Prosthetic Gait Deviations

Question 1

Content: Terms to Describe Gait Deviation (6)

Answer 1

1. Toe lever arm (shoe size)
2. Heel lever arm
3. Heel/Keel Stiffness
4. Socket Flexion
5. Socket Rotation
6. External foot rotation

Question 2

Q: How can too short of a toe lever effect gait?

Answer 2

Can cause fall off/fall forward over the toe

Question 3

Q: How can a anteriorly shifted foot effect gait?

Answer 3

Makes it hard for the ankle to roll over the foot

Question 4

Q: What gait deviation is socket flexion used to accomodate?

Answer 4

Contractures (hip and knee flexion)

Question 5

T/F: Socket flexion can effect which areas are under pressure in the socket.

Answer 5

True

Question 6

Q: What degree of foot ER is normal?

Answer 6

~5 degrees

Question 7

Defn: Bench Alignment

Answer 7

Bench alignment is were the WB line is in relationship to the foot. Each prothesis has a preset (optimum) bench alignment with multiple components that can be altered by a prothetist

Question 8

Content: Static Alignment (4)

Answer 8

1. Before assessment it is important to be all the way down into the socket
2. Height
3. Foot Rotation
4. Socket Position

Question 9

Content: Assessing prosthetic height (3)

Answer 9

1. “Do you feel level”
2. Distance from tibial plateau to floor equal bilaterally
3. ASIS symmetrical

Question 10

Q: Why may a pt. feel unlevel when first trying a prosthesis? (2)

Answer 10

1. Not used to WB
2. Typically initially feel tall

Question 11

Q: What question can be asked to assess socket position?

Answer 11

“Do you feel equal weight under your heel and the ball of your foot?”

Question 12

Q: If the patient feels like they are on their toes, how can you adjust the socket position to achieve flat foot?

Answer 12

Flex the socket

Question 13

Defn: Dynamic Alignment

Answer 13

The alignment of the prosthesis while the pt. is moving/ambulating

Question 14

Q: What force do you want to see at the knee during mid stance?

Answer 14

Varus thrust

Question 15

Q: How can too long of a toe lever affect gait?

Answer 15

Cause the knee to flex/buckle

Question 16

Q: How would you alter socket flexion to a hip flexion contracture?

Answer 16

Increase socket flexion by 5 degrees

• Allows for the knee to be in proper alignment
• Allows pt. to swing forward
• Increases step length by increases ability for hip to extend back

Question 17

Q: What is the degree of ER at the foot and knee during stance?

Answer 17

5-7 degrees for both

Question 18

Q: What is the Foot, Knee and Hip Joint/Pelvis alignment during swing?

Answer 18

Foot - perpendicular to line of progression

Knee - perpendicular to line of progression

Hip Joint/Pelvis - IR 5-7 degrees

Question 19

Content: Trochanter/Knee/Ankle (TKA) (4)

Answer 19

1. Stationary alignment line identifies the relative alignment between center of socket weight, rotation point of knee, rotation point of ankle
2. WB line anterior to TKA = stable
3. WB line posterior to TKA = buckle
4. Socket angled, T moves posterior, knee can’t straighten (move knee posterior)

Question 20

Content: AKA: Prosthetic Cause of Medial Whip (3)

Answer 20

1. ER of the knee
2. Tight socket
3. Mis-aligned toe break

Question 21

Content: AKA: Amputee Cause of Medial Whip (2)

Answer 21

1. Gait habit
2. Socket not put on properly

Question 22

Content: AKA: Prosthetic Cause of Lateral Whip (3)

Answer 22

1. IR of the knee
2. Loose socket
3. Mis-aligned toe break

Question 23

Content: AKA: Amputee Cause of Lateral Whip (3)

Answer 23

1. Gait habit
2. Socket not put on properly
3. IR of hip at toe off/hip flexion

Question 24

Content: AKA: Prosthetic Cause of Abducted Gait (4)

Answer 24

1. Prosthesis too long
2. Medial wall to high
3. Insufficient femoral stability
4. Induces medial whip

Question 25

Q: What question can you ask if you see whip?

Answer 25

"Do you feel like the socket is on right/feels good?"

Question 26

Content: AKA: Amputee Cause of Abducted Gait (3)

Answer 26

1. Poor gait habit 2. Abduction contracture 3. Pt. insecure and desires wide base in belief it will increase stability

Question 27

Q: What positions should amputees never be left in?

Answer 27

With pillows under or between their legs (prevent flexion and abd contracture)

Question 28

Content: AKA: Prosthetic Cause of Circumducted Gait (2)

Answer 28

1. Long prosthesis 2. Excessive knee friction stability

Question 29

Content: AKA: Amputee Cause of Circumducted Gait (4)

Answer 29

1. Lack of confidence in flexing knee 2. Abd contracture 3. Weak hip flexors 4. Habit, using entire hip and pelvis to initiate gait

Question 30

Content: AKA: Prosthetic Cause of Vaulting (4)

Answer 30

1. Long prosthesis 2. Poor suspension 3. Excessive PF 4. Excessive knee resistance/stability

Question 31

Content: AKA: Amputee Cause of Vaulting (3)

Answer 31

1. Gait habit - fear of catching toe 2. Weak hip flexors on residual limb 3. Improper initiation of hip flexors on residual limb

Question 32

T/F: Vaulting gait deviations are easy to fix.

