Transcript Gait Deviations in Transfemoral and Transtibial Amputees

Andrew Whittle



Gait analysis
Transtibial Gait




Excessive knee flexion
Absent or insufficient knee flexion
Midstance instability
Early or delayed knee flexion at midstance to toe off








Lateral trunk bending
Wide walking base
Circumduction
Vaulting
Swing phase whips
Foot rotation at heel strike
Uneven heel rise
Excessive terminal impact
Transfemoral Gait


Gait laboratory
Observation
◦ Sagittal plane
◦ Frontal plane

Identification of gait deviations
◦ Symmetrical???

Determination of causes
◦ Prosthetic vs non prosthetic
◦ Accommodation of gait deviations

Excessive knee flexion
◦ At heel strike 15 to 20 degrees




Knee flexion contracture
Weak knee extensors/quadriceps strength
Higher heeled shoe
Heel lever to big
 Excessive dorsiflexion of foot or excessive socket flexion
 Anteriorly placed socket
 Heel/plantar flexion bumper too stiff

Absent or insufficient knee flexion
◦ At heel strike (uncommon)
 Weak quadriceps musculature
 Pre existing
 Heel lever too short
 Excessive plantarflexion of the prosthetic foot
 Heel too soft

Midstance medio-lateral instability
◦ Complicated by genu varum and valgum
 Ligament laxity
 Excessively abducted or adducted socket
 Excessive outset or inset of prosthetic foot

Between midstance and toe-off
◦ Early knee flexion
 Weak quadriceps musculature
 Excessive dorsiflexion of foot or excessive socket
flexion
◦ Delayed knee flexion
 Excessive plantarflexion of the foot or extension of the
socket

Lateral trunk bending
◦ Lean toward amputated side in stance phase





Weak hip abductors
Abducted socket
Insufficent support by lateral socket wall
Lateral distal discomfort
Short prosthesis

Wide walking base
◦
◦
◦
◦
◦
Contracture of hip abductors
Weak hip abductors
Pain or discomfort in the groin
Prosthesis too long
Excessive socket adduction

Circumduction
◦ Prosthesis follows a laterally curved line as it swings
 Prosthesis too long
 Inadequate suspension
 Insufficient knee flexion during swing (fear)
 Lock knee

Vaulting
◦ Early and excessive plantar flexion of the sound
foot
 Insufficient friction of the prosthetic foot
 Prosthesis too long
 Lock knee
 Inadequate suspension

Swing phase whips
◦ Weak flabby musculature
◦ Check that the socket has been donned in correct
rotation

Swing phase whips
◦ Medial Whip
 At toe off heel moves medially
 Knee axis of the prosthesis is in excessive external
rotation
◦ Lateral Whip
 At toe off heel moves laterally
 Knee axis of the prosthesis is in excessive external
rotation

Foot rotation at heel strike
◦ At heel contact the heel rotates laterally
 Too hard a heel/plantar flexion bumper

Uneven heel rise
◦ Excessive heel rise
 Forceful hip flexion to ensure prosthesis is fully
extended at heel strike
 Insufficient friction at prosthetic knee
◦ Insufficient heel rise
 Fear or insecurity
 Walking with little or no knee flexion

Terminal impact
◦ The prosthesis comes to a sudden stop at full
extension may be audible or visual
 Fear that the prosthesis may not be locked or safe
 Insufficient friction at knee joint
 Too much extension assistance
◦ Causes specific to the type
of prosthetic knee