Gait deviations in amputees: Difference between revisions
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Socket too loose <br> | Socket too loose <br> | ||
Poor limb control <br> | Poor limb control <br> | ||
Alignment of foot on the prosthesis <br> | Alignment of foot on the prosthesis <br> | ||
Heel of the prosthesis too hard<ref name="Evans">Evans S. Prosthetics Education Session. July 2012. Ottobock</ref> | Heel of the prosthesis too hard<ref name="Evans">Evans S. Prosthetics Education Session. July 2012. Ottobock</ref> | ||
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| The prosthetic knee has a tendency to buckle on weight bearing<br> | | The prosthetic knee has a tendency to buckle on weight bearing<br> | ||
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Knee set too far anterior <br>Heel cushion too firm <br>Weak hip extensors <br>Heel of the shoe too high causing the pylon of the prosthesis to move anteriorly <br>Severe hip flexion contracture<ref name="Smith" /><ref name="Hunter New England" /> | Knee set too far anterior <br> | ||
Heel cushion too firm <br> | |||
Weak hip extensors <br> | |||
Heel of the shoe too high causing the pylon of the prosthesis to move anteriorly <br> | |||
Severe hip flexion contracture<ref name="Smith" /><ref name="Hunter New England" /> | |||
| {{#ev:youtube|guzHBE_TDVY|200}} | | {{#ev:youtube|guzHBE_TDVY|200}} | ||
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| Foot progresses too quickly from heel strike to foot flat, creating a slapping noise<br> | | Foot progresses too quickly from heel strike to foot flat, creating a slapping noise<br> | ||
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Patient forcing foot contact to gain knee stability <br>Heel cushion too soft <br>Plantar flexion cushion too soft <br>Excessive dorsiflexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Patient forcing foot contact to gain knee stability <br> | ||
Heel cushion too soft <br> | |||
Plantar flexion cushion too soft <br> | |||
Excessive dorsiflexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
| {{#ev:youtube|O9xB_SivZ7E|200}} | | {{#ev:youtube|O9xB_SivZ7E|200}} | ||
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| Increased base of support during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle<ref name="Evans" /> | | Increased base of support during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle<ref name="Evans" /> | ||
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Prosthesis too long <br>Socket too small <br>Suspension belt may be insufficient-band may be too far from the ileum <br>Pain in the groin or medial wall of the prosthesis <br>Hip abductor contractures <br>Lateral wall of the prosthesis not supporting the femur sufficiently <br>Socket of prosthesis abducted in alignment <br>Fear/lack of confidence transferring weight onto prosthesis <br>Alignment of the lower half of the pylon of the prosthesis in relation to socket<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Prosthesis too long <br> | ||
Socket too small <br> | |||
Suspension belt may be insufficient-band may be too far from the ileum <br> | |||
Pain in the groin or medial wall of the prosthesis <br> | |||
Hip abductor contractures <br> | |||
Lateral wall of the prosthesis not supporting the femur sufficiently <br> | |||
Socket of prosthesis abducted in alignment <br> | |||
Fear/lack of confidence transferring weight onto prosthesis <br> | |||
Alignment of the lower half of the pylon of the prosthesis in relation to socket<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
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| Trunk flexes towards prosthesis during prosthetic stance phase | | Trunk flexes towards prosthesis during prosthetic stance phase | ||
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Prosthesis too short <br>Short stump length <br>Weak or contracted hip abductors <br>Foot outset excessively in relation to socket <br>Lack of prosthetic lateral wall support <br>Pain on the lateral distal end of the stump <br>Lack of balance <br>Habit<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Prosthesis too short <br> | ||
Short stump length <br> | |||
Weak or contracted hip abductors <br> | |||
Foot outset excessively in relation to socket <br> | |||
Lack of prosthetic lateral wall support <br> | |||
Pain on the lateral distal end of the stump <br> | |||
Lack of balance <br> | |||
Habit<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
| {{#ev:youtube|b2n0USprXmQ|200}} | | {{#ev:youtube|b2n0USprXmQ|200}} | ||
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| Excessive pelvic lift on heel lift on prosthetic side | | Excessive pelvic lift on heel lift on prosthetic side | ||
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Toe lever too long<ref name="Smith" /> | Toe lever too long<ref name="Smith" /> | ||
| {{#ev:youtube|A9f69mmgBzk|200}} | | {{#ev:youtube|A9f69mmgBzk|200}} | ||
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| Pelvic dip on heel lift on prosthetic side | | Pelvic dip on heel lift on prosthetic side | ||
