Post on 01-Apr-2015
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Prosthetic Gait DeviationsKaryn Duff
Prosthetist / OrthotistHunter Prosthetics and Orthotics Service
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What is a gait deviation? Any gait characteristic that differs from the
normal pattern
Unsymmetrical gait
Many possible causes:
– Prosthetic
– Reduced ROM
– Muscle weakness
– Fear / Insecurity
– Habit
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Prosthetic Alignment Correct alignment of the prosthesis allows:
– Optimal gait
– Optimal pressure distribution across stump
– Optimal stability
– Optimal control
– Reduces energy expenditure
Three steps to prosthetic alignment
– Bench alignment
– Static alignment
– Dynamic alignment
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Bench alignment – Trans tibialSagittal Plane
Heel height matches patient’s shoe
Socket 5° flexed
Weight line
– Centre of lateral socket
– Posterior 1/3 of foot
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Bench alignment – Trans tibialFrontal Plane
Abduction / Adduction to match patient
Weight line
– Centre of posterior socket
– Centre of heel (or up to 10mm laterally)
Transverse Plane
5-10° toe out
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Bench alignment – Trans femoral Heel height matches
patient’s shoe
Socket 5° flexed
Weight line
– Centre of lateral socket
– 5-15mm anterior to knee centre
– Posterior 1/3 or foot
Length may be up to 10mm shorter than sound side
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Common Prosthetic Gait Deviations
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Rotation of prosthetic foot at IC Description
– Prosthetic foot externally rotates at Initial Contact
Causes
– Too hard a heel
– Too hard a plantarflexion bumper
– Socket too loose
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Foot slap Description
– Foot progresses too quickly from heel strike to foot flat, creating a slapping noise
Causes
– Heel too soft
– Plantarflexion bumper too soft
– Excessive socket flexion
– Excessive dorsiflexion
– Poor knee extension control
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Excessive knee flexion (at IC) Description
– Knee flexes excessively at I.C
– Patient feels like he’s walking downhill
Causes
– Heel cushion too hard
– Excessive dorsiflexion of prosthetic foot
– Foot too posterior in relation to socket
– Excessive flexion built into socket
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Lateral Trunk Bending Description
– Trunk bends towards amputated side during prosthetic stance phase
Causes
– Short prosthesis
– Pain on lateral distal aspect of stump
– Abducted socket
– Low lateral wall of socket
– Weak hip abductors
– Short stump
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Medio-lateral knee thrust Description
– Knee shifts medially or laterally during prosthetic stance phase
Causes
– Foot placed too medially (lateral thrust)
– Foot placed too laterally (medial thrust)
– ML dimension of proximal socket too large
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Abducted gait Description
– Walking base significantly larger than normal range of 50-100mm
Causes
– Prosthesis too long
– Too small socket
– Insufficient suspension
– Locked knee
– Abducted socket
– Pain in groin area
– Fear / Insecurity
– Contracted hip abductors
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Absent or insufficient knee flexion
Description
– Insufficient knee flexion at I.C and / or knee hyperextension at T.S
– Patient may report pressure on distal tibia
– Patient feels like he’s walking uphill
Causes
– Excessive plantarflexion of prosthetic foot
– Heel too soft
– Too soft a plantarflexion bumper
– Insufficient socket flexion
– Foot too anterior in relation to socket
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Circumduction Description
– Prosthesis follows a lateral curved line as it swings through
Causes
– Prosthesis too long
– Locked knee
– Inadequate suspension
– Too small a socket
– Foot set in plantarflexion
– Lack of knee flexion (fear / insecurity of patient)
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Vaulting Description
– Amputee bobs up and down excessively as he walks. He raises his entire body by plantar-flexing the sound foot.
Causes
– Prosthesis too long
– Inadequate suspension
– Locked knee
– Socket too small
– Foot set in plantarflexion
– Lack of knee flexion (fear / insecurity of patient)
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Uneven Timing Description
– Steps are of uneven duration or length, usually a short stance phase on the prosthetic side
Causes
– Poorly fitting socket causing pain
– Fear / insecurity
– Poor balance
– Weak stump musculature
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Instability of prosthetic knee Description
– The prosthetic knee has a tendency to buckle on weight bearing
Causes
– Incorrect alignment of prosthesis (weight line passes behind knee centre creating flexion moment)
– Weak hip extensor muscles
– Severe hip flexion contracture
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Terminal swing impact Description
– The prosthetic shank comes to a sudden stop with a visible or audible impact
Causes
– Insufficient knee friction
– Extension assist too great
– Habit of forceful knee flexion
– Fear of knee buckling at I.C
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Increased Lumbar Lordosis Description
– Lumbar lordosis is exaggerated during prosthetic stance phase
Causes
– Insufficient AP socket support
– Insufficient socket flexion
– Pain on ischial tuberosity area
– Hip flexion contracture
– Weak hip extensors or abdominals
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Swing Phase Whips Description
– At toe off heel moves laterally (lateral whip) or medially (medial whip)
Causes
– Inadequate suspension
– Knee internally rotated (lateral whip)
– Knee externally rotated (medial whip)
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Uneven heel rise Description
– Prosthetic heel rise does not match sound side.
Causes
– Inadequate knee friction (high heel rise)
– Inadequate extension assist (high heel raise)
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Excessive forward flexion Description
– During stance patient excessively leans forward
Causes
– Unstable knee joint
– Hip flexion contracture
– Too short gait aids
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Any Questions???