Gait Deviations in Transfemoral and

Transtibial AmputeesAndrew Whittle

Gait analysis Transtibial Gait

Excessive knee flexion Absent or insufficient knee flexion Midstance instability Early or delayed knee flexion at midstance to toe off

Transfemoral Gait Lateral trunk bending Wide walking base Circumduction Vaulting Swing phase whips Foot rotation at heel strike Uneven heel rise Excessive terminal impact

Gait laboratory Observation

◦ Sagittal plane◦ Frontal plane

Identification of gait deviations◦ Symmetrical???

Determination of causes◦ Prosthetic vs non prosthetic◦ Accommodation of gait deviations

Gait Analysis

Excessive knee flexion◦ At heel strike 15 to 20 degrees

Knee flexion contracture Weak knee extensors/quadriceps strength Higher heeled shoe Heel lever to big

Excessive dorsiflexion of foot or excessive socket flexion Anteriorly placed socket

Heel/plantar flexion bumper too stiff

Transtibial Gait

Absent or insufficient knee flexion◦ At heel strike (uncommon)

Weak quadriceps musculature Pre existing Heel lever too short

Excessive plantarflexion of the prosthetic foot Heel too soft

Transtibial Gait

Midstance medio-lateral instability ◦ Complicated by genu varum and valgum

Ligament laxity Excessively abducted or adducted socket Excessive outset or inset of prosthetic foot

Transtibial Gait

Between midstance and toe-off◦ Early knee flexion

Weak quadriceps musculature Excessive dorsiflexion of foot or excessive socket

flexion

◦ Delayed knee flexion Excessive plantarflexion of the foot or extension of

the socket

Transtibial Gait

Lateral trunk bending◦ Lean toward amputated side in stance phase

Weak hip abductors Abducted socket Insufficent support by lateral socket wall Lateral distal discomfort Short prosthesis

Transfemoral Gait

Wide walking base◦ Contracture of hip abductors◦ Weak hip abductors◦ Pain or discomfort in the groin◦ Prosthesis too long◦ Excessive socket adduction

Transfemoral Gait

Circumduction◦ Prosthesis follows a laterally curved line as it

swings Prosthesis too long

Inadequate suspension Insufficient knee flexion during swing (fear) Lock knee

Transfemoral Gait

Vaulting◦ Early and excessive plantar flexion of the sound

foot Insufficient friction of the prosthetic foot Prosthesis too long

Lock knee Inadequate suspension

Transfemoral Gait

Swing phase whips◦ Weak flabby musculature◦ Check that the socket has been donned in correct

rotation

Transfemoral Gait

Swing phase whips◦ Medial Whip

At toe off heel moves medially Knee axis of the prosthesis is in excessive external

rotation

◦ Lateral Whip At toe off heel moves laterally

Knee axis of the prosthesis is in excessive external rotation

Transfemoral Gait

Foot rotation at heel strike◦ At heel contact the heel rotates laterally

Too hard a heel/plantar flexion bumper

Transfemoral Gait

Uneven heel rise◦ Excessive heel rise

Forceful hip flexion to ensure prosthesis is fully extended at heel strike

Insufficient friction at prosthetic knee

◦ Insufficient heel rise Fear or insecurity Walking with little or no knee flexion

Transfemoral Gait

Terminal impact◦ The prosthesis comes to a sudden stop at full

extension may be audible or visual Fear that the prosthesis may not be locked or safe Insufficient friction at knee joint Too much extension assistance

◦ Causes specific to the type of prosthetic knee

Tranfemoral Gait