TT and TF prosthetic gait deviations Flashcards
(57 cards)
1
Q
describe normal transtibial prothetic gait
A
- Flexion moment through out stance
- Slight varus moment (about ½. Inch)
- Slight toe out
- Knee should be 5-10° of knee flxn to promote weight bearing through the patella
2
Q
common causes of transtibial gait deviations caused by prosthetic
A
Misalignment of prosthesis
3
Q
common causes of transtibial gait deviations caused by individual
A
- Variations in limb volume (diet, meds, shrinker wear, activity, weather)
- Change in shoe wear affecting heel height and orientation of socket to ground
- Muscle weakness or tightness
4
Q
TRANSTIBIAL
deviations that can occur at IC or LR
A
- excessive knee extension
- excessive knee flexion
5
Q
TRANSTIBIAL
possible prosthetic causes for excessive knee extension during IC or LR
A
- Heel cushion too soft
- Foot too anterior to socket (toe lever too long)
- Excessive plantarflexion of foot
6
Q
TRANSTIBIAL
Possible Amputee causes for excessive knee extension during IC or LR
A
- Shoe height too low
- Excessive use of knee extensors – can lead to anterior distal pain on tibia and cause skin abrasions; if complaints arise encourage a soft knee
7
Q
TRANSTIBIAL
possible prosthetic causes for excessive knee flexion (knee instability) during IC or LR
A
- Heel too firm – translation occurs took quickly throwing person forward
- Foot too far posterior – loss of lever arm
- Foot too dorsiflexed – causing crouch
8
Q
TRANSTIBIAL
possible amputee causes for excessive knee flexion (knee instability) during IC or LR
A
- Knee flexion contracture
- Shoe height too high
- Weak quads – causing buckling
9
Q
What are possible midstance transtibial deviations?
A
- narrow based gait with excessive varus thrust
- wide based gait with excessive valgus thrust
- lateral trunk bending to prosthetic side
10
Q
Transtibial
possible prosthetic causes for narrow based gait w/ excessive varus thrust
A
- pylon leans laterally
- foot too inset
- socket too wide – may just need to adjust sock amount
11
Q
Transtibial
possible prosthetic causes for wide based gait w/ excessive valgus thrust
A
- pylon leans medially
- foot to outset
- socket too wide
12
Q
Transtibial
possible prosthetic causes for lateral trunk bending to prosthetic side
A
- Prosthetic is too short
- Abducted socket
13
Q
Transtibial
possible amputee causes for lateral trunk bending to prosthetic side
A
- Pain on lateral distal aspect of residual limb
- Weak hip abductors
- Limb volume – if shrunken or swollen pt could have functional leg discrepancy and therefore compensating with trunk lean
14
Q
What are possible transtibial gait deviations during terminal stance to preswing?
A
- early, abrupt heal off (drop-off)
- pistoning
15
Q
transtibial
what are possible prosthetic causes for early, abrupt heal off (drop-off) during terminal stance or preswing?
A
- Toe lever arm too short or too soft d/t excessive posterior position of the foot
- Foot excessively dorsiflexed (socket in too much flexion)
16
Q
transtibial
what are possible amputee causes for early, abrupt heal off (drop-off) during terminal stance or preswing?
A
heel height too high
17
Q
transtibial
what are possible prosthetic causes for pistoning during terminal stance or preswing?
A
- socket too large – allowing vertical translation
- suspension inadequate
18
Q
transtibial
what are possible amputee causes for pistoning during terminal stance or preswing?
A
- Limb shrinkage – add socks
19
Q
what is pistoning?
A
vertical translation of residual limb in socket
20
Q
what are some transtibial gait deviations that can occur during swing phase?
A
- foot whips medially or laterally
21
Q
which way does the knee rotate if the foot whips laterally?
A
knee internally rotates
22
Q
which way does the knee rotate if the foot whips medially?
A
knee externally rotates
23
Q
what are some prosthetic causes for medial or lateral foot whips during swing phase?
A
- Inadequate suspension; misalignment
24
Q
what are some amputee causes for medial or lateral foot whips during swing phase?
A
- Irregular loading at terminal stance
- Improperly donned prosthesis
25
what are some common causes of TRANSFEMORAL gait deviations?
* limb volume changes
* inappropriate number of socks
* changing footwear - affecting limb length or heel height
* improper donning - donning with ER/IR
* inadequate suspension
26
what are some possible transfemoral gait deviations during IC?
* knee instability (knee flexion)
* foot slap
* external rotation of prosthetic foot (can occur during IC or LR)
27
transfemoral
what are some possible prosthetic causes of knee instability (uncontrollable knee flexion) during IC?
* Knee axis set too far anterior --> creating flexion moment
* Heel cushion too hard --> creates flexion moment at heel strike
28
transfemoral
what are some possible amputee causes of knee instability (uncontrollable knee flexion) during IC?
