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Transtibial Dynamic Alignment

The document outlines various adjustments and corrections needed for a prosthetic socket based on observed gait issues and alignment problems. It details specific areas of excessive pressure, gaps, and instability, emphasizing that adjustments should be made one at a time and provides solutions for each identified problem. Key issues include improper socket alignment leading to medial or lateral instability and excessive pressure at various points, as well as knee flexion issues during different phases of walking.

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1 WARNING!!! OBSERVE THE GAIT CAREFULLY FROM ANTERIOR, POSTERIOR AND LATERAL VIEWS. LISTEN TO THE PATIENT. PROCEED WITH ONE ADJUSTMENT AT A TIME. ADJUST WITH A SMALL RANGE.
2 SOCKET IS COMFORTABLE NORMAL ALIGNMENT (NO DEVIATIONS OBSERVED) TT DYNAMIC ALIGNMENT: ANTERIOR VIEW EQUAL SUPRACODYLAR COMPRESION PLUMBLINE IS IN THE CENTER TUBE IS VERTICAL FOOT IS FLAT OBSERVATION DURING MID STANCE PHASE WITH FULL WEIGTH BEARING ON PROSTHESIS
3 PROBLEMS!!! EXCESSIVE PRESSURE AT MEDIAL PROXIMAL AND LATERAL DISTAL AREAS. GAP AT LATERAL SUPRACONDYLAR AREA. LATERAL INSTABILITY. P P CORRECTION: 1 - ADDUCTION OF THE SOCKET 2 - TRANSLATION MEDIALLY Avoid doing two different adjustments at the same time! 1 2CAUSE: EXCESSIVE ABDUCTUION OF THE SOCKET. TT DYNAMIC ALIGNMENT: ANTERIOR VIEW DEVIATION OBSERVED DURING MID STANCE PHASE WITH FULL WEIGTH BEARING ON PROSTHESIS GAP PLUMBLINE IS LATERALLY DISPLACED TUBE IS LATERALLY INCLINED FOOT IS SUPINATED (VARUM GAIT) FORCES
4 P P TT DYNAMIC ALIGNMENT: ANTERIOR VIEW CORRECTION: TRANSLATION MEDIALLY GAP TUBE IS VERTICAL PLUMBLINE IS LATERALLY DISPLACED PROBLEMS!!! EXCESSIVE PRESSURE AT MEDIAL PROXIMAL AND LATERAL DISTAL AREAS. GAP AT LATERAL SUPRACODYLAR AREA. LATERAL INSTABILITY. FORCES CAUSE: LATERAL DISPLACEMENT OF THE SOCKET. DEVIATION OBSERVED DURING MID STANCE PHASE WITH FULL WEIGTH BEARING ON PROSTHESIS. FOOT IS FLAT
5 P P 1 2 TT DYNAMIC ALIGNMENT: ANTERIOR VIEW CORRECTION: 1 - ABDUCTION OF THE SOCKET 2 - TRANSLATION MEDIALLY Avoid doing two different adjustments at the same time! GAP CAUSE: EXCESSIVE ADDUCTION OF THE SOCKET. PROBLEMS!!! EXCESSIVE PRESSURE AT LATERAL PROXIMAL AND MEDIAL DISTAL AREAS. GAP AT MEDIAL SUPRACONDYLAR AREA. MEDIAL INSTABILITY. TUBE IS MEDIALLY INCLINED PLUMBLINE IS MEDIALLY DISPLACED FOOT IS PRONATED (VALGUM GAIT) FORCES DEVIATION OBSERVED DURING MID STANCE PHASE WITH FULL WEIGTH BEARING ON PROSTHESIS.
6 P P TT DYNAMIC ALIGNMENT: ANTERIOR VIEW CORRECTION: TRANSLATION LATERALLY GAP PROBLEMS!!! EXCESSIVE PRESSURE AT LATERAL PROXIMAL AND MEDIAL DISTAL AREAS. GAP AT MEDIAL SUPRACONDYLAR AREA. MEDIAL INSTABILITY. CAUSE: MEDIAL DISPLACEMENT OF THE SOCKET. TUBE IS VERTICAL PLUMBLINE IS MEDIALLY DISPLACED DEVIATION OBSERVED DURING MID STANCE PHASE WITH FULL WEIGTH BEARING ON PROSTHESIS. FORCES FOOT IS FLAT
7 PROBLEMS!!! RAPID AND PREMATURE KNEE FLEXION. PREMATURE FOREFOOT CONTACT (SLAP FOOT). EXCESSIVE PRESSURE AT POSTERIOR PROXIMAL AND ANTERIOR DISTAL AREAS. P P1 FORCES TT DYNAMIC ALIGNMENT: LATERAL VIEW DEVIATION OBSERVED DURING HEEL STRIKE PHASE. CORRECTION: 1 - EXTENTION OF THE SOCKET 2 - TRANSLATION POSTERIORLY Avoid doing two different adjustments at the same time! CAUSE 1: EXCESSIVE FLEXION OF THE SOCKET. CAUSE 2: ANTERIOR DISPLACEMENT OF THE SOCKET . 2 SLAP FOOT
8 PROBLEMS!!! HYPEREXTENSION OF KNEE. PAIN AT PATELLA AREA. EXCESSIVE PRESSURE AT PATELLAR TENDON AND POSTERIOR DISTAL AREAS. CAUSE 1 : POSTERIOR DISPLACEMENT OF THE SOCKET. CORRECTION: 1- TRANSLATION ANTERIORLY 2 - USE A FIRMER HEEL CUSHION Avoid doing two different adjustments at the same time! FORCES P P 1 TT DYNAMIC ALIGNMENT: LATERAL VIEW CAUSE 2 : TOO SOFT HEEL CUSHION. DEVIATION OBSERVED DURING MID STANCE PHASE. FOREFOOT IS RAISED (DORSAL FLEXION)
9 CORRECTION : FLEXION OF THE SOCKET P P TT DYNAMIC ALIGNMENT: LATERAL VIEW DEVIATION OBSERVED DURING MID STANCE PHASE. FORCES PROBLEMS!!! HYPEREXTENSION OF KNEE. PAIN AT PATELLA AREA. EXCESSIVE PRESSURE AT PATELLAR TENDON AND POSTERIOR DISTAL AREAS. CAUSE : INSUFFICIENT FLEXION OF THE SOCKET. HEEL IS RAISED (PLANTAR FLEXION)
10 CORRECTION: 1 - EXTENSION OF THE SOCKET 2 - TRANSLATION POSTERIORLY Avoid doing two different adjustments at the same time! P 1 2 FORCES TT DYNAMIC ALIGNMENT: LATERAL VIEW DEVIATION OBSERVED DURING HEEL OFF PHASE. PROBLEMS!!! ABNORMAL PERMANENT FLEXION OF KNEE. PATIENT FEELS LIKE WALKING "DOWN THE HEEL". EXCESSIVE PRESSURE AT POSTERIOR PROXIMAL AREA. CAUSE 1 : EXCESSIVE FLEXION OF THE SOCKET. CAUSE 2 : ANTERIOR DISPLACEMENT OF THE SOCKET.