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TRANSFEMORAL GAIT DEVIATIONS with causes and managment

The document discusses typical gait deviations observed in transfemoral amputees and assesses their causes, including prosthetic and amputee-related factors. It outlines various management strategies like socket adjustments, gait training, and strength building. Additionally, the document provides specific assessments and views for analyzing issues during different phases of the gait cycle.

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Transfemoral Gait Deviation Abdulaziz Alkhalaf R3 SBAHC
Objectives: 1) Review typical gait deviations in transfemoral amputees (e.g., hip hiking, circumduction). 2) Discuss assessment methods, including gait analysis and clinical evaluation. 3) Explore strategies for managing these deviations, including prosthetic modifications, therapeutic interventions, and gait training.
Your Assessment ?
Initial Contact Rotation of the foot at heel strike As heel contacts the ground, the foot rotates laterally, sometimes with vibrating motion Prosthetic causes: – Prosthetic foot bumper too firm – Loose socket fit – Too much toe out Amputee causes: – poor muscle control Management: Adjust socket fit add belt for rotation control Reduce heel stiffness Assessment view: Frontal (and dorsal)
Initial Contact Foot slap The foot plantar flexes too rapidly and strikes the floor with a slap Prosthetic cause: Plantar flexion bumper is too soft, Amputee causes: None Manamgment: Adjust Plantar flexion bumper Assessment view: Lateral
Your Assessment ?
Loading Response Knee instability (Knee buckling ) Prosthetic knee flexion is not stable or controlled and may look “jerky” Prosthetic causes: - Knee set too far anterior – The socket is placed too far anteriorly – Heel support is too hard that “unlocks” the knee at heel strike – Hip flexion contracture not accommodated in the socket. Amputee causes: – Weak hip extensors. -Severe hip flexion contracture may cause instability Management: Realign limb reduce heel stiffness Gait training hip extensors strengthening Assessment view: Lateral
Loading Response Lumbar lordosis The amputee creates an active lumbar lordosis. Prosthetic causes: – Insufficient stability in knee mechanism – Insufficient socket flexion – Discomfort on ischial plate Amputee causes: – Hip flexion contracture – Weak hip extensors – Weak abdominal muscles Management: Adjust socket fit strengthening of hip extensors strengthening abdominal muscles Assessment view: Lateral
Midstance Lateral trunk bending (towards the prosthetic side) Amputee leans towards the prosthesis Prosthetic causes : – Prosthesis too short – High medial wall socket – Excessive abduction of socket – Insufficient femoral support of lateral socket wall (too wide open) Amputee causes: – hip abduction contracture – Very short residual limb – Sensitive or painful stump – Weak hip abductor muscles (Trendelenberg gait) – Bad gait habit Manamgment: Realign prosthesis Adjust height prosthesis Adjust socket fit Gait training and strengthening Assessment view: Frontal and dorsal
Midstance Abducted gait Prosthesis held away from midline throughout the gait cycle Prosthetic causes : – Prosthesis too long – Too much abduction may have been built into prosthesis – High medial wall may cause amputee to hold prosthesis away to avoid ramus pressure – Insufficient femoral support of the lateral socket wall (too wide open) – Excessive suspension or incorrect location Amputee causes: – Contracture of the abductor muscles (stump side) – Weak hip adductor muscles – Short stump – Pain in the perineum – Bad habit Management : Realign prosthesis Shorten prosthesis Adjust socket fit Adjust suspension Gait training and strengthening Assessment view: Dorsal (and frontal)
Your Assessment ?
Terminal Stance Drop off There is a downwards movement of the body as weight is transferred forwards over the prosthetic foot (early knee flexion). Prosthetic causes: – Too soft dorsiflexion resistance in prosthetic foot – Socket set too far forward to the foot – Too much dorsiflexion – Foot too small Amputee causes: none Management: Adjust socket placement Adjust foot unit Assessment view: Lateral
Your Assessment ?
Initial swing Uneven heel rise Prosthetic heel rises quite markedly and rapidly when knee is flexed at beginning of swing phase Prosthetic causes: – Insufficient friction in the knee axis – Insufficient strength of the knee extension aid Amputee causes: – Amputee may be using more power than necessary to force knee into flexion – Too fast (uncontrolled) gait Management: Adjust knee friction or damping Gait training Assessment view: Lateral and dorsal
Initial swing Medial whip Heel travels medially on initial flexion at beginning of the swing phase. prosthetic causes: – Excessive external rotation of prosthetic knee axis – Socket too narrow – Excessive valgus set into the prosthesis at knee level Amputee causes: – Bad habit – Improper donning of socket Management : Prosthetic Alignment Adjustment Ensure Proper Socket Fit Assessment view: Dorsal
Medial whip
Initial swing Lateral whip Heel travels laterally on initial flexion at beginning of the swing phase. prosthetic causes: – Excessive internal rotation of prosthetic knee axis – Socket too narrow – Excessive varus set into the prosthesis at knee level Amputee causes: – Improper donning of socket – Bad habit Management : Prosthetic Alignment Adjustment Ensure Proper Socket Fit Assessment view: Dorsal
Lateral whip
Initial and Swing phase Pelvic rise (hip hiking) Excessive pelvic elevation and shoulder to clear foot during swing phase Prosthetic causes: – Prosthesis too long – Excessive plantar flexion – anterior displacement of the foot – Incorrect socket fitting – Insufficient prosthetic suspension – Excessive friction in the knee axis – Excessive strength of the knee extension aid Amputee causes: – Weak hip flexors – Weak internal rotators – Fear of touching the ground – Bad habit – The amputee may have donned the prosthesis in external rotation. Management : Prosthetic hieght Adjustment Ensure Proper suspension Fit Hip flexor strengthening Gait training Assessment view: Dorsal (and frontal)
Swing phase Vaulting The amputee rises up on the toe of the sound leg to swing the prosthesis through from toe off to heel strike. Prosthetic causes: – Prosthesis too long – Excessive plantar flexion – Prosthesis too stable – Socket suspension may be inadequate Amputee causes: – Fear of stubbing toe – Residual limb discomfort – fairly frequent habit pattern Management : Prosthetic highet Adjustment Ensure Proper suspension Fit examine stump Gait training Assessment view: Lateral and dorsal
Swing phase Circumduction Semicircular swing of the prosthesis to the side Prosthetic causes : – Prosthesis too long – Socket too wide – Insufficient prosthetic suspension – Excessive friction in the knee axis – Locked knee joint Amputee causes: – Weak hip flexors and/or adductors – Lack of confidence in flexing the knee – Contracture of abductor muscles of the stump – Bad habit Management: Adjust knee friction or damping Adjust prosthesis length Physical therapy Realign prosthesis Adjust socket fit Assessment view: Dorsal (and frontal)
Terminal swing Terminal swing impact Knee reaches extension too quickly prior to heel strike Prosthetic causes: – Insufficient knee friction – Excessively strong extension aid Amputee causes : – Bad habit (The amputee uses the sound to indicate that the knee is ready for heel contact) Management: Adjust knee friction or damping Gait training Assessment view: Lateral
Terminal swing impact
Various gait cycles Uneven step length The length of the step taken with the prosthesis differs from that of the sound leg Prosthetic causes: – Insufficient flexion of the socket – Insufficient prosthetic suspension (pistoning) – Insufficient friction at the prosthetic knee amputee causes: – Short, weak or painful stump – Hip flexion contracture – The amputee feels insecure with the knee mechanism. Management: Adjust socket fit Physical therapy Realign prosthesis Assessment view: Lateral
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