Transfemoral Gait Deviations

Question 1

What are the causes of rotation of the prosthetic foot at initial contact? (1 amputee, 2 prosthetic)

Answer 1

Amputee:
1. Too vigorous extension of knee

Prosthetic:

1. Heel cushion too firm/ too hard PF bumper
2. Loose socket

Question 2

What are the causes of instability of the prosthetic knee? (3 amputee, 4 prosthetic)

Answer 2

Amputee:

1. Weak hip extensors
2. Significant flexion contracture
3. Lack of gait training

Prosthetic:

1. Alignment instability (too far anterior to TKA line)
2. Too firm heel cushion/PF bumper
3. Insufficient flexion in socket
4. Heel too high or excessive dorsiflexion

Question 3

In what stage of gait are we concerned about instability of the prosthetic knee?

Answer 3

Initial contact to loading response

Question 4

What are the causes of foot slap?

Answer 4

Amputee:
1. Forceful driving of prosthesis into ground to ensure knee stability

Prosthetic:
1. Posterior bumper too soft

Question 5

In which stage of gait are we concerned about foot slap?

Answer 5

Initial contact to loading response

Question 6

What are the causes of ipsilateral bending of the trunk? (5 amputee, 4 prosthetic)

Answer 6

Amputee:

1. Very short residual limb
2. Habit/fear/poor balance
3. Weak abductors
4. Abduction contracture
5. Habit or poor gait training (inadequate weight shifting)

Prosthetic:

1. Too short
2. Lateral wall allows too much abduction of femur
3. Foot outset
4. Distal lateral residual limb pain

Question 7

What gait deviation does crotch pressure cause?

Answer 7

Contralateral bending of the trunk

Question 8

In what phase of gait are we concerned about ipsilateral bending of the trunk?

Answer 8

Midstance

Question 9

What can cause drop-off at the end of stance?

Answer 9

Amputee:
None

Prosthetic:

1. Inadequate limitation of dorsiflexion
2. Too soft dorsiflexion bumper
3. Toe break too far posterior
4. Socket too anterior on pylon
5. Foot too posterior

Question 10

What can cause excessive heel rise? (1 amputee, 3 prosthetic)

Answer 10

Amputee:
1. Forcible hip flexion

Prosthetic:

1. Insufficient friction at knee
2. Inadequate extension aid
3. Improper knee selection

Question 11

When are we concerned about excessive heel rise?

Answer 11

Initial swing

Question 12

What can cause excessive pistoning?

Answer 12

Amputee:
1. May occur with large, flabby residual limb with poor muscular control

Prosthetic:
1. Patient not seated in socket (socket too big or improperly donned)

Question 13

What can cause a lateral whip?

Answer 13

Amputee:
1. Improper donning

Prosthetic:
1. Too much IR at knee

Question 14

What can cause a medial whip?

Answer 14

Amputee:
1. Improper donning

Prosthetic:

1. Too much ER at knee
2. Too loose socket

Question 15

In what stage of gait are we concerned about whips?

Answer 15

Initial swing

Question 16

In what stage of gait are we concerned about pistoning?

Answer 16

Initial swing

Question 17

What can cause vaulting? (4 amputee, 4 prosthetic)

Answer 17

Amputee:

1. Habit
2. Poor balance/poor knee control (such as weak hip extensors)
3. Fear of stubbing prosthetic toe
4. Weak hip flexors or improper gait training for initiation of flexion

Prosthetic:

1. Too long
2. Inadequate suspension
3. Too much knee friction leading to insufficient knee flexion
4. Excessive built in knee stability (such as knee joint too far posterior to TKA line)

Question 18

In what stage of gait are we concerned with vaulting?

Answer 18

Midswing

Question 19

What can cause circumduction? (3 amputee, 1 prosthetic)

Answer 19

Amputee:

1. Habit
2. Weak hip extensors
3. Insecurity regarding knee control

Prosthetic:
1. Too much stability at knee joint (too much friction or too far posterior to TKA line)

Question 20

In what stage of gait are we concerned about circumduction?

