This document discusses gait evaluation and common gait deviations seen in individuals with transtibial and transfemoral amputations using prosthetic devices. It outlines the components of static and dynamic gait evaluations, including checking prosthetic alignment, weight bearing, and identifying potential causes of deviations. Common gait deviations are described for each phase of the gait cycle from initial contact through swing phase for both levels of amputation. Energy expenditure is also compared between vascular/traumatic transtibial amputees and normative data.

1. Gait Deviations In Prosthesis

2. Heel lever – distance between the back of
the heel of the prosthetic foot and point on
the foot that intersects a perpendicular line
from the proximal centre of socket
Toe lever – distance between the end of
the toe and same perpendicular line from
the proximal centre of socket

4. TRANSTIBIAL AMPUTATION
PROSTHETIC EVALUATION
 Prosthetic alignment
Relationship between the socket and the
prosthetic foot.

5. STATIC EVALUATION
standing in the parallel bar with
prosthesis.
3 things:-
Fit
Comfort
Force distribution

6. Checklist
Equal weight bearing on the both side
without discomfort
Length of prosthesis and intact leg
Contact between foot and floor
Forces on the lower limb above socket

7. DYNAMIC EVALUATION
Done during gait analysis
 Causes of gait deviation
1. Malalignment of prosthesis
2. Physical limitation of patient
Effective gait analysis should be done in 3
Perspectives
 Anterior
 Posterior
 lateral

8. Initial contact through mid stance
Lack of knee flexion in loading response
Excessive knee flexion throughout early
stance
Unequal stride length of prosthetic and
intact limb
Poor controlled or rapid knee flexion as
midstance begins

9.  Possible causes of deviations
1. Knee fully extended
 Faulty suspension
 Insufficient preflexion of the socket
 Foot too anterior
2. Excessive knee flexion
 Faulty suspension
 Pt may have flexion contracture

10. 3. Unequal stride length
 Poor gait pattern
 Faulty suspension
 Pain and discomfort on sound limb or on
the prosthetic side.
4. Poorly controlled or rapid knee flexion
 Weakness of quadriceps
 Improper footwear

11. Mid stance to terminal stance
Deviations:-
 Prosthetic foot leans medially or laterally
 Abnormal varus or valgus moment at the
knee
 Lateral trunk bending

12.  Prosthetic foot leans medially or laterally
Causes :-
a. Socket is set in excessive adduction
b. Foot is set in pronated position
c. Foot is in more laterally
d. Uneven shoe wear
 Abnormal varus or valgus moment at the
knee
Causes :-
Too wide socket in mediolaterally
dimension

13.  Lateral trunk bending
causes:-
a. Too long or too short prosthesis
b. Discomfort within the socket
c. Prosthetic foot is positioned too far
laterally w.r.t. socket
d. Weakness of abductor muscle of hip

14. Terminal stance to preswing
1. Premature heel rise or sense of dropping
off.
2. Delayed heel rise or sense of walking
uphill
3. Abnormal step width
4. Medial or lateral rotation of the heel
5. Excessive motion b/w residual limb and
socket

15. 1. Premature heel rise or sense of dropping
off.
 Toe lever is too short
 Malpositioning of foot w.r.t. socket
 Shoe with high heel
 Knee or hip flexor contracture is present.
2. Delayed heel rise or sense of walking
uphill
 Toe lever is too long functionally
 Foot is positioned too far forward w.r.t.
socket
 Too firm or stiff keel

16. 3. Abnormal step width
 Less than 2 inch b/w medial borders of
the foot - Prosthetic foot may be
positioned too far inset w.r.t. socket
 > 4 inch – increased displacement during
forward progress of gait and fear of
instability

17. 4. Medial or lateral rotation of the heel
 Prosthetic foot set in too much pronation
or supination
 Shortening of hip flexor muscle
 Inappropriate cuff strap attachment on
the socket
5. Excessive motion b/w the residual limb
and socket
 Inadequacy of the suspension
 Too few or too many ply of sock

