Gait Deviations in Transfemoral and Transtibial Amputees

1. Gait Deviations in Transfemoral and Transtibial Amputees Andrew Whittle

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. Transfemoral Gait • Swing phase whips • Weak flabby musculature • Check that the socket has been donned in correct rotation

13. 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

14. Transfemoral Gait • Foot rotation at heel strike • At heel contact the heel rotates laterally • Too hard a heel/plantar flexion bumper

15. 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

16. 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