Answer 32

False: Hard to get rid of

Question 33

Content: AKA: Prosthetic Cause of Heel Rise (3)

Answer 33

1. Inadequate extension aid 2. Insufficient knee friction 3. Improper knee selection

Question 34

Content: AKA: Amputee Cause of Heel Rise

Answer 34

Excessive use of hip flexors to initiate swing phase, overpowering knee unit

Question 35

Content: AKA: Prosthetic Cause of Knee Instability (4)

Answer 35

1. Excessive DF 2. Knee aligned in unstable position 3. Insufficient socket flexion 4. Mal-alignment of foot

Question 36

Content: AKA: Amputee Cause of Knee Instability (2)

Answer 36

1. Weak hip extensors 2. Hip flexion contracture

Question 37

Q: What is one thing pts. can do that can effect their gait?

Answer 37

Change their shoes - altered heel height

Question 38

Q: Which leg should an amputee start their gait with?

Answer 38

Sound leg The prosthesis is like a pendulum, its easier to start a pendulum from a pulled back position as opposed to the bottom of the swing

Question 39

Q: What are two types of uneven timing?

Answer 39

1. Short Prosthetic Step 2. Long Prosthetic Step

Question 40

Content: AKA: Prosthetic Cause of Short Prosthetic Step (5)

Answer 40

1. Socket Pain 2. Weak extension aid 3. Unstable knee 4. Excessive DF 5. Poor suspension

Question 41

Content: AKA: Amputee Cause of Short Prosthetic Step (3)

Answer 41

1. Patient Insecurity 2. Weak hip muscles 3. Poor balance

Question 42

Content: AKA: Prosthetic Cause of Long Prosthetic Step (3)

Answer 42

1. Excessive PF 2. Insufficient initial socket flexion 3. Long toe lever arm

Question 43

Content: AKA: Amputee Cause of Long Prosthetic Step (3)

Answer 43

1. Flexion contracture 2. Patient insecurity 3. Pain on sound side

Question 44

Content: AKA: Prosthetic Cause of Lateral Shift (2)

Answer 44

1. Prosthetic foot too far inset 2. Excessive socket adduction

Question 45

Content: AKA: Amputee Cause of Lateral Shift (2)

Answer 45

1. Weak hip abductors 2. Narrow gait base

Question 46

Content: AKA: Prosthetic Cause of Lateral Trunk Bend (4)

Answer 46

1. Foot too far outset 2. Ineffective lateral socket containment 3. High medial wall 4. Aligned in Abd

Question 47

Content: AKA: Amputree Cause of Lateral Trunk Bend (4)

Answer 47

1. Habit 2. Inadequate balance 3. Abd contracture 4. Short residual limb

Question 48

Content: AKA: Prosthetic Cause of Toe Drag (3)

Answer 48

1. Long prosthesis 2. Excessive PF 3. Excessive knee friction

Question 49

Content: AKA: Amputree Cause of Toe Drag (4)

Answer 49

1. Weak hip flexors 2. Weak hip abd on sound side 3. Poor posture 4. Poor gait habits

Question 50

Q: What are the 4 factors of Gait?

Answer 50

1. Patient 2. Prosthetic alignment 3. Socket fit 4. Rehab teamwork

Question 51

Q: When are patients typically fit for prosthetics?

Answer 51

anywhere from 4 (early) to 8 wks, sometimes 12 wks

Question 52

Content: BKA: Prosthetic Causes of Drop Off (with excess knee flexion) (4)

Answer 52

1. Short toe lever 2. Excessive socket flexion - throws torso forward 3. Excessive DF 4. Incorrect foot type (ex. keel not firm enough)

Question 53

Content: BKA: Amputee Cause of Drop Off (with excess knee flexion) (3)

Answer 53

1. Gait Habit 2. Weak Quads 3. Knee Flexion Contracture

Question 54

Content: BKA: Prosthetic Cause of Vaulting (4)

Answer 54

1. Long prosthesis 2. Poor suspension 3. Excessive PF 4. Excessive knee resistance/stability

Question 55

Content: BKA: Amputee Cause of Vaulting (3)

Answer 55

1. Gait habit - fear of catching toe 2. Weak hip flexors on residual limb 3. Improper initiation of hip flexors on residual limb

Question 56

Content: BKA: Prosthetic Cause of Wide Gait (2)

Answer 56

1. Prosthetic foot too far outset 2. Excessive socket adduction

Question 57

Content: BKA: Amputee Cause of Wide Gait (3)

Answer 57

1. Gait Habit 2. Insecurity, wants to widen base in attempt to increase stability 3. Weak ML knee control

Question 58

Content: BKA: Prosthetic Cause of Lateral Shift (3)

Answer 58

1. Foot too far inset 2. Insufficient socket adduction 3. Short prosthesis

Question 59

Content: BKA: Amputee Cause of Lateral Shift (3)

Answer 59

1. Inadequate balance 2. Weak knee 3. Narrow gait base

Question 60

Content: BKA: Long Prosthesis (5)

Answer 60

1. LBP 2. Feel like walking up a hill 3. Noticeable rise and drop of shld on effected side 4. Hesitation in gait timing from prosthetic mid-stance to sound side heel strike 5. Pain in hip on amputated side - taking more pressure

Question 61

Content: BKA: Short Prosthesis (6)

Answer 61

1. LBP 2. Feel like stepping in a hole 3. Noticeable rise and drop of shld on the sound side 4. Uneven arm motion to accommodate uneven stride length 5. Appears like patient may be vaulting 6. Hip pain on sound side

Question 62

Content: BKA: External Foot Rotation (7)

Answer 62

1. Pt. wants foot to match sound side 2. IR of knee at toe off 3. Induces "medial whip" 4. Drop off at end of stance phase 5. LBP 6. Skin irritation due to rotational stress in socket 7. Mid stance falling over foot (valgus thrust)