Transtibial And Transfemoral Prosthetic Gait Deviaitons

Question 1

During TT gait assessment what should u consider

Answer 1

All 3 planes

Normal gait with flexion thru out stance , slight varus moment and slight toe out

Question 2

How should the knee be for Transtibial gait

Answer 2

5-10° of knee flexion to promote weight bearing thru the patella

Question 3

What is the cause of gait deviation for a TT pt from the prosthesis

Answer 3

Misalignment of the prosthesis

Question 4

What is the cause of gait deviation for a TT pt because of the individual

Answer 4

• variation in limb volume
• changes in show wear (changes in heel height can change the orientationof the socket to the ground)
• mm weakness
• mm tightness

Question 5

What are things that could affect limb volume for a TT pt

Answer 5

• changes in diet
• meds
• shrinker wear
• activity level

Question 6

If there is excessive knee extension during IC—> LR for a TT pt , how could the prosthetic be causing this (3)

Answer 6

• foot to anterior to socket ( too long toe lever)
• heel cushion too soft –> delays pylon translation foward
• excessive PF of the foot

Question 7

If there is excessive knee extension during IC—> LR for a TT pt , how could the person be causing this

Answer 7

• shoe heel height to low
• excessive use of knee extensors

Question 8

Excessive knee extension during IC —> LR for a TT can lead to pain where

Answer 8

Anterior distal pain on the residual limb and skin abrasion

Question 9

If a TT pt complains of anterior distal pain on the residual limb and skin abrasions and u see they have excessive knee extension during IR—>LR what can u encourage them to do

Answer 9

Bend knee slightly to promote weigh bearing thru the patella tendon –> 5-10° of knee flexion for soft knee

Question 10

If there is excessive knee flexion during IC—> LR for a TT pt , how could the prosthetic be causing this (3)

Answer 10

• Heel too firm–> throws pylon forward way to fast leading to knee flexion
• Foot too far posterior
• Foot too dorsiflexed

Question 11

If there is excessive knee flexion during IC—> LR for a TT pt , how could the person be causing this

Answer 11

• Knee flexion contracture
• Shoe height too high
• Weak quadriceps

Question 12

If a TT patient has a narrow based gait adn excessive varus thrust during midstance how can the prosthetic be causing this

Answer 12

• Pylon leans laterally
• Foot too inset
• Socket too wide

Question 13

If a TT patient has a wide based gait adn excessive valgus thrust during midstance how can the prosthetic be causing this

Answer 13

• Pylon leans medially
• Foot too outset
• Socket too wide

Question 14

If a TT patient has a lateral trunk bending to the prosthetic side during midstance how can the prosthetic be causing this

Answer 14

• Prosthesis too short–> so they lean to that side in order to get their sound limb up bc limb differnce
• Abducted socket

Question 15

If a TT patient has a laterla trunk bending to the prosthetic side during midstance how can the person be causing this

Answer 15

• pain on laterla distal aspect of residual limb
• weak HIP ABDUCTORS

Question 16

If a TT patient has a early, abrupt heel off (drop off) during Terminal stance to pre swing how can the prosthetic be causing this

Answer 16

• Toe lever arm too short or too soft due to excessive posterior position of the foot
• Foot excessively dorsiflexed (socket in too much flexion

Question 17

If a TT patient has a early, abrupt heel off (drop off) during Terminal stance to pre swing how can the person be causing this

Answer 17

• heel height to high

Question 18

If a TT patient has pistoning during Terminal stance to pre swing how can the prosthetic be causing this

pistoning is when there is vertical displacement of the residual limb in the socket

Answer 18

• socket to large
• inadequate supsension (unable to keep it on)

Question 19

If a TT patient has pistoning during Terminal stance to pre swing how can the persons be causing this

Answer 19

Limb shrinkage

Question 20

If a TT patient has a foot whip medial or lateral during swing how is the knee positioned

Answer 20

Lateral whip: knee IR
Medial whip: knee ER

Question 21

If a TT patient has a foot whip medial or lateral during swing how may the prosthetic cause this

Answer 21

• inadequate suspension- misaligned

Question 22

If a TT patient has a foot whip medial or lateral during swing how may the person cause this

Answer 22

• Irregular loading at terminal stance
• Improperly donned prosthesis

Question 23

What are some causes of TF gait deviations (5)

Answer 23

• Limb volume changes
• Inappropriate number of socks
• Changing footwear
• Improper donning
• Inadequate suspension

Question 24

If a TF patient has knee instability at IC how may the prosthetic be causing this

Answer 24

• Knee axis set too far anterior, creating a flexion moment
• Heel cushion is too hard creates a flexion moment at heel strike

Question 25

If a **TF** patient has **knee instability** at IC how may the **person** be causing this

Answer 25

* Hip flexion contracture * Hip extensor weakness (active hip extension in prosthesis assist in stabilizing knee) * Change in heel height

Question 26

If a **TF** patient has **foot slap** at IC how may the **person** be causing this

Answer 26

Forces heel into the ground to ensure complete knee extension/stability

Question 27

If a **TF** patient has **foot slap** at IC how may the **prosthetic** be causing this

Answer 27

* Insufficient plantarflexion resistance in the prosthetic foot * Heel cushion too soft for users weight and activity level

Question 28

If a **TF** patient has **ER of the prosthetic foot** at IC —> LR how may the **prosthetic** be causing this