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Toe lever too short<ref name="Smith" /> | Toe lever too short<ref name="Smith" /> | ||
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| Lumbar lordosis is exaggerated during prosthetic stance phase<br><br> | | Lumbar lordosis is exaggerated during prosthetic stance phase<br><br> | ||
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Poor shaping of posterior wall of the prosthesis or pain on ischial weight bearing, resulting in anterior pelvic rotation <br>Flexion contracture at the hip <br>Weak hip extensor <br>Habit <br>Poor abdominal muscles <br>Lack of support from the anterior wall of the socket <br>Insufficient socket flexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Poor shaping of posterior wall of the prosthesis or pain on ischial weight bearing, resulting in anterior pelvic rotation <br> | ||
Flexion contracture at the hip <br> | |||
Weak hip extensor <br> | |||
Habit <br> | |||
Poor abdominal muscles <br> | |||
Lack of support from the anterior wall of the socket <br> | |||
Insufficient socket flexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
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| At toe off heel moves laterally (lateral whip) or medially (medial whip)<br> | | At toe off heel moves laterally (lateral whip) or medially (medial whip)<br> | ||
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Prosthetic knee alignment <br>Incorrect donning of the prosthesis i.e. applied internally rotated or externally rotated weakness around femur <br>Prosthetic too tight<ref name="Smith" /><ref name="Evans" /> | Prosthetic knee alignment <br> | ||
Incorrect donning of the prosthesis i.e. applied internally rotated or externally rotated weakness around femur <br> | |||
Prosthetic too tight<ref name="Smith" /><ref name="Evans" /> | |||
| {{#ev:youtube|wfG7sg7dQMA|200}} | | {{#ev:youtube|wfG7sg7dQMA|200}} | ||
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| Socket dropping off when prosthesis lifted | | Socket dropping off when prosthesis lifted | ||
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Insufficient suspension <br>Socket too loose<ref name="Smith" /> or delayed knee flexion during toe off (‘free knee only’) caused by increased resistance of the prosthesis <br>Alignment of prosthesis<ref name="Smith" /> | Insufficient suspension <br> | ||
Socket too loose<ref name="Smith" /> or delayed knee flexion during toe off (‘free knee only’) caused by increased resistance of the prosthesis <br> | |||
Alignment of prosthesis<ref name="Smith" /> | |||
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| Prosthetic heel rises more than sound side | | Prosthetic heel rises more than sound side | ||
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Lack of friction on prosthetic knee <br>Amputee generating more force then required to gain knee flexion <br>Poor/lack of extension aid<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Lack of friction on prosthetic knee <br> | ||
Amputee generating more force then required to gain knee flexion <br> | |||
Poor/lack of extension aid<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
| {{#ev:youtube|3sH3DAePmLk|200}} | | {{#ev:youtube|3sH3DAePmLk|200}} | ||
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| Prosthetic heel does not rise as much as sound side<br> | | Prosthetic heel does not rise as much as sound side<br> | ||
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Locked knee <br>Lack of hip flexion <br>Too much friction on free knee <br>Extension aid to tight<ref name="Hunter New England" /> | Locked knee <br> | ||
Lack of hip flexion <br> | |||
Too much friction on free knee <br> | |||
Extension aid to tight<ref name="Hunter New England" /> | |||
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| Lateral curvature of swing phase of prosthesis | | Lateral curvature of swing phase of prosthesis | ||
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Prosthesis too long <br>Fixed knee and poor hip hitching <br>Poor suspension causing prosthesis to slip <br>Excessive plantar flexion of the foot <br>Abduction contractures <br>Habit <br>Weak hip flexors <br>Socket too small <br>Insufficient knee flexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | Prosthesis too long <br> | ||
Fixed knee and poor hip hitching <br> | |||
Poor suspension causing prosthesis to slip <br> | |||
Excessive plantar flexion of the foot <br> | |||
Abduction contractures <br> | |||
Habit <br> | |||
Weak hip flexors <br> | |||
Socket too small <br> | |||
Insufficient knee flexion<ref name="Smith" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
| {{#ev:youtube|-m9D2GRTPU|200}} | | {{#ev:youtube|-m9D2GRTPU|200}} | ||
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| Amputee rises onto toe of the non prosthetic limb during prosthetic swing phase | | Amputee rises onto toe of the non prosthetic limb during prosthetic swing phase | ||
