Transtibial Gait Deviations

Question 1

What are causes of a hyperextension moment at the knee? (2 amputee, 5 prosthetic)

Answer 1

Amputee:

1. Weak quads
2. Too forceful quad contraction

Prosthetic:

1. Too soft/too low heel cushion
2. Too low a shoe heel
3. Posterior leaning pylon
4. Foot too anterior=short heel lever
5. Foot too plantarflexed

Question 2

In what part of gait are we concerned about a knee hyperextension moment?

Answer 2

Initial contact to loading response

Question 3

What are causes of a flexion moment at the knee? (2 amputee, 6 prosthetic)

Answer 3

Amputee:

1. Unaccommodated knee flexion contracture
2. Weak quads

Prosthetic:

1. Too hard heel cushion
2. Too high shoe heel
3. Anterior leaning pylon (socket flexed greater than 5 to 15 degrees)
4. Foot too posterior=long heel lever
5. Foot too dorsiflexed
6. Excessive Pressure against distal, anterior tibia

Question 4

In what part of gait are we concerned about a flexion moment in the knee?

Answer 4

Initial contact to loading response

Question 5

What are the causes of external rotation of the prosthesis? (1 amputee, 2 prosthetic)

Answer 5

Amputee:
1. weak internal rotators

Prosthetic:

1. Too hard or too high a heel cushion
2. Too much toe out

Question 6

In what part of stance are we concerned about external rotation of the prosthesis?

Answer 6

Initial contact to loading response

Question 7

What are the causes of abducted gait? (1 amputee, 2 prosthetic)

Answer 7

Amputee:
1. Habit

Prosthetic:

1. Pylon too long
2. Outset foot may mimic this

Question 8

In what phase of gait are we most concerned about abducted gait?

Answer 8

Midstance

Question 9

What are the causes of a trunk lean? (1 amputee, 4 prosthetic)

Answer 9

Amputee:
1. Weak abductors

Prosthetic:

1. Too short or too long
2. Outset foot
3. Improper socket fit causing pain
4. Medial leaning pylon

Question 10

In what phase of gait are we concerned about a trunk lean?

Answer 10

Midstance

Question 11

What are the causes of a valgus moment at the knee?

Answer 11

Amputee:
None

Prosthetic:
1. Outset foot

Question 12

What are the causes of a varus moment at the knee?

Answer 12

Amputee:
None

Prosthetic:
1. Inset foot

Question 13

In what stage of gait are we concerned about valgus/varus moments at the knee?

Answer 13

Midstance

Question 14

What causes walking on the lateral border of the foot?

Answer 14

Amputee:
None

Prosthetic:
1. Laterally leaning pylon

Question 15

What causes walking on the medial border of the foot?

Answer 15

Amputee:
None

Prosthetic:
1. Medially leaning pylon

Question 16

In what stage of gait are we most concerned with walking on the borders of the foot?

Answer 16

Midstance

Question 17

What causes decreased stance time? (2 amputee, 1 prosthetic)

Answer 17

Amputee:

1. Inadequate weight bearing
2. Poor balance

Prosthetic:
1. Pain from socket

Question 18

What causes a Trendelenburg gait?

Answer 18

Amputee:

1. Weak hip abductors
2. Poor balance

Prosthetic:
None

Question 19

in what stage of gait are we concerned about a Trendelenburg gait?

Answer 19

Midstance

Question 20

What causes a drop-off? (1 amputee, 3 prosthetic)

Answer 20

Amputee:
1. Habit

Prosthetic:

1. Toe lever too short (foot too posterior, keel too short)
2. Excessive socket flexion
3. Excessive dorsiflexion

Question 21

In what stage of gait are we concerned about a drop-off?

Answer 21

Terminal stance to pre-swing

Question 22

What causes delayed knee flexion? (2 amputee, 2 prosthetic)

Answer 22

Amputee:

1. Poor pelvic control
2. Weak knee flexors

Prosthetic:

1. Foot too anterior
2. Excessive plantarflexion

Question 23

In what phase of gait are we concerned about delayed knee flexion?

