TFA Deviations

Question 1

stance phase gait deviations

IC to loading response

Answer 1

foot rotation
knee flexion instability

Question 2

IC to loading response

knee flexion instability
prosthetic causes

Answer 2

• Knee joint anterior to TKA line
• Socket too posterior
• Insufficient socket flexion
• Not enough stance control
• Too stiff heel cushion or PF bumper
• Too much DF

Question 3

IC to loading response

knee flexion instability
patient causes

Answer 3

• Weak hip extensors
• Hip Flexion contracture not accommodated in alignment

Question 4

IC to loading response

foot rotation
prosthetic causes

Answer 4

• Heel of SACH foot too hard
• Too much resistance to PF
• Socket fits too loosely
• Excessive toe out

Question 5

IC to loading response

foot rotation
patient causes

Answer 5

• Short or fleshy residual limb
• Poor residual limb hip muscle control
• Poor weight bearing on prosthetic foot to compress heel

Question 6

TFA mid stance to terminal stance deviations

Answer 6

• Lateral Trunk Bending
• Lateral Hip Thrust
• Abducted Gait
• Trunk flexion
• Decreased Stance Time on Prosthetic Limb

Question 7

mid stance to terminal stance

lateral trunk lean prosthetic cause

Answer 7

• Inadequate socket adduction
  Shortens abductors
• Prosthesis too short
• High medial brim that leads to groin discomfort
• Improperly shaped lateral wall failing to provide adequate support to femur

Question 8

mid stance to terminal stance

lateral trunk lean
patient causes

Answer 8

• Weak hip abductors/adductors
• Abduction Contracture
• Short residual limb
• Fear of weight bearing
• Painful residual limb

Question 9

mid stance to terminal stance

lateral hip thrust prosthetic causes

Answer 9

• Foot too inset
• Wide medio-lateral socket dimensions
• Prosthesis too short
• Ischial tuberosity is not contained within the socket

Question 10

mid stance to terminal stance

lateral hip thrust patient causes

Answer 10

• Foot placement, narrow BOS

Question 11

mid stance to terminal stance

ABDucted gait
prosthetic cause

Answer 11

• Prosthesis too long
• Medial wall too high

Question 12

mid stance to terminal stance

ABDucted gait
patient cause

Answer 12

Hip ABD contracture
habit/Fear

Question 13

mid stance to terminal stance

trunk flexion patient cause

Answer 13

• Flexion contracture not accommodated in alignment
• Weak hip and trunk extensors
• Bring center of gravity forward to stabilize knee into extension to avoid buckling
• UE dependence on AD

Question 14

mid stance to terminal stance

trunk flexion proshetic cause

Answer 14

• Insufficient socket
  flexion

Question 15

mid stance to terminal stance

decreased stance time on prosthetic
prosthetic causes

Answer 15

pain from socket
unstable prosthetic knee

Question 16

mid stance to terminal stance

decreased stance time on prosthetic
patient causes

Answer 16

inadequate WB
apprehension

Question 17

TFA Deviations stance phase

terminal stance to pre swing

Answer 17

lumbar lordosis
ER in late stance

Question 18

terminal stance to pre swing

lumbar lordosis
prosthetic causes

Answer 18

• Insufficient flexion of socket
• Poor tolerance of pressure at ischial
  tuberosity, which leads to forward rotation of
  pelvis to avoid weight bearing

Question 19

terminal stance to pre swing

lumbar lordosis
patient cause

Answer 19

• Hip flexion contracture
• Weak abdominal muscles
• Weak hip extensors with posterior lean to get COG behind hip joint

Question 20

terminal stance to pre swing

ER at late stance
prosthetic causes

Answer 20

• Insufficient socket flexion
• Excessive foot PF
• Foot too anterior
• Forefoot too hard
• DF bumper too hard

Question 21

terminal stance to pre swing

ER at late stance
patient causes

Answer 21

• Hip flexion contracture not accommodated in alignment
• Weak hip flexors, externally rotating to compensate with adductors

Question 22

TFA Deviations Swing phase

initial swing

Answer 22

excessive pistoning
medial whip
lateral whip

Question 23

initial swing

excessive pistoning prosthetic causes

Answer 23

• Inadequate suspension
• Inadequate sock ply

Question 24

initial swing

excessive pistoning patient causes

Answer 24

• Improper donning of suspension
• Excessive residual limb soft tissue

Question 25

# initial swing medial whip prosthetic causes

Answer 25

* Excessive external rotation of the prosthetic knee * Knee axis not parallel to the floor

Question 26

# initial swing medial whip patient causes

Answer 26

* Prosthesis donned in external rotation * Excessive soft tissue leading to rotation within the socket

Question 27

# initial swing lateral whip prosthetic causes

Answer 27

* excessive IR of prosthetic knee * knee axis not parallel to the floor

Question 28

# initial swing lateral whip patient causes

Answer 28

* Prosthesis donned in internal rotation * Excessive soft tissue leading to rotation within the socket

Question 29

# transfemoral deviations swing phase mid swing

Answer 29

* decreased toe clearace * vaulting on sound side * circumduction

Question 30

# mid swing decreased toe clearance prosthetic causes

Answer 30

* Inadequate suspension * Prosthesis too long * Too much resistance to knee flexion * Too much PF

Question 31

# mid swing decreased toe clearance patient causes

Answer 31

* Improper donning of suspension * Weak hip flexors on involved side * Contralateral gluteus medius weakness

Question 32

# mid swing vaulting on sound side prosthetic causes

Answer 32

Compensation for toe drag

Question 33

# mid swing vaulting on sound side patient causes

Answer 33

* Fear of stubbing prosthetic toe * Habit

Question 34

# mid swing circumduction prosthetic causes

Answer 34

* Compensation for toe drag

Question 35

# mid swing circumduction patient causes

Answer 35

* Abduction contracture * Fear * Habit

Question 36

# transfemoral deviation swing phase terminal swing

Answer 36

terminal impact decreased stride length on prosthetic side

Question 37

# terminal swing terminal impact prosthetic causes

Answer 37

* Not enough resistance to knee extension * Too strong extension assist

Question 38

# terminal swing terminal impact patient causes

Answer 38

* Habit to ensure knee is in extension prior to initial contact

Question 39

# terminal swing decreased stride length on prosthetic side prosthetic causes

Answer 39

inadequate suspension

Question 40

# terminal swing decreased stride length on prosthetic side patient causes

Answer 40

* Pain in the sound limb * Hip flexion contracture on the sound limb * Weak PF on sound limb