Transcript Gait Deviations - Australian Physiotherapists in Amputee

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Prosthetic Gait Deviations
Karyn Duff
Prosthetist / Orthotist
Hunter Prosthetics and Orthotics Service
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
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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
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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
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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
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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
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Common Prosthetic Gait Deviations
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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
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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
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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
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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
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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
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Abducted gait
 Description
– Walking base significantly larger than normal range of 50100mm
 Causes
– Prosthesis too long
– Too small socket
– Insufficient suspension
– Locked knee
– Abducted socket
– Pain in groin area
– Fear / Insecurity
– Contracted hip abductors
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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
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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)
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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)
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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
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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
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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
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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
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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)
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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)
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Excessive forward flexion
 Description
– During stance patient excessively leans forward
 Causes
– Unstable knee joint
– Hip flexion contracture
– Too short gait aids
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Any Questions???
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