Answer 23

Terminal stance to pre-swing

Question 24

What can cause a shortened prosthetic stride length/shorter prosthetic swing? ( 1 amputee, 3 prosthetic)

Answer 24

Amputee:
1. Knee flexion contracture

Prosthetic:

1. Anterior leaning pylon
2. Pylon too short
3. Inadequate suspension

Question 25

What are the causes of inability for the leg to clear the floor?

Answer 25

Amputee: None Prosthetic: 1. Prosthesis too long 2. Inadequate suspension

Question 26

What are the causes vaulting? (2 amputee, 3 prosthesis)

Answer 26

Amputee: 1. Habit or fear of catching toe 2. Improper gait training for initiation of hip flexion Prosthetic: 1. Prosthesis too long 2. Inadequate suspension 3. Excessive plantarflexion

Question 27

What can cause a lateral whip? (1 amputee, 1 prosthetic)

Answer 27

Amputee: 1. Improperly donned (rotated) Prosthetic: 1. Internally rotated socket

Question 28

What can cause a medial whip? (1 amputee, 1 prosthetic)

Answer 28

Amputee: 1. Improperly donned (rotated) Prosthetic: 1. Externally rotated socket

Question 29

In what phase of gait are we concerned about lateral and medial whips?

Answer 29

Initial swing to terminal swing

Question 30

What can cause pistoning?

Answer 30

Amputee: None Prosthetic: 1. Socket too loose 2. Improperly donned

Question 31

In what stage of gait are we concerned mainly about pistoning?

Answer 31

Swing

Question 32

What gait deviations can result from too hard or too high of a heel cushion?

Answer 32

1. Flexion moment at the knee during Initial contact to loading response 2. External rotation of the prosthesis during initial contact to loading response

Question 33

What gait deviations can result from an anterior leaning pylon?

Answer 33

1. Flexion moment at the knee during initial stance to loading response 2. Shorted prosthetic stride length/short prosthetic swing

Question 34

What gait deviations can result from a too far posterior foot?

Answer 34

1. Flexion moment at the knee during initial contact to loading response 2. Drop-off in terminal stance to preswing

Question 35

What gait deviations can result from a too far anterior foot?

Answer 35

1. Hyperextension moment at the knee during initial contact to loading response 2. Delayed knee flexion in terminal stance to preswing

Question 36

What gait deviations can result from a foot that is too plantarflexed?

Answer 36

1. Hyperextension moment of the knee during initial contact to loading response 2. Delayed knee flexion in terminal stance to preswing 3. Vaulting in swing

Question 37

What gait deviations can result from a foot that is too dorsiflexed?

Answer 37

1. Flexion moment of the knee during initial contact to loading response 2. Drop-off in terminal stance to preswing

Question 38

What gait deviations are related to habit?

Answer 38

1. Abducted gait 2. Drop off 3. Vaulting

Question 39

What gait deviations are related to a socket with too much initial flexion?

Answer 39

1. Flexion moment of the knee during initial stance to loading response 2. Drop off in terminal stance to preswing

Question 40

What gait deviations can result from a pylon/prosthesis that is too long?

Answer 40

1. Abducted gait during midstance 2. Inability to clear the floor 3. Vaulting during swing 4. Trunk leaning during midstance

Question 41

What gait deviations can result from a pylon/prosthesis that is too short?

Answer 41

1. Trunk leaning during midstance | 2. Shorted prosthetic stride length (short prosthetic swing)

Question 42

What gait deviations can result from an outset foot?

Answer 42

1. Abducted gait appearance during midstance 2. Trunk leaning during midstance 3. Valgus moment at the knee during midstance

Question 43

What gait deviations can result from a medially leaning pylon?

Answer 43

1. Trunk leaning during midstance | 2. Walking on medial border of foot during midstance

Question 44

What gait deviations can result from poor balance?

Answer 44

1. Decreased stance time | 2. Trendelenburg gait during midstance

Question 45

What gait deviations can result from inadequate suspension?

Answer 45

1. Vaulting 2. Inability to clear the floor 3. Shortened prosthetic stride/swing

Question 46

What gait deviations can result from improperly donning a socket?

Answer 46

1. Lateral/medial whip | 2. pistoning