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Prosthetic Gait Deviations
Karyn Duff
Prosthetist / Orthotist
Hunter 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 / nsecurity
Habit
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!7osthetic AIignment
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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ench aIignment - T7ans tibiaI
Sagittal 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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ench aIignment - T7ans tibiaI
Frontal 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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ench aIignment - T7ans femo7aI
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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ommon !7osthetic Gait Deviations
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#otation of p7osthetic foot at I
Description
Prosthetic foot externally rotates at nitial Contact
Causes
Too hard a heel
Too hard a plantarflexion bumper
Socket too loose
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oot sIap
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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cessive knee fIeion (at I
Description
Knee flexes excessively at .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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ate7aI T7:nk ending
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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edio-Iate7aI knee th7:st
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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Abd:cted gait
Description
Walking base significantly larger than normal range of 50-
100mm
Causes
Prosthesis too long
Too small socket
nsufficient suspension
Locked knee
Abducted socket
Pain in groin area
Fear / nsecurity
Contracted hip abductors
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Absent o7 ins:fficient knee fIeion
Description
nsufficient knee flexion at .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
nsufficient socket flexion
Foot too anterior in relation to socket
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i7c:md:ction
Description
Prosthesis follows a lateral curved line as it swings
through
Causes
Prosthesis too long
Locked knee
nadequate suspension
Too small a socket
Foot set in plantarflexion
Lack of knee flexion (fear / insecurity of patient)
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'a:Iting
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
nadequate suspension
Locked knee
Socket too small
Foot set in plantarflexion
Lack of knee flexion (fear / insecurity of patient)
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&neven 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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InstabiIity of p7osthetic knee
Description
The prosthetic knee has a tendency to buckle on
weight bearing
Causes
ncorrect alignment of prosthesis (weight line
passes behind knee centre creating flexion
moment)
Weak hip extensor muscles
Severe hip flexion contracture
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Te7minaI swing impact
Description
The prosthetic shank comes to a sudden stop with
a visible or audible impact
Causes
nsufficient knee friction
Extension assist too great
Habit of forceful knee flexion
Fear of knee buckling at .C
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Inc7eased :mba7 o7dosis
Description
Lumbar lordosis is exaggerated during prosthetic
stance phase
Causes
nsufficient AP socket support
nsufficient socket flexion
Pain on ischial tuberosity area
Hip flexion contracture
Weak hip extensors or abdominals
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$wing !hase Whips
Description
At toe off heel moves
laterally (lateral whip)
or medially (medial
whip)
Causes
nadequate suspension
Knee internally rotated
(lateral whip)
Knee externally rotated
(medial whip)
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&neven heeI 7ise
Description
Prosthetic heel rise
does not match sound
side.
Causes
nadequate knee
friction (high heel rise)
nadequate extension
assist (high heel raise)
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cessive fo7wa7d fIeion
Description
During stance patient excessively leans forward
Causes
Unstable knee joint
Hip flexion contracture
Too short gait aids
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Any Questions???