are the causes for foot slap? (transfemoral gait deviaton in IC)

Answer 30

prosthetic: 1. poor PF resistance in prosthetic foot 2. heel cushion too soft amputee: 1. land hard on heel to ensure knee extension/stabilty

Question 31

What are the causes for ER of prosthetic foot? (transfemoral gait deviaton in IC)

Answer 31

prosthetic: * heel cushion too firm * innappropriate toe out alignment amputee: * poor mm control (hip in ER) * limb shrinkage

Question 32

# TF What are the PROSTHETIC causes for abducted gait? (transfemoral gait deviaton in midstance)

Answer 32

prosthetic causes: * **medial socket brim too high** --> hits pubic bone * prosthetic **too long** socket **too abducted** * **lateral wall** giving insufficient support

Question 33

What are the AMPUTEE causes for abducted gait? (transfemoral gait deviaton in midstance)

Answer 33

* increased limb volume * too much pressure on pubic ramus * pain at distal lateral femur * hip ABD contracture * patient insecurity (wide BOS)/habit

Question 34

What are the PROSTHETIC causes for lateral trunk bending? (transfemoral gait deviaton in midstance)

Answer 34

* prosthetic too short * foot too outset * medial wall of socket too high * socket too much ABDuction

Question 35

What are the AMPUTEE causes for lateral trunk bending? (transfemoral gait deviaton in midstance)

Answer 35

* weak hip abductors * pain (medially?) * limb shrinks (too deep in socket -> functionally shorter leg)

Question 36

What are the causes for pelvic rise? (transfemoral gait deviaton in terminal stance) | hip hike

Answer 36

PROSTHETIC CAUSES --> *limb is functionally longer!* * toe too long * foot is too anterior to knee/socket * excessively PF foot

Question 37

What are the causes for drop off? (transfemoral gait deviaton in terminal stance) | "stepping into a hole" = excess pelvic drop = drop off

Answer 37

PROSTHETIC CAUSES * toe too short * foot too DF

Question 38

what causes medial or lateral whip in transfemoral gait? (preswing)

Answer 38

medial whip: * prosthetic cause: knee aligned too ER * amputee cause: socket donned with too much ER lateral whip: opposite (IR)

Question 39

what causes inadequate or delayed knee flexion in transfemoral gait? (preswing)

Answer 39

prosthetic causes: * too much knee resistance to flexion (mechanically) * aligned with too much stability (too decrease chance of buckling if patient is kinda big fall risk) amputee causes: * poor gait mechanics (they dont trust the knee, walk locked out!)

Question 40

If a transfemoral patient has delayed knee flexion/not enough knee flexion in preswing... this could cause

Answer 40

circumduction or vaulting!

Question 41

what are prosthetic causes of transfemoral patients having **circumduction** in swing?

Answer 41

**FUNCTIONALLY TOO LONG** * prosthetic has too much resistance to knee flexion * prosthetic knee locked in extension * too long

Question 42

what are amputee causes of transfemoral patients having **circumduction** in swing?

Answer 42

* pain due to high medial brim * not enough hip flexion * fear! knee flexion or catching toe

Question 43

what is vaulting?

Answer 43

Client rises on the toe of the sound limb to swing the prosthesis through with little knee flexion

Question 44

causes of **vaulting** in someone with transfemoral amputation

Answer 44

* Inadequate socket suspension * Prosthesis too long * Too much resistance to knee flexion * Prosthetic knee locked in extension (extension bias too strong) OR amputee causes: * fear or habit

Question 45

What is excessive terminal impact?

Answer 45

Shin of prosthesis moves forward so quickly that the fully extended position is reached early, with an audible or visible impact against the proximal section of prosthetic knee | LIKE A LEG FLING

Question 46

tranfemoral gait deviation: terminal swing --> **excessive terminal impact** causes...

Answer 46

* prosthetic cause: Insufficient resistance to extension of knee unit amputee: * forceful hip flexion in initial swing to build knee extension momentum * forceful hip extension in terminal swing to snap knee back into full extension before weight acceptance

Question 47

causes of **unequal step length **in someone with transfemoral amputation (terminal swing)

Answer 47

long prosthetic side step prosthetic causes: * Insufficient initial socket flexion to accommodate hip flexion contracture amputee causes: * hip flexion contracture * fear of falling or pain