* Hip flexion contracture
* Hip extensor weakness (*remember active hip extn in prosthesis assist in stabilizing heel)
* Change in heel height (too high of heal forces pressure forward into flexion moment)
29
transfemoral
what are some possible prosthetic causes of foot slap during IC?
* Insufficient plantarflexion resistance in prosthetic foot
* Heel cushion too soft for users weight or activity level
30
what are some possible transfemoral gait deviations during midstance?
- abducted gait
- excessive lateral trunk bending
30
transfemoral
what are some possible amputee causes of foot slap during IC?
* Forces heel into ground to ensure complete knee extension/stability
31
transfemoral
what are some possible prosthetic causes of abducted gait during midstance?
* Medial brim of socket too high – hitting pubic ramus
* Prosthesis is too long
* Insufficient femur support by lateral wall
* Socket too abducted
32
transfemoral
what are some possible amputee causes of abducted gait during midstance?
* Increased limb volume
* Excess pressure on pubic ramus (pressure should be on ischial tuberosity)
* Pain at distal lateral femur
* Contracted hip abductors
* Pt insecurity or habit
33
transfemoral
what are some possible prosthetic causes of excessive lateral trunk bending during midstance?
* Prosthesis is too short
* Excessively outset foot
* Medial wall of socket too high
* Adduction of socket inadequate (too much abduction)
34
transfemoral
what are some possible amputee causes of excessive lateral trunk bending during midstance?
* Weak abductors
* Pain
* Limb shrinkage – positioned too deeply in socket
35
what are some possible transfemoral gait deviations that can occur during terminal stance?
* pelvic rise (uphill walking/hip hiking)
* drop-off
* excessive lumbar lordosis
36
transfemoral
what are some possible prosthetic causes of pelvic rise (hip hiking) during terminal stance?
* Toe lever too long
* Foot placed too anteriorly with respect to knee/socket
* Excessively plantarflexed foot
(no amputee causes)
37
transfemoral
what are some possible prosthetic causes of drop off during terminal stance? (feels like stepping into a hole)
* Toe lever too short
* Foot too dorsiflexed
no amputee causes
38
what are some transfemoral gait deviations that could occur during preswing?
- medial or lateral whip
- inadequate or delayed knee flexion
39
transfemoral
if the knee externally rotates which way does the foot whip? medial or lateral?
medially
40
transfemoral
if the knee internally rotates which way does the foot whip? medial or lateral?
laterally
41
transfemoral
what are some possible prosthetic causes of medial whip during preswing?
* prosthetic knee aligned in excessive ER
42
transfemoral
what are some possible amputee causes of medial whip during preswing?
socket donned in too much ER
43
transfemoral
what are some possible prosthetic causes of lateral whip during preswing?
knee is aligned in excessive IR
44
transfemoral
what are some possible amputee causes of lateral whip during preswing?
socket donned in too much IR
45
transfemoral
what are some possible prosthetic causes of inadequate or delayed knee flexion during preswing?
* Excessive mechanical resistance to knee flexion
* Prosthesis aligned with too much stability
46
transfemoral
what are some possible amputee causes of inadequate or delayed knee flexion during preswing?
* Poor gait mechanics – pt not trusting knee and walking on it locked
47
what are some transfemoral gait deviations that can occur during IC or midswing?
* circumducted gait
* vaulting (rising up on toes of sound leg)
48
transfemoral
what are some possible prosthetic causes of circumducted gait during IC or midswing?
* Prosthetic knee with excessive mechanical resistance to knee flexion (can bend it well so they just circumduct)
* Prosthetic knee locked in extension (extension bias too strong)
* Prosthesis too long
49
transfemoral
what are some possible amputee causes of circumducted gait during IC or midswing?
* Fear of knee flexion or catching toe
* Inadequate hip flexion
* Pain due to high medial brim
50
transfemoral
what are some possible prosthetic causes of vaulting gait during IC or midswing?
* Inadequate socket suspension
* Prosthesis too long
* Too much resistance to knee flexion
* Prosthetic knee locked in extension (extension bias too strong)
51
transfemoral
what are some possible amputee causes of vaulting gait during IC or midswing?
* Fear of knee flexion or dragging toe
* Patient habit
52
what are some possible transfemoral gait deviations that could occur during terminal swing?
* excessive terminal impact
* unequal step length
53
transfemoral
what are some possible prosthetic causes of excessive terminal impact during terminal swing?
* Insufficient resistance to extension of knee unit
54
transfemoral
what are some possible amputee causes of excessive terminal impact during terminal swing?
* 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 prep for IC
55
transfemoral
what are some possible prosthetic causes of unequal step length during terminal swing?
* Insufficient initial socket flexion to accommodate hip flexion contracture
56
transfemoral
what are some possible amputee causes of unequal step length during terminal swing?
* Hip flexion contracture
* Fear of falling
* Pain
