Gait deviations in amputees
Original Editor - Abby Cain as part of the WCPT Network for Amputee Rehabilitation Project
Top Contributors - Admin, Shaimaa Eldib, Kalyani Yajnanarayan, Naomi O'Reilly, Kim Jackson, Tarina van der Stockt and Tony Lowe
Introduction[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].
Common deviations are listed in the tables below:
Transtibial[edit | edit source]
Name | Description | Causes | Illustration |
Absent knee flexion | Knee fully extended at heel strike |
Faulty suspension of the prosthesis - too soft heel cushion or plantar flexor bumpers Foot placement too far forward on stepping Lack of pre-flexion of the socket Discomfort/pain |
|
Excessive Knee Flexion | Increased knee flexion at heel strike (or mid stance), patient feels as though walking downhill |
Faulty suspension of prosthesis Prosthetic foot set in too much dorsiflexion Stiff heel cushion Flexion contracture of the knee |
|
External Rotation of Foot at Heel Strike | External rotation of the prosthesis/foot at heel strike. |
heel to hard loose socket[3] |
|
Knee instability | Knee flexion ‘jerky’ in presentation during heel strike to foot flat | Weak Quadriceps[2] | |
Valgus/Varus Moment | Knee shifts medially or laterally during prosthetic stance phase |
Foot placement (medial placement causes lateral thrust and vice versa) Foot alignment on the prosthesis |
|
Drop Off | Heel off occurs too early causing early knee flexion |
Foot too posterior on the prosthesis in relation to the socket Excessive dorsiflexion of the foot on the prosthesis |
|
Knee Hyperextension | Delayed heel causing hyperextension of the knee, walking up hill sensation |
Foot set too far forward on the prosthesis in relation to socket Too hard a heel cushion Too much plantar flexion on the foot[4] |
|
Whip | During swing phase foot ‘whips’ laterally or medially |
Poor suspension |
|
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 |
Lack of prosthetic socks Suspension loose or inadequate Too large or faulty socket
|
Transfemoral Gait Deviations[edit | edit source]
Name | Description | Causes | Illustration |
Prosthetic Instability | The prosthetic knee has a tendency to buckle on weight bearing |
Knee set too far anterior Heel cushion too firm Weak hip extensors Heel of the shoe too high causing the pylon of the prosthesis to move anteriorly |
|
Foot Slap | Foot progresses too quickly from heel strike to foot flat, creating a slapping noise |
Patient forcing foot contact to gain knee stability Heel cushion too soft Plantar flexion cushion too soft |
|
Abducted Gait | Increased base of support during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle[5] |
Prosthesis too long Socket too small Suspension belt may be insufficient-band may be too far from the ileum Pain in the groin or medial wall of the prosthesis Hip abductor contractures Lateral wall of the prosthesis not supporting the femur sufficiently Socket of prosthesis abducted in alignment Fear/lack of confidence transferring weight onto prosthesis Alignment of the lower half of the pylon of the prosthesis in relation to socket[2][3][5] |
|
Lateral Trunk Bending | Trunk flexes towards prosthesis during prosthetic stance phase |
Prosthesis too short Short stump length Weak or contracted hip abductors Foot outset excessively in relation to socket Lack of prosthetic lateral wall support Pain on the lateral distal end of the stump Lack of balance |
|
Anterior Trunk Bending | Trunk flexes forwards during prosthetic stance phase | ||
Increased Lumbar Lordosis | Lumbar lordosis is exaggerated during prosthetic stance phase |
Poor shaping of posterior wall of the prosthesis or pain on ischial weight bearing, resulting in anterior pelvic rotation Flexion contracture at the hip Weak hip extensor Habit Poor abdominal muscles Lack of support from the anterior wall of the socket |
|
Whip (during swing phase) | At toe off heel moves laterally (lateral whip) or medially (medial whip) |
Prosthetic knee alignment Incorrect donning of the prosthesis i.e. applied internally rotated or externally rotated weakness around femur |
|
Pistoning | Socket dropping off when prosthesis lifted |
Insufficient suspension Socket too loose[2] or delayed knee flexion during toe off (‘free knee only’) caused by increased resistance of the prosthesis Alignment of prosthesis[2] |
|
Excessive Heel Rise | Prosthetic heel rises more than sound side |
Lack of friction on prosthetic knee Amputee generating more force then required to gain knee flexion |
|
Reduced Heel Rise | Prosthetic heel does not rise as much as sound side |
Locked knee Lack of hip flexion Too much friction on free knee Extension aid to tight[3] |
|
Circumduction | Lateral curvature of swing phase of prosthesis |
Prosthesis too long Fixed knee and poor hip hitching Poor suspension causing prosthesis to slip Excessive plantar flexion of the foot Abduction contractures Habit Weak hip flexors Socket too small |
|
Vaulting | Amputee rises onto toe of the non prosthetic limb during prosthetic swing phase |
Prosthesis too long Habit Fear of catching toe on the floor Insufficient knee flexion (free knee) due to decreased confidence Lack of ‘hip hitching’ with a ‘locked/fixed knee’ Poor suspension prosthesis-slips off during swing phase Socket too small Excessive friction on knee flexion of the prosthesis[2][4][3][5] |
|
Terminal Impact | Forcible impact as knee goes into extension at end of terminal swing phase, just before heel strike |
Lack of friction of knee flexion Extension aid too excessive Absent extension bumper Amputee deliberately snaps knee into extension by excessive force to ensure extension[2][5] |
Both Transfermoral and Transtibial[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 |
Fixed flexion deformity at knee Insufficient friction of prosthetic knee creating an increased step length on prosthetic side, Hip flexion contracture Pain leading to decreased weight bearing on prosthetic side[2][5] Fear Poor balance Painful poorly fitting socket |
|
Uneven Arm Swing | Arm on the prosthetic side is held close to the body |
Poor prosthetic fit Poor balance Fear Habit[5] |
|
Unequal weight bearing/reduced stance phase on prosthesis |
Poor fitting socket leading to reduced stability Pain Muscle weakness Poor balance Fear and insecurity Poor extension aid or insufficient knee friction resulting in early excessive heel off and reduce stance time on prosthesis Inadequate prosthetic foot position[5] |
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.f
- ↑ Cite error: Invalid
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- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 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)
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