Gait Deviations in Transfemoral and Transtibial Amputees Andrew

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 � Transfemoral Gait �Lateral trunk bending �Wide walking base �Circumduction �Vaulting �Swing phase whips �Foot rotation at heel strike �Uneven heel rise �Excessive terminal impact

Gait Analysis � Gait laboratory � Observation ◦ Sagittal plane ◦ Frontal plane � Identification of gait deviations ◦ Symmetrical? ? ? � Determination of causes ◦ Prosthetic vs non prosthetic ◦ Accommodation of gait deviations

Transtibial Gait � 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

Transtibial Gait � 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

Transtibial Gait � Midstance medio-lateral instability ◦ Complicated by genu varum and valgum �Ligament laxity �Excessively abducted or adducted socket �Excessive outset or inset of prosthetic foot

Transtibial Gait � 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

Transfemoral Gait � 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

Transfemoral Gait � Wide ◦ ◦ ◦ walking base Contracture of hip abductors Weak hip abductors Pain or discomfort in the groin Prosthesis too long Excessive socket adduction

Transfemoral Gait � Circumduction ◦ Prosthesis follows a laterally curved line as it swings �Prosthesis too long �Inadequate suspension �Insufficient knee flexion during swing (fear) �Lock knee

Transfemoral Gait � Vaulting ◦ Early and excessive plantar flexion of the sound foot �Insufficient friction of the prosthetic foot �Prosthesis too long �Lock knee �Inadequate suspension

Transfemoral Gait � Swing phase whips ◦ Weak flabby musculature ◦ Check that the socket has been donned in correct rotation

Transfemoral Gait � 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

Transfemoral Gait � Foot rotation at heel strike ◦ At heel contact the heel rotates laterally �Too hard a heel/plantar flexion bumper

Transfemoral Gait � 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

Tranfemoral Gait � 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