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Prosthetic Gait Deviations

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Presentation on theme: "Prosthetic Gait Deviations"— Presentation transcript:

1 Prosthetic Gait Deviations
Karyn Duff Prosthetist / Orthotist Hunter Prosthetics and Orthotics Service

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 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 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 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 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 Common Prosthetic Gait Deviations

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 Foot slap Description Causes
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 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 Lateral Trunk Bending Description Causes
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 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 Abducted gait Description Causes
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 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 Circumduction Description Causes
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 Vaulting Description Causes
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 Uneven Timing Description Causes
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 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 Terminal swing impact Description Causes
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 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 Swing Phase Whips Description Causes
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 Uneven heel rise Description Causes
Prosthetic heel rise does not match sound side. Causes Inadequate knee friction (high heel rise) Inadequate extension assist (high heel raise)

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

24 Any Questions???

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