prosthetic gait deviations

what are patient causes of gait deviations in lower limb amputees?

muscle weakness

contracture

pain

decreased confidence in prosthesis or residual limb

habitual/learned behaviors

what are prosthetic causes of gait deviations in lower limb amputees?

prosthetic malalignment

poor-fitting prosthetic socket

what are the various transtibial gait deviations?

absent/inadequate knee flexion

excessive knee flexion

external rotation of foot at heel strike

knee instability

valgus/varus moment

drop off

knee hyperextension

whip

pistoning

what are transfemoral gait deviations?

prosthetic instability

foot slap

abducted gait

lateral trunk bending

increased lumbar lordosis

whip (during swing phase)

pistoning

excessive heel rise

reduced heel rise

circumduction

vaulting

terminal impact

what are gait deviations for both transtibial and transfemoral amputees?

uneven step length

uneven (or absent) arm swing

describe absent/inadequate knee flexion

description:

patient cause:

prosthetic cause

description: knee fully extended at heel strike

patient cause: discomfort pain, quads weakness, foot placement too far forward on stepping

prosthetic cause: faulty suspension of the prosthesis (too soft heel cushion or plantar flexor bumpers), lack of pre-flexion of the socket

describe excessive knee flexion

description:

patient cause:

prosthetic cause

description: increase knee flexion at heel strike (or mid stance), pt feels as though they're walking downhill

patient cause: flexion contracture

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

describe external rotation of the foot at heel strike

description:

patient cause:

prosthetic cause

description: external rotation of the prosthetic foot at heel strike

patient cause: N/A

prosthetic cause: heel too hard, loose socket

describe knee instability

description:

patient cause:

prosthetic cause

description: knee flexion 'jerky' in the presentation during heel strike to foot flat

patient cause: weak quads

prosthetic cause: N/A

describe valgus/varus moment

description:

patient cause:

prosthetic cause

describe drop off

description:

patient cause:

prosthetic cause

description: heel off occurs too early cause early knee flexion

patient cause: N/A

prosthetic cause: foot too posterior on the prosthesis in relation to the socket, excessive DF of the foot on the prosthesis, soft heel bumper on the prosthesis

describe knee hyperextension

description:

patient cause:

prosthetic cause

description: delayed heel causing hyperextension of the knee, walking uphill sensation

patient cause: N/A

prosthetic cause: foot set too far forward on the prosthesis in relation to the socket, too hard a heel cushion, too much PF on the foot

describe whip

description:

patient cause:

prosthetic cause

description: during swing phase, foot 'whips' laterally or medially

patient cause: knee internally or externally rotated

prosthetic cause: poor suspension

describe pistoning for a TT amputation

description:

patient cause:

prosthetic cause

description: amputee drops into the socket as the foot moves into flat foot, tibia moves vertically during alternately weight bearing and non-weight bearing periods of gait

patient cause: N/A

prosthetic cause: lack of prosthetic socks, suspension loose or inadequate, too large or faulty socket

describe prosthetic instability

description:

patient cause:

prosthetic cause

description: the prosthetic knee has a tendency to buckle on weight bearing

patient cause: severe hip flexion contracture or weak hip extensors

prosthetic cause: knee set too far anterior, heel cushion too firm, heel of shoe too high causing pylon of prosthesis to move anteriorly

describe foot slap

description:

patient cause:

prosthetic cause

description: foot progresses to quickly from heel strike to foot flat, creating a slapping noise

patient causes: patient forcing foot contact to gain knee stability

prosthetic cause: heel cushion too soft, PF cushion too soft, excessive DF

describe abducted gait

description:

patient cause:

prosthetic cause

description: increase base of support during mobility, prosthetic foot placement too lateral to normal foot placement during the gait cycle

patient cause: pain in the groin or medial wall of the prosthesis, hip abductor contractures, fear/lack of confidence transferring weight onto prosthesis

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

describe lateral trunk bending

description:

patient cause:

prosthetic cause

description: trunk flexes toward prosthesis during prosthetic stance phase

patient cause: weak or contracted hip abductors, pain on lateral distal end of the stump, lack of balance, habit, short stump length

prosthetic cause: prosthesis too short, foot outset excessively in relation to socket, lack of prosthetic wall support

describe increased lumbar lordosis

description:

patient cause:

prosthetic cause

description: lumbar lordosis is exaggerated during prosthetic stance phase

patient cause: flexion contracture at the hip, weak hip extensors, habit, poor abdominal muscles

prosthetic cause: poor shaping of the posterior wall of the prosthesis or pain on ischial weight bearing resulting in anterior pelvic rotation, lack of support from the anterior wall of the socket, insufficient socket flexion

describe whip (during swing phase)

description:

patient cause:

prosthetic cause

description: at toe-off heel moves laterally (lateral whip) or medially (medial whip)

patient cause: incorrect donning of the prosthesis i.e applied internally rotated or externally rotated weakness around the femur, prosthetic too tight (needs less socks)

prosthetic cause: prosthetic knee alignment

describe pistoning for a TF amputation

description:

patient cause:

prosthetic cause

description: socket dropping off when prosthesis lifted

patient cause: N/A

prosthetic cause: insufficient suspension, socket too loose or delayed knee flexion during toe off caused by increased resistance of prosthesis, alignment of prosthesis

describe excessive heel rise

description:

patient cause:

prosthetic cause

description: prosthetic heel rises more than sound side

patient cause: lack of friction on prosthetic knee

prosthetic cause: amputee generating more force than required to gain knee flexion

describe reduced heel rise

description:

patient cause:

prosthetic cause

describe circumduction

description:

patient cause:

prosthetic cause

description: lateral curvature of the swing phase of prosthesis

patient cause: abduction contractures, habit, weak hip flexors, socket too small (too many socks)

prosthetic cause: prosthesis too long, fixed knee and poor hip hitching, poor suspension causing prosthesis to slip, excessive PF of the foot, insufficient knee flexion

describe vaulting

description:

patient cause:

prosthetic cause

description: amputee rises onto the toe of non-prosthetic limb during prosthetic swing phase

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

prosthetic cause: prosthesis too long, poor suspension (prosthesis slips off during swing phase, excessive friction on knee flexion of the prosthesis

describe terminal impact

description:

patient cause:

prosthetic cause

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

patient cause: amputee deliberately snaps knee into extension by excessive force to ensure extension

prosthetic cause: lack of friction of knee flexion, extension aid too excessive

describe uneven step length

description:

patient cause:

prosthetic cause

description: steps are of uneven duration or length, usually a short stance phase on the prosthetic side

patient cause: fixed flexion deformity at the knee, hip flexion contracture, pain leading to decreased weight bearing on prosthetic side, fear, poor balance

prosthetic cause: insufficient friction of prosthetic knee creating increased step length on prosthetic side, painful poorly fitting socket

describe uneven or absent arm swing

description:

patient cause:

prosthetic cause

description: one or two arms are held close to the body

patient cause: poor balance, fear, habit, lack of training

prosthetic cause: poor prosthetic fit

describe drop off

description:

patient cause:

prosthetic cause

describe valgus/varus moment

description:

patient cause:

prosthetic cause

description: knee shifts medially or laterally during prosthetic stance phase

patient cause: foot placement (medial placement creates lateral thrust and vice versa)

prosthetic cause: foot alignment on the prosthesis, socket loose