Gait deviations in amputees
Original Editor - Abby Cain as part of the World Physiotherapy Network for Amputee Rehabilitation Project
Top Contributors - Admin, Shaimaa Eldib, Kalyani Yajnanarayan, Naomi O'Reilly, Kim Jackson, Tarina van der Stockt and Tony LoweIntroduction[edit | edit source]
While assessing amputee gait it is important to be aware of normal gait and how normal gait in the amputee is affected. You can learn about this on the Gait in prosthetic rehabilitation page.
Furthermore, there may be deviations which an amputee will adopt to compensate for the prosthesis, muscle weakness or tightening, lack of balance and fear. These deviations create an altered gait pattern and it is important that these are recognised, as rehabilitation of the gait will need to encompass corrections of these deviations[1][2][3][4][5].
Gait deviations in lower limb amputees can be broadly broken into the patient and the prosthetic causes:[6]
- Patient Causes:
- Muscle weakness
- Contracture
- Pain
- Decreased confidence in the prosthesis or residual limb
- Habitual/learned behaviours
- Prosthetic Causes:
- Prosthetic malalignment
- Poor-fitting prosthetic socket
Important things to note about the gait of people with lower-limb amputations:[7]
- Gait patterns are different than age-matched people without an amputation
- "Transtibial and transfemoral amputees show a common and specific gait pattern"[7]
- Transfemoral amputees have a more asymmetric gait than transtibial amputees
- The level of the amputation and the type of prosthesis affect gait, for e.g. in transfemoral amputees, the type of prosthesis will influence the gait pattern of the same person, in both performance and adaptation. [7]
The trunk and lower limb gait:[8]
- Someone with a lower limb amputation can have altered trunk motion during functional tasks
- Increased trunk flexion and trunk velocity can be some of the risks associated with falling for this population.
- Assessment and rehab should include not only trunk-pelvis, core, and hip abductor strength but also focus on training of the placement of the prosthetic knee and foot to help modify trunk movement during gait. [8]
Common deviations are listed in the tables below:
Transtibial Gait Deviations :[2][9][4][edit | edit source]
Name | Description | Causes | Illustration |
Absent/inadequate knee flexion | Knee fully extended at heel strike |
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Excessive Knee Flexion | Increased knee flexion at heel strike (or mid stance), the patient feels as though walking downhill |
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External Rotation of Foot at Heel Strike | External rotation of the prosthesis/foot at heel strike. |
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Knee instability | Knee flexion ‘jerky’ in the presentation during heel strike to foot flat |
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Valgus/Varus Moment | Knee shifts medially or laterally during prosthetic stance phase |
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Drop Off | Heel off occurs too early causing early knee flexion |
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Knee Hyperextension | Delayed heel causing hyperextension of the knee, walking uphill sensation |
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Whip | During swing phase foot ‘whips’ laterally or medially |
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Pistoning | Amputee drops into the socket as the foot moves into flat foot, tibia moves vertically during alternately weight bearing and non-weight bearing periods of gait |
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Transfemoral Gait Deviations:[4][edit | edit source]
Name | Description | Causes | Illustration |
Prosthetic Instability | The prosthetic knee has a tendency to buckle on weight bearing |
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Foot Slap | Foot progresses too quickly from heel strike to foot flat, creating a slapping noise |
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Abducted Gait | Increased base of support during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle. |
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Lateral Trunk Bending | Trunk flexes towards prosthesis during prosthetic stance phase |
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Anterior Trunk Bending | Trunk flexes forwards during prosthetic stance phase | ||
Increased Lumbar Lordosis | Lumbar lordosis is exaggerated during prosthetic stance phase |
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Whip (during swing phase) | At toe-off heel moves laterally (lateral whip) or medially (medial whip) |
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Pistoning | Socket dropping off when prosthesis lifted |
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Excessive Heel Rise | Prosthetic heel rises more than sound side |
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Reduced Heel Rise | Prosthetic heel does not rise as much as sound side |
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Circumduction |
Lateral curvature of the swing phase of prosthesis |
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Vaulting | Amputee rises onto the toe of the non-prosthetic limb during the prosthetic swing phase |
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Terminal Impact | Forcible impact as the knee goes into extension at end of terminal swing phase, just before heel strike |
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Both Transfemoral and Transtibial: [11][5][edit | edit source]
Steps are of uneven duration or length, usually a short stance phase on the prosthetic side
Name | Description | Causes | Illustration |
Uneven Step Length | Steps are of uneven duration or length, usually a short stance phase on the prosthetic side |
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Uneven Arm Swing (secondary deviation) | The arm on the prosthetic side is held close to the body |
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This is not an exhaustive list and the deviation described for each level of amputation is not exclusive to that level, but is more likely to occur for that amputation.
Resources[edit | edit source]
YouTube Playlist with Amputee Gait Deviations
References[edit | edit source]
- ↑ Esquenazi A. Gait analysis in lower-limb amputation and prosthetic rehabilitation. Physical Medicine and Rehabilitation Clinics. 2014 Feb 1;25(1):153-67.
- ↑ 2.0 2.1 Silverman AK, Fey NP, Portillo A, Walden JG, Bosker G, Neptune RR. Compensatory mechanisms in below-knee amputee gait in response to increasing steady-state walking speeds. Gait & posture. 2008 Nov 1;28(4):602-9.
- ↑ Murphy DP, editor. Fundamentals of amputation care and prosthetics. Demos Medical Publishing; 2013 Aug 28.
- ↑ 4.0 4.1 4.2 Pasquina PF, Cooper RA. l-ower Extremity Amputation.
- ↑ 5.0 5.1 REhABiLitAtion A. Evidence Based Clinical Guidelines for the Physiotherapy Management of Adults with Lower Limb Prostheses.
- ↑ LE VAN TU. Evaluation of Trans-femoral Prosthesis Function Using Finite Element Analysis (Doctoral dissertation, SHIBAURA INSTITUTE OF TECHNOLOGY).
- ↑ 7.0 7.1 7.2 Varrecchia T, Serrao M, Rinaldi M, Ranavolo A, Conforto S, De Marchis C, Simonetti A, Poni I, Castellano S, Silvetti A, Tatarelli A. Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components. Human movement science. 2019 Aug 1;66:9-21.
- ↑ 8.0 8.1 Yoder AJ, Silder AB, Farrokhi S, Dearth CL, Hendershot BD. Lower extremity joint contributions to trunk control during walking in persons with transtibial amputation. Scientific reports. 2019 Aug 22;9(1):1-8.
- ↑ Winter DA, Sienko SE. Biomechanics of below-knee amputee gait. Journal of biomechanics. 1988 Jan 1;21(5):361-7.
- ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 Hunter New England. NSW Health Duff K. Prosthetic gait deviations. Page link on Australian Physiotherapist in Amputee Rehabilitation. http://www.austpar.com/portals/gait/docs-and-presentations/ProstheticGaitDeviations.pps (accessed 6 February 2015)
- ↑ Gailey R. Rehabilitation of a traumatic lower limb amputee. Physiotherapy Research International. 1998 Nov;3(4):239-43.
- ↑ PT Final Exam. PT Final Exam. June 2019. Available from: https://youtu.be/VtPQrHmnmhw