Answer 20

Midswing

Question 21

What causes abduction gait? (4 amputee, 3 prosthetic)

Answer 21

Amputee:

1. Abduction contracture
2. Habit
3. Fear (such as from weak hip extensors)
4. Residual limb pain “crotch pressure”

Prosthetic:

1. Too long
2. Too high medial wall
3. Too much foot outset or valgus alignment between shank and socket may mimic this

Question 22

What does an abducted gait cause?

Answer 22

Excessive distal, lateral pressure

Question 23

In what phase of gait are we concerned with abducted gait?

Answer 23

Midswing

Question 24

What can cause terminal impact? (2 amputee, 2 prosthetic)

Answer 24

Amputee:

1. Intentional to get an audible click
2. Too vigorous hip flexion followed by too strong hip extension

Prosthetic:

1. Insufficient friction at knee
2. Too strong extension aid

Question 25

In what phase of gait are we concerned with terminal impact?

Answer 25

Terminal swing

Question 26

What causes uneven timing/short prosthetic stance? ( 3 amputee, 5 prosthetic)

Answer 26

Amputee: 1. Weakness/unstable knee 2. Poor balance/insecurity 3. Pain Prosthetic: 1. Socket fits poorly causing pain 2. Alignement instability 3. Excessive dorsiflexion 4. Poor suspension 5. Unaccommodated hip flexion contracture

Question 27

What causes uneven arm swing?

Answer 27

Amputee: 1. Habit/poor balance/insecurity Prosthetic: 1. Occasionally due to stump pain 2. Inadequate suspension

Question 28

What gait deviations can too firm of a heel cushion cause?

Answer 28

1. Rotation of the prosthetic foot during initial contact | 2. Instability of prosthetic knee during initial contact

Question 29

What gait deviations can too hard of a plantarflexion bumper cause?

Answer 29

1. Rotation of the prosthetic foot during initial contact | 2. Instability of the prosthetic knee during initial contact

Question 30

What gait deviations can weak hip extensors cause?

Answer 30

1. Instability of prosthetic knee during initial contact to loading response 2. Vaulting during midswing 3. Circumduction during midswing 4. Abducted gait during midswing 5. Short prosthetic stance/uneven timing

Question 31

What gait deviations can alignment instability cause?

Answer 31

1. Instability of the prosthetic knee during initial contact to loading response 2. Short prosthetic stance/uneven timing

Question 32

What gait deviations can excessive dorsiflexion cause?

Answer 32

1. Instability of prosthetic knee during initial contact 2. Drop off at terminal stance 3. Uneven timing/short prosthetic stance

Question 33

What gait deviations can habit cause?

Answer 33

1. Ipsilateral bending of trunk during midstance 2. Vaulting during midswing 3. Circumduction during midswing 4. Abducted gait during midswing 5. Uneven arm swing

Question 34

What can poor balance cause?

Answer 34

1. ipsilateral bending of the trunk during midstance 2. Vaulting 3. Uneven timing/short prosthetic stance 4. Uneven arm swing

Question 35

What gait deviations can an abduction contracture cause?

Answer 35

1. Ipsilateral trunk lean | 2. Abducted gait during midswing

Question 36

What gait deviations can insufficient knee friction cause?

Answer 36

1. Excessive heel rise in initial swing | 2. Terminal impact in terminal swing

Question 37

What can improper donning of the socket cause?

Answer 37

1. Excessive pistoning during initial swing 2. Lateral whip 3. Medial whip

Question 38

What gait deviations can too long of a prosthesis cause?

Answer 38

1. Vaulting 2. (Circumduction) 3. Abducted gait during midswing

Question 39

What gait deviations can a hip flexion contracture cause?

Answer 39

1. Flexion moment of prosthetic knee at initial contact | 2. Short prosthetic stance/uneven timing

Question 40

What gait deviations can inadequate suspension cause?

Answer 40

1. Vaulting 2. Short prosthetic stance 3. Uneven arm swing

Question 41

What gait deviations can excessive knee friction cause?

Answer 41

1. Vaulting | 2. Circumduction

Question 42

What gait deviations can excessive stability of the knee joint cause?

Answer 42

1. Vaulting | 2. Circumduction

Question 43

What gait deviations can pain cause?

Answer 43

1. Abducted gait during midswing 2. Short prosthetic stance/uneven timing 3. Uneven arm swing 4. Ipsilateral trunk lean