gait deviations

what are pt causes of gait deviations?

Muscle weakness

Contracture

Pain

Decreased confidence in prosthesis or residual limb

Habitual/learned behaviors

what are prosthetic causes of gait deviations?

Prosthetic malalignment

Poor-fitting prosthetic socket

list gait deviations that are possible for TT amputations

1. absent/inadequate knee flexion

2. excessive knee flexion

3. external rotation of foot at heel strike

4. knee instabiulity

5. vaglus/varus moment

6. drop off

7. knee hyperextension

8. whip

9. pistoning

list gait deviations that are possible for TF amputations

1. prosthetic instability

2. foot slap

3. abducted gait

4. lateral trunk bending

5. increased lumbar lordosis

6. whip (during swing phase)

7. pistoning

8. excessive heel rise

9. reduced heel rise

10. circumduction

11. vaulting

12. terminal impact

list gait deviations that are possible for both TT and TF amputations

1. uneven step length

2. uneven (or absent) arm swing

absent/inadequate knee flexion:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: knee fully extended at heel strike

2. pt cause: discomfort/pain; quad weakness; foot placement too far forward on stepping

3. prosthetic cause: faulty suspension of the prosthesis- too soft heel cushion or PF bumpers; lack of pre-flexion of the socket

excessive knee flexion:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: increased knee flexion at heel strike (or mid stance), pt feels like they are walking downhill

2. pt cause: Flexion contracture of the knee

3. prosthetic cause: Faulty suspension of the prosthesis; prosthetic foot set in too much DF; stiff heel cushion; foot too posterior in relation to the socket

external rotation of foot at heel strike

1. description:

2. pt cause:

3. prosthetic cause:

1. description: ER of prosthetic foot at heel strike

2. pt cause: N/A

3. prosthetic cause: heel too hard; loose socket

knee instability:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: knee flexion "jerky" in the presentation during heel strike to foot flat

2. pt cause: weak quads

3. prosthetic cause: N/A

valgus/varus moment:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: knee shifts medially/laterally during prosthetic stance phase

2. pt cause: foot placement (medial placement = lateral thrust/varus moment; lateral placement = medial thrust/valgus moment)

3. prosthetic cause: foot alignment on the prosthesis; socket loose

drop off:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: heel off occurs too early causing early knee flexion

2. pt cause: N/A

3. prosthetic cause: foot too posterior in relation to socket; excessive DF of foot on prosthesis; hard heel bumper

knee hyperextension:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: delayed heel-off causing hyperextension of the knee; pt feels like they're walking uphill

2. pt cause: N/A

3. prosthetic cause: foot set too far forward in relation to socket; too soft heel cushion; too much PF on the foot

TT whip:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: during swing phase foot 'whips' laterally or medially

2. pt cause: knee internally or externally rotated

3. prosthetic cause: poor suspension

TT pistoning:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: amputee drops into socket as foot moves into flat foot; tibia moves vertically during alternating weight bearing and non-weight bearing periods of gait

2. pt cause: N/A

3. prosthetic cause: lack of prosthetic socks; suspension loose or inadequate; too large or faulty socket

prosthetic instability:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: prosthetic knee has tendency to buckle on weight bearing

2. pt cause: severe hip flexion contracture; weak hip extensors

3. prosthetic cause: knee set too far anterior; heel cushion too firm; heel of the shoe too high causing pylon to move anteriorly

foot slap:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: foot progresses too quickly from heel strike to foot flat, creating slapping noise

2. pt cause: pt forcing foot contact to gain knee stability

3. prosthetic cause: heel cushion too soft; PF cushion too soft; excessive DF

abducted gait:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: increased BOS during mobility, prosthetic foot placement is lateral to normal foot placement during gait

2. pt cause: pain in the groin/medial wall of prosthesis; hip abductor contractures; fear/lack of confidence transferring weight onto prosthesis

3. prosthetic cause: prosthesis too long; socket too small; lateral wall of prosthesis not supporting femur sufficiently; socket of prosthesis abducted in alignment; alignment of the lower half of pylon in relation to socket

lateral trunk bending:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: trunk flexes towards prosthetic during prosthetic stance phase

2. pt cause: weak or contracted hip abductors; pain on the lateral distal end of the stump; lack of balance; habit; short stump length

3. prosthetic cause: prosthesis too short; foot outset excessively in relation to socket; lack of prosthetic lateral wall support

increased lumbar lordosis:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: lumbar lordosis exaggerated during prosthetic stance phase

2. pt cause: hip flexion contracture; weak hip extensors; habit; poor abdominal muscles

3. prosthetic cause: poor shaping of posterior wall of prosthesis; pain on ischial weight bearing resulting in anterior pelvic tilt; lack of support from anterior wall of socket; insufficient socket flexion

TF whip (during swing phase):

1. description:

2. pt cause:

3. prosthetic cause:

1. description: at toe-off heel moves medially or laterally

2. pt cause: incorrect donning of the prosthesis (applied internally rotated or externally rotated); weakness around femur; prosthetic too tight (need less socks)

3. prosthetic cause: prosthetic knee alignment

TF pistoning:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: socket dropping off when prosthesis lifted

2. pt cause: N/A

3. prosthetic cause: insufficient suspension; socket too loose; delayed knee flexion during toe off due to increased resistance of the prosthesis; alignment of prosthesis

excessive heel rise:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: prosthetic heel rises more than sound side

2. pt cause: amputee generating more force than required to gain knee flexion

3. prosthetic cause: lack of friction on prosthetic knee

reduced heel rise:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: prosthetic heel does not rise as much as sound side

2. pt cause: lack of hip flexion

3. prosthetic cause: locked knee; excessive friction on free knee

circumduction:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: lateral curvature of swing phase of prosthesis

2. pt cause: ABD contracture; weak hip flexors; habit; socket too small (too many socks)

3. prosthetic cause: prosthesis too long; fixed knee and poor hip hitching; poor suspension causing prosthesis to slip; excessive PF; insufficient knee flexion

vaulting:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: amputee rises onto the toe of sound limb during prosthetic swing phase

2. pt cause: fear of catching toe of prosthesis on the floor; socket too small (too many socks); lack of 'hip hitching' with a 'locked/fixed knee'; habit

3. prosthetic cause: prosthesis too long; poor suspension prosthesis; excessive friction on knee flexion of the prosthesis

terminal impact:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: forcible impact as knee goes into extension at end of terminal swing phase, just before heel strike

2. pt cause: amputee deliberately snaps knee into extension excessively to ensure extension

3. prosthetic cause: lack of friction of knee flexion; extension aid too excessive

uneven step length:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: steps are uneven in duration or length; usually short STANCE phase on prosthetic side

2. pt cause: fixed flexion deformity at knee; hip flexion contracture; pain leading to decreased WB on prosthetic side; fear; poor balance

3. prosthetic cause: insufficient friction of prosthetic knee creating an increased step length on prosthetic side; painful poorly fitting socket

uneven (or absent) arm swing:

1. description:

2. pt cause:

3. prosthetic cause:

1. description: one/both arms held close to body

2. pt cause: poor balance; fear; habit; lack of training

3. prosthetic cause: poor prosthetic fit