Answer 28

* Excessively firm heel cushion * Inappropriate toe-out alignment

Question 29

If a **TF** patient has **ER of the prosthetic foot** at IC —> LR how may the **person** be causing this

Answer 29

* Poor muscle control (maintains hip in external rotation) * Limb shrinkage-may need to add socks

Question 30

If a **TF** patient has as **abducted gait** during midstance how may the **person** be causing this (5)

Answer 30

* Increased volume of the limb * Excess pressure on the pubic ramus * Pain at distal lateral femur * Contracted hip abductors * Patient insecurity, habit

Question 31

If a **TF** patient has as **abducted gait** during midstance how may the **prosthetic** be causing this

Answer 31

* Medial brim of socket too high * Prosthesis too long * Insufficient femur support by lateral wall * Socket too abducted

Question 32

If a **TF** patient has **excessive laterla trunk** bending during midstance how may the **prosthetic** be causing this (4)

Answer 32

* Prosthesis is too short * Excessively outset foot * Medial wall of the socket too high * Adduction of socket inadequate (too much abduction

Question 33

If a **TF** patient has **excessive laterla trunk bending** during midstance how may the **person** be causing this (3)

Answer 33

* Weak abductors * Pain * Limb shrinkage-positioned too deeply in socket

Question 34

If a **TF** patient has **pelvic rise (“uphill walking”)** durign terminal stance how may the **prosthetic** be causing this

Answer 34

* Toe lever too long * Foot placed too anteriorly with respect to knee/socket * Excessively plantarflexed foot

Question 35

If a **TF** patient has **drop off** during terminal stance how may the **prosthetic** be causing this ## Footnote premature roll overof foot, excessive pelvic drop with forward prorgessiong (stepping inot a hole)

Answer 35

* Toe lever too short * Foot too dorsiflexed

Question 36

What is **drop off** during terminal stance for a **TF** gait deviation

Answer 36

Excessive pelvic drop with forward progression

Question 37

If a TF patient has excessive lumbar lordosis during terminal stance how may the prosthetic be causing this

Answer 37

• Insufficient initial socket flexion leads the client to extend the lumbar spine to obtain hip extension necessary for knee control • Improperly shaped posterior wall causing painful ischial weight bearing

Question 38

If a TF patient has excessive lumbar lordosis during terminal stance how may the person be causing this

Answer 38

• Weak hip extensors or abdominals • Hip flexion contracture that cannot be accommodated prosthetically • Pain from ischial weight bearing

Question 39

If a **TF** patient has **medial or lateral whip** during pre swing how may the **person** be causing this

Answer 39

* Medial whip: Socket donned with too much ER * Lateral whip: Socket donned with too much IR

Question 40

If a TF patient has medial or lateral whip during pre swing how may the prosthetic be causing this

Answer 40

• Medial whip : Prosthetic knee aligned in excessive ER • Lateral whip: prosthetic knee aligned in excessive IR

Question 41

If a **TF** patient has **inadequate or delayed knee flexion** during pre swing how may the **prosthetic** be causing this

Answer 41

* Excessive mechanical resistance to knee flexion * Prosthesis aligned with too much stability

Question 42

If a **TF** patient has **inadequate or delayed knee flexion** during pre swing how may the **person** be causing this

Answer 42

* Poor gait mechanics (patient not trusting knee and walking on it locked)

Question 43

If a **TF** patient has **circumducted gait** during IS and MS how may the **person** be causing this (3)

Answer 43

* Fear of knee flexion or catching toe * Inadequate hip flexion * Pain due to high medial brim

Question 44

If a **TF** patient has **circumducted** **gait** during IS and MS how may the **prosthetic** be causing this (3)

Answer 44

* Prosthetic knee with excessive mechanical resistance to knee flexion * Prosthetic knee locked in extension (extension bias too strong) * Prosthesis too long

Question 45

If a **TF** patient has **vaulting** during IS and MS how may the **prosthetic** be causing this (4) ## Footnote clinent rises on the toe of the sound limn to swing th eproshtesis thru w little knee flexion

Answer 45

* Inadequate socket suspension * Prosthesis too long * Too much resistance to knee flexion * Prosthetic knee locked in extension (extension bias too strong

Question 46

If a **TF** patient has **vaulting** during IS and MS how may the **person** be causing this

Answer 46

* Fear of knee flexion or dragging toe * Patient habit

Question 47

What is vaulting as a gait deviation for a TF pt

Answer 47

Client rises on the toe of the sound limb to swing the prosthesis thru wiht little knee flexion

Question 48

If a **TF** patient has **excessive terminal impact** during terminal swing how may the **person** be causing this

Answer 48

* Forceful hip flexion in initial swing to build momentum for knee extension * Forcefully extends hip in terminal swing to snap knee into full extension in preparation for initial contact

Question 49

If a **TF** patient has **excessive terminal impact** during terminal swing how may the **prosthetic** be causing this

Answer 49

I nsufficient resistance to extension of knee unit

Question 50

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 What does this describe

Answer 50

Excessive terminal impact during terminal swing ofr a TF

Question 51

If a **TF** patient has **unequal step length** during terminal swing how may the **prosthetic** be causing this

Answer 51

Insufficient initial socket flexion to accommodate hip flexion contracture

Question 52

If a **TF** patient has **unequal step length** during terminal swing how may the **person** be causing this

Answer 52

* Hip flexion contracture * Fear of falling * Pain

Question 53

What is unequal step length mean for a TF gait deviate

Answer 53

Long prosthetic side step