Prosthetic Gait

PROSTHETIC GAIT
DEVIATION
Dr Dibyendu Dutta
INTRODUCTION
Gait pattern of amputee varies widely from
individual to individual.
Gait analysis involves

 Observation- From front and side
 Identification of gait deviations
 Determination of the causes.

Causes are following types:
1.Patients Factor :
 Range of motion
 Muscle strength
 Limb length
 Prosthetic factor:
 1.Socket design
 2.Suspension
 3.Foot selection
NORMAL GAIT
FEW DEFINITIONS
 GAIT CYCLE OR STRIDE : Activity that occurs
between the time one foot touches the floor &
the time the same foot touches the floor again.
 STRIDE LENGTH : Is the distance traveled during
gait cycle.
 STEP : one half of a stride. It takes two steps ( a rt.
one & a lt. one ) to complete a stride or gait cycle.
 CADENCE : Is the number of steps taken per
minute, & can vary greatly.
10 January 2020 6
FEW DEFINITIONS
 STEP LENGTH : Is that distance
between heel strike of one foot &
heel strike of the other foot.
10 January 2020 7
10 January 2020 8
GAIT CYCLE
STANCE PHASE SWING PHASE
 Heel Strike(initial Contact)  Acceleration
 Foot Flat(loading Response)  (Initial swing)
 Midswing
 Midstance
 Heel-off(Terminal Stance)
 Decceleration
 Toe-off(preswing)  (Terminal swing)
10 January 2020 9
TRANSTIBIAL GAIT AND DEVIATION
10
INITIAL CONTACT to LOADING
RESPONSES
GAIT DEVIATION CAUSES
1.Abrupt Heel Contact Excessive Heel lever
2.Prolonged heel contact Inadequate heel lever
3.Excessive knee flexion Excesssive ant tilt

Displacement of socket
Dorsiflexion of foot
Stiff heel cushion
4.Absent knee flexion Excesssive post tilt or
displacement of socket or
planiflexion of foot
Cont…
Uncontrolled Weak quadriceps Strengthening of
Knee Flexion Quad
Jerky knee Foot too posterior Move foot anterior

flexion
foot too Make foot
dorsiflexed Plantiflexed
Make it stiff
Keel too soft
Soften
Heel wedge too
MID STANCES
Deviation Causes
Medial or lateral socket Foot too far outset or

thrust inset
Early knee flexion(Drop Ant displacement of
off) socket over foot
Posterior displacement
of toe break or keel
Pelvis drops or elevates Too short or long
TERMINAL STANCES
Deviation Causes Modification
Heel off early Excess toe liver Realign

Too uch socket prosthesis
ext
Heel off late Inadequate toe same
liver
Socket flexion
SWING PHASE
 Prosthetic foot drag
 Causes
 Too long
Inadequate
suspension
Modification:
Shorten limb
Modify suspension
Transfemoral Gait & Deviations
16
Foot rotation at heel strike
Initial Conact – Loading Response
Causes Poor socket

fit/rotation
Management Adjust
socket fit
 Add belt
for rotation
control
FOOT SLAP
Causes Management
Too soft
Planter Hardening
Flexion
bumper
Lateral Trunk BENDING At midstance
Lateral Trunk Bending
Causes Managemen
t
Abducted
socket. Realign
Insufficient socket
support by the
lateral socket
wall.
Short Strengthenin
prosthesis g
Weak Hip
Abductor
Cont..
Exaggarated lumbar
lordosis
Causes
Managemen
t
Insufficient
socket
flexion. Realign
socket
Insufficient
support from
the anterior
socket brim Strengthen
SWING PHASE
Uneven heel rise
Cause Managemen
t
Knee Adjust knee

friction friction or
insufficient damping
 loose
extnsion
band
Circumduction
Cause Management
Causes
Pain or insecurity
Adjust knee friction
Excessive friction or damping
at the prosthetic Adjust prosthesis
knee or too loose an length
extension aid.
Physical therapy
Insufficient socket
flexion
VAULTING
Excessive plantiflexion of normal
foot
VAULTING
 Causes
 Prosthesis too long
 Inadequate suspension
 Excesive knee stability
 Modification
 Shorten prosthesis
 Realign suspension
SWING PHASE
TERMINAL IMPACT
The prosthetic shank comes to a sudden stop with a
visible and possibly audible impact as the knee reaches
full extension
Causes Managment
Insufficient
knee friction
Adjust knee
Too tight an friction and
extension aid. extensor
mechanism
Worn or
absent
extension
bumper
WIDE WALKING BASE (ABDUCTED
GAIT)
 Causes:
 Abductor contracture
 Pain in groin
 Prosthesis too long
 Shank in valgus
 Management:
 Adjust length of
prosthesis and
angulation of shank
Unequal step length
 Causes
 Pain or insecurity
 Insufficient friction at the prosthetic knee or too loose

an extension aid.
 Hip flexion contracture
 Insufficient socket flexion

GAIT TRAINING
 After completing the final prosthetic evaluation, the
individual with a new amputation will require a period
of gait training under supervision.
Cont..
 The individual with an amputation is instructed on how to
 put on and take off the prosthesis
 To Determine The Appropriate Number Of

Limb Socks To Be Worn
 To Check The Skin For Evidence Of Irritation
 To Clean and care for the prosthesis.

Cont..
Gait training may last from

weeks to months.
The more proximal levels of

amputation require lengthier
gait training.
Cont..
Weight shifting and balance activity in parallel bar
Independent level of ambulation with or without gait aid
Specific training of transfer ,knee stability.
From even surface to unevensurface

Prosthetic Gait

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PROSTHETIC GAIT

Gait analysis involves

 Identification of gait deviations

 Determination of the causes.

1.Abrupt Heel Contact Excessive Heel lever

2.Prolonged heel contact Inadequate heel lever

3.Excessive knee flexion Excesssive ant tilt

Jerky knee Foot too posterior Move foot anterior

Medial or lateral socket Foot too far outset or

Heel off early Excess toe liver Realign

Causes Poor socket

Knee Adjust knee

 Insufficient friction at the prosthetic knee or too loose

 Hip flexion contracture

 Insufficient socket flexion

 To Determine The Appropriate Number Of

 To Check The Skin For Evidence Of Irritation

 To Clean and care for the prosthesis.

Gait training may last from

The more proximal levels of

Independent level of ambulation with or without gait aid

Specific training of transfer ,knee stability.

From even surface to unevensurface

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