18. SWING PHASE
Deviations
1. Medial and lateral whips
2. Inadequate or excessive toe clearance

19. 1. Medial and lateral whips
causes:-
 Occurs when the prosthetic foot rotates
in the transverse plane after toe-off
 Foot is aligned in too much out or toe in
 Changes the path of forward progression
from a straight line in to a whip

20. 2. Catching the toes during midswing
causes :-
Functionally or actually too long prosthesis

21. ENERGY EXPENDITURE
Prosthetic feature that affect energy
expenditure
Weight of the prosthesis
Quality of the socket feet
Accuracy of alignment of prosthesis
Functional characteristic of prosthetic
components

22.  In vascular transtibial amputation
Gait velocity- decreased by 44%
Oxygen consumption – increased by 33%
In traumatic transtibial amputation
Gait velocity – decreases by 11%
Oxygen consumption – increases by 7%

23. TRANSFEMORAL PROSTHESIS
 STATIC EVALUATION
1. Level of pelvis
2. Knee stability
3. Width of BOS

24.  Height of prosthesis
Two methods
1. Manual examination
2. Using a hip leveling guide
 Evaluation of knee stability
 Ideal base of support – 2 to 3 inches

25. DYNAMIC EVALUATION
Lateral/ sagittal view
Four key areas evaluated are
Knee stability throughout stance
Transition from initial contact to foot-flat
position
Symmetry of step length and step duration
Quality of knee flexion during late stance
and swing phase

26. Anterior/ frontal view
Key areas are
Adequacy of suspension - circumduction
Width of the base of support
Control of pelvis during prosthetic stance
Quality and pattern of prosthetic swing

27. GAIT DEVAITIONS
 EARLY STANCE PHASE
1. Knee stability
2. Foot slap
3. External rotation of prosthetic foot

28.  Knee instability
1. Knee axis aligned too far ant. to the TKA
line
2. Excessive dorsiflexion of foot
3. Too stiff PF bumper or SACH heel
4. Hip flexor contracture
5. Weakness of hip extensor

29.  Foot slap
1. Stiffness of plantar flexion bumper / heel
cushion
2. Rapid, PF at heel contact
3. Insufficient PF resistance

30.  External rotation of prosthetic foot
1. Excessive firm heel cushion or PF
bumper
2. Weakness of hip muscle
3. Fear of instability
4. Shoe may be too tight for prosthetic foot

31. Mid stance to late stance phase
a. Pelvis rise
 Excessive dorsiflexion of prosthetic foot
 Foot is aligned too far ant. w.r.t. knee and
socket.
b. Drop – off
 Rollover occurs too early
 Inappropriate prosthetic alignment

32. c. Lateral trunk bending
 Laterally , prosthesis is unable to stable
the femur in a natural position of
adduction.
 Too few ply of prosthetic socks

33. Swing phase
a. Excessive lumbar lordosis
b. Excessive knee flexion
c. Medial and lateral whip
d. Terminal impact
e. Vaulting
f. Circumduction during swing

34.  Excessive lumbar lordosis
1. Hip flexion contracture
2. Insufficient flexion of socket
3. Hip extensor weak
4. Painful ischial bearing
 Excessive knee flexion and heel rise
1. Insufficient knee friction
2. Inadequate adjustment for extension aid

35.  Medial and lateral whip
–forward progression of distal parts of
the prosthesis follows an oblique path
Lateral whip
 Knee unit positioned in too much of
internal rotation
 Socket is positioned in internal rotation
during donning.
Medial whip
 Externally rotated knee unit
 Externally rotated socket

36.  Terminal impact
1. Insufficient resistance to extension of
knee unit
2. Excessive strong extension aid
3. Worn out extension bumper

37.  Vaulting
1. Excessive length of prosthesis
2. Insufficient knee flexion
3. Manual knee lock/ excessive friction
4. Foot set in PF

38.  Circumduction
1. Too long prosthesis
2. Little/no knee flexion due to fear
3. Manual knee lock,
excessive friction
4. Inadequate suspension

39. Transfemoral
Speed – decreases by 43%
 energy cost in Kcal/meter (as compared
to normal) - 89% more