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Prosthetic Gait DeviationsKaryn Duff

Prosthetist / OrthotistHunter Prosthetics and Orthotics Service

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What is a gait deviation? Any gait characteristic that differs from the

normal pattern

Unsymmetrical gait

Many possible causes:

– Prosthetic

– Reduced ROM

– Muscle weakness

– Fear / Insecurity

– Habit

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Prosthetic Alignment Correct alignment of the prosthesis allows:

– Optimal gait

– Optimal pressure distribution across stump

– Optimal stability

– Optimal control

– Reduces energy expenditure

Three steps to prosthetic alignment

– Bench alignment

– Static alignment

– Dynamic alignment

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Bench alignment – Trans tibialSagittal Plane

Heel height matches patient’s shoe

Socket 5° flexed

Weight line

– Centre of lateral socket

– Posterior 1/3 of foot

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Bench alignment – Trans tibialFrontal Plane

Abduction / Adduction to match patient

Weight line

– Centre of posterior socket

– Centre of heel (or up to 10mm laterally)

Transverse Plane

5-10° toe out

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Bench alignment – Trans femoral Heel height matches

patient’s shoe

Socket 5° flexed

Weight line

– Centre of lateral socket

– 5-15mm anterior to knee centre

– Posterior 1/3 or foot

Length may be up to 10mm shorter than sound side

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Common Prosthetic Gait Deviations

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Rotation of prosthetic foot at IC Description

– Prosthetic foot externally rotates at Initial Contact

Causes

– Too hard a heel

– Too hard a plantarflexion bumper

– Socket too loose

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Foot slap Description

– Foot progresses too quickly from heel strike to foot flat, creating a slapping noise

Causes

– Heel too soft

– Plantarflexion bumper too soft

– Excessive socket flexion

– Excessive dorsiflexion

– Poor knee extension control

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Excessive knee flexion (at IC) Description

– Knee flexes excessively at I.C

– Patient feels like he’s walking downhill

Causes

– Heel cushion too hard

– Excessive dorsiflexion of prosthetic foot

– Foot too posterior in relation to socket

– Excessive flexion built into socket

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Lateral Trunk Bending Description

– Trunk bends towards amputated side during prosthetic stance phase

Causes

– Short prosthesis

– Pain on lateral distal aspect of stump

– Abducted socket

– Low lateral wall of socket

– Weak hip abductors

– Short stump

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Medio-lateral knee thrust Description

– Knee shifts medially or laterally during prosthetic stance phase

Causes

– Foot placed too medially (lateral thrust)

– Foot placed too laterally (medial thrust)

– ML dimension of proximal socket too large

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Abducted gait Description

– Walking base significantly larger than normal range of 50-100mm

Causes

– Prosthesis too long

– Too small socket

– Insufficient suspension

– Locked knee

– Abducted socket

– Pain in groin area

– Fear / Insecurity

– Contracted hip abductors

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Absent or insufficient knee flexion

Description

– Insufficient knee flexion at I.C and / or knee hyperextension at T.S

– Patient may report pressure on distal tibia

– Patient feels like he’s walking uphill

Causes

– Excessive plantarflexion of prosthetic foot

– Heel too soft

– Too soft a plantarflexion bumper

– Insufficient socket flexion

– Foot too anterior in relation to socket

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Circumduction Description

– Prosthesis follows a lateral curved line as it swings through

Causes

– Prosthesis too long

– Locked knee

– Inadequate suspension

– Too small a socket

– Foot set in plantarflexion

– Lack of knee flexion (fear / insecurity of patient)

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Vaulting Description

– Amputee bobs up and down excessively as he walks. He raises his entire body by plantar-flexing the sound foot.

Causes

– Prosthesis too long

– Inadequate suspension

– Locked knee

– Socket too small

– Foot set in plantarflexion

– Lack of knee flexion (fear / insecurity of patient)

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Uneven Timing Description

– Steps are of uneven duration or length, usually a short stance phase on the prosthetic side

Causes

– Poorly fitting socket causing pain

– Fear / insecurity

– Poor balance

– Weak stump musculature

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Instability of prosthetic knee Description

– The prosthetic knee has a tendency to buckle on weight bearing

Causes

– Incorrect alignment of prosthesis (weight line passes behind knee centre creating flexion moment)

– Weak hip extensor muscles

– Severe hip flexion contracture

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Terminal swing impact Description

– The prosthetic shank comes to a sudden stop with a visible or audible impact

Causes

– Insufficient knee friction

– Extension assist too great

– Habit of forceful knee flexion

– Fear of knee buckling at I.C

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Increased Lumbar Lordosis Description

– Lumbar lordosis is exaggerated during prosthetic stance phase

Causes

– Insufficient AP socket support

– Insufficient socket flexion

– Pain on ischial tuberosity area

– Hip flexion contracture

– Weak hip extensors or abdominals

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Swing Phase Whips Description

– At toe off heel moves laterally (lateral whip) or medially (medial whip)

Causes

– Inadequate suspension

– Knee internally rotated (lateral whip)

– Knee externally rotated (medial whip)

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Uneven heel rise Description

– Prosthetic heel rise does not match sound side.

Causes

– Inadequate knee friction (high heel rise)

– Inadequate extension assist (high heel raise)

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Excessive forward flexion Description

– During stance patient excessively leans forward

Causes

– Unstable knee joint

– Hip flexion contracture

– Too short gait aids

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Any Questions???