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Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Prosthetic.

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Presentation on theme: "Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Prosthetic."— Presentation transcript:

1 Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Prosthetic Gait Deviations Karyn Duff Prosthetist / Orthotist Hunter Prosthetics and Orthotics Service

2 2 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

3 3 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

4 4 Bench alignment – Trans tibial Sagittal Plane  Heel height matches patient’s shoe  Socket 5° flexed  Weight line –Centre of lateral socket –Posterior 1/3 of foot

5 5 Bench alignment – Trans tibial Frontal 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

6 6 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

7 7 Common Prosthetic Gait Deviations

8 8 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

9 9 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

10 10 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

11 11 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

12 12 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

13 13 Abducted gait  Description –Walking base significantly larger than normal range of mm  Causes –Prosthesis too long –Too small socket –Insufficient suspension –Locked knee –Abducted socket –Pain in groin area –Fear / Insecurity –Contracted hip abductors

14 14 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

15 15 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)

16 16 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)

17 17 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

18 18 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

19 19 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

20 20 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

21 21 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)

22 22 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)

23 23 Excessive forward flexion  Description –During stance patient excessively leans forward  Causes –Unstable knee joint –Hip flexion contracture –Too short gait aids

24 24 Any Questions???


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