Gt Deviations

How can prosthetics cause lateral trunk bending?

• Short prosthesis

• Inadequate lateral wall adduction

• High or sharp medial wall

• Prosthesis aligned in abduction

How can anatomy cause lateral trunk bending?

• Poor balance/ instability

• Abduction contracture

• Poor gait training

• Short residual limb

• Weak hip abductors on prosthetic side

• Hypersensitive and/or painful residual limb

How can prosthetics cause an abducted gait?

• Prosthesis too long

• High medial wall

• Poorly shaped lateral wall (not enough adduction)

• Prosthesis positioned in abduction

• Inadequate suspension

• Excessive knee friction

How can anatomy cause an abducted gait?

• Abduction contracture

• Weak hip flexors and adductors (Giles)

• Comment about O’S

• Pain over lateral residual limb

• Adductor roll/ adductor redundancy instability

How can prosthetics cause a circumducted gait?

• Prosthesis too long

• Socket too small

• Loose socket

• Loose friction (O’S – rapid extension) vs. Too

much friction (Giles)

• Excessive plantar flexion of prosthetic foot

• Inadequate suspension

• Locked knee

How can anatomy cause a circumducted gait?

• Abduction contracture

• Improper training

• Weak hip flexors

• Poor knee control/ Lack of confidence to flex the

knee / Inability to initiate knee flexion

• Painful anterior distal residual limb

How can prosthetics cause excessive knee flexion during stance?

• High shoe heel

• Insufficient plantarflexion

• Stiff heel cushion

• Socket too far anterior

• Socket excessively flexed

• Cuff tabs too posterior

How can anatomy cause excessive knee flexion during standing?

• Knee flexion contracture

• Weak quadriceps

• Hip flexion contracture

• Pain anteriorly in residual limb

• Poor balance

How can prosthetics cause vaulting gait?

• Prosthesis too long

• Inadequate socket suspension

• Excessive alignment stability

• Foot in excessive plantarflexion

How can anatomy cause vaulting gait?

• Residual limb discomfort

• Improper training

• Fear of stubbing toe

• Short residual limb

• Painful hip on residual limb side

How can prosthetics cause rotation of the forefoot at heel strike during gait?

• Steel heel cushion / Rigid SACH heel cushion

• Excessive toe-out built in (malrotated foot)

• Loose fitting socket

• Inadequate suspension

How can anatomy cause rotation of the forefoot at heel strike during gait?

• Poor muscle control

• Improper training

• Weak medial rotators

• Short residual limb

How can prosthetics cause forward trunk flexion?

• Socket too big

• Poor suspension

• Knee instability

• Short walker or crutches

How can anatomy cause forward trunk flexion?

• Hip flexion contracture

• Weak hip extensors

• Pain with ischial weight bearing

• Inability to initiate prosthetic knee flexion

How can prosthetics cause medial or lateral whip?

• Excessive rotation of the knee

• Tight socket fit

• Valgus in the prosthetic knee

• Improper alignment

• Faulty socket contour

How can anatomy cause medial or lateral whip?

• Improper training

• Weak hip rotators

• Knee irritability

Milwaukee orthosis

• Promote realignment due to scoiliotic curvature

• Extends from pelvis to upper chest

Taylor Brace

Limits trunk flexion and extension through 3 point control

Thoracolumbosacral orthosis

• Prevent trunk motion

• Used post surgically