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Prosthesis too long <br>Habit <br>Fear of catching toe on the floor <br>Insufficient knee flexion (free knee) due to decreased confidence <br>Lack of ‘hip hitching’ with a ‘locked/fixed knee’ <br>Poor suspension prosthesis-slips off during swing phase <br>Socket too small <br>Excessive friction on knee flexion of the prosthesis<ref name="Smith" /><ref name="Berger" /><ref name="Hunter New England" /><ref name="Evans" /> | Prosthesis too long <br> | ||
Habit <br> | |||
Fear of catching toe on the floor <br> | |||
Insufficient knee flexion (free knee) due to decreased confidence <br> | |||
Lack of ‘hip hitching’ with a ‘locked/fixed knee’ <br> | |||
Poor suspension prosthesis-slips off during swing phase <br> | |||
Socket too small <br> | |||
Excessive friction on knee flexion of the prosthesis<ref name="Smith" /><ref name="Berger" /><ref name="Hunter New England" /><ref name="Evans" /> | |||
| {{#ev:youtube|i2bxODibvb0|200}} | | {{#ev:youtube|i2bxODibvb0|200}} | ||
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| Forcible impact as knee goes into extension at end of terminal swing phase, just before heel strike | | Forcible impact as knee goes into extension at end of terminal swing phase, just before heel strike | ||
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Lack of friction of knee flexion <br>Extension aid too excessive <br>Absent extension bumper <br>Amputee deliberately snaps knee into extension by excessive force to ensure extension<ref name="Smith" /><ref name="Evans" /><br> | Lack of friction of knee flexion <br> | ||
Extension aid too excessive <br> | |||
Absent extension bumper <br> | |||
Amputee deliberately snaps knee into extension by excessive force to ensure extension<ref name="Smith" /><ref name="Evans" /><br> | |||
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Revision as of 15:46, 6 May 2015
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 |
Excessive Toe Out | External rotation of the prosthesis at heel strike |
Heel to hard Plantar flexion bumper too hard Socket too loose[3] |
|
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 |
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Excess Knee Flexion | Increased knee flexion at heel strike, 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 | Rotation of foot at heel strike |
Heel too hard Loose socket[4] |
|
x | Knee flexion ‘jerky’ in presentation during heel strike to foot flat | Weak Quadriceps[2] | |
x | Abrupt knee flexion as foot moves in flat foot contact with the floor |
Excessive dorsiflexion of the prosthetic foot Foot too posterior in relation to socket of the prosthesis Lack of suspension in the prosthesis Lack of cushion due to the shoe Heel of the shoe too high[2] |
|
x | Knee stays extended from heel strike to flat foot contact |
Step length too long Foot too anterior on the prosthesis Foot too planter flexed on the prosthesis Heel too soft Discomfort when flexing the knee in the prosthesis |
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x | Amputee drops into the socket as the foot moves into flat foot |
Lack of prosthetic socks Suspension loose Faulty socket |
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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 |
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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 |
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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[3] |
|
x | The socket drops down off the limb after ‘toe off’ |
Socket too lose Not enough prosthetic socks[2] |
|
Whip | During swing phase foot ‘whips’ laterally or medially |
Poor suspension |
|
Pistoning | tibia moves vertically during alternately weight bearing and non-weight bearing periods of gait |
Socket too large Suspension inadequate |
Transfemoral Gait Deviations[edit | edit source]
Name | Description | Causes | Illustration |
Socket too loose Poor limb control Alignment of foot on the prosthesis Heel of the prosthesis too hard[5] |
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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][4][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 | ||
Excessive pelvic lift on heel lift on prosthetic side |
Toe lever too long[2] |
||
Pelvic dip on heel lift on prosthetic side |
Toe lever too short[2] |
||
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 |
|
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[4] |
|
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][3][4][5] |
|
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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- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 Cite error: Invalid
<ref>
tag; no text was provided for refs namedSmith
- ↑ 3.0 3.1 3.2 3.3 3.4 Berger N. Analysis of Amputee Gait. Chapter 14. Atlas of limb prosthetics: Surgical, Prosthetic and rehabilitation Principles. Abridged version. O and P Virtual library http://oandplibrary.org/alp/chap14-01.asp (accessed 5 February 2015)
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 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)
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 Evans S. Prosthetics Education Session. July 2012. Ottobock