TRANSFEMORAL GAIT

DEVIATION
TATCOT-DOT II
REVIEW NORMAL GAIT
NORMAL GAIT
 HUMAN LOCOMOTION
• AN UNDERSTANDING OF NORMAL HUMAN LOCOMOTION
PROVIDES A BASIS FOR THE SYSTEMATIC TREATMENT OF THE
PATHOLOGICAL GAIT, ESPECIALLY WHEN PROSTHETIC AND
ORTHOTIC AIDS ARE EMPLOYED.
 HUMAN LOCOMOTION CONT…
• NORMAL HUMAN LOCOMOTION IS A SERIES OF RHYTHMICAL
AND VARYING MOVEMENTS OF THE LIMBS AND THE TRUNK,
WHICH LEAD TO FORWARD PROGRESSION OF THE CENTRE OF
GRAVITY
DEFINITION OF FREQUENTLY USED TERMS
ONE GAIT CYCLE CONSISTS OF THOSE
ACTIVITIES OCCURRING BETWEEN THE HEEL
STRIKE OF ONE LEG AND THE NEXT HEEL
STRIKE ON THE SAME SIDE. DURING EACH
GAIT CYCLE, EACH LIMB PASSES THROUGH A
STANCE PHASE AND A SWING PHASE.
DEFINITION OF FREQUENTLY USED TERMS
• STANCE PHASE:
• THIS BEGINS WHEN THE HEEL MAKES CONTACT WITH THE
GROUND. IT ENDS WHEN THE TOES OF THE SAME FOOT LEAVE
THE GROUND.
DEFINITION OF FREQUENTLY USED TERMS
• SWING PHASE:
• THIS BEGINS WITH PUSH-OFF AND ENDS WITH THE HEEL
STRIKE
DEFINITION OF FREQUENTLY USED TERMS
GAIT CYCLE
TIME PERCENT OF GAIT CYCLE
CHARACTERISTICS OF THE NORMAL GAIT
• SHOCK ABSORPTION PHASE: THE PHASE DURING WHICH FORCE
IS APPLIED TO THE LEADING EXTREMITY AND THE GROSS
VERTICAL MOVEMENTS OF THE CENTRE OF GRAVITY OF THE
BODY ARE SMOOTHED OUT. IT LASTS FROM HEEL STRIKE TO
FOOT FLAT.
CHARACTERISTICS OF THE NORMAL GAIT
• MID-STANCE PHASE: DURING THIS PHASE THE
SUPPORTING EXTREMITY BEARS THE GREATEST
WEIGHT. IT LASTS FROM FOOT FLAT TO HEEL
OFF.
• PUSH OFF PHASE: THIS PHASE OCCURS FROM
HEEL OFF TO TOE-OFF AND DURING IF THE BODY
IS PROPELLED FORWARD BY THE ACTION OF THE
CALF MUSCLES.
CHARACTERISTICS OF THE NORMAL GAIT
• HEEL STRIKE: THE INSTANT THE HEEL OF THE LEADING
EXTREMITY TOUCHES THE GROUND.
• FOOT FLAT: THE INSTANT, SHORTLY AFTER HEEL STRIKE, WHEN
THE SOLE OF THE FOOT TOUCHES THE GROUND.
CHARACTERISTICS OF THE NORMAL GAIT
• MID-STANCE: THE INSTANT WHEN BOTH HEELS ARE IN
APPOSITION.
• HEEL OFF: THE INSTANT WHEN THE HEEL OF THE SUPPORTING
EXTREMITY LEAVES THE GROUND.
• TOE OFF: THE INSTANT WHEN THE TOE LOSES CONTACT WITH
THE GROUND.
STANCE PHASE
 SWING PHASE

• ACCELERATION: THE SWING PHASE BEGINS AT THE

MOMENT THE TOES LEAVE THE GROUND. AT THIS
TIME THE FOOT MUST BE AC­CELERATED SO AS TO
SWING FORWARDS AND TO LIE IN FRONT OF THE
BODY IN PREPARATION FOR THE NEXT HEEL
STRIKE.
• MID-SWING PHASE: TAKES PLACE WHEN THE FOOT
SWINGS FORWARDS BELOW THE BODY. AT THIS
TIME THE FOOT MUST BE SUFFICIENTLY RAISED
THAT IT DOES NOT TOUCH THE GROUND.
 SWING PHASE CONT…
• DECELERATION: THIS TAKES PLACE AFTER THE MID-SWING
PHASE, WHEN THE FORWARD MOTION OF THE LEG IS BRAKED
IN ORDER TO CONTROL THE FOOT POSITION IMMEDIATELY
BEFORE HEEL STRIKE.
 SWING PHASE
acceleration mid-stance deceleration
 DOUBLE SUPPORT
DURING NORMAL WALKING, THERE IS A PERIOD OF
DOUBLE SUPPORT WHEN BOTH LIMBS SIMULTANEOUSLY
TOUCH THE GROUND.
 TIME DIVISION OF THE GAIT CYCLE

THE RELATIVE TIME TAKEN FOR EACH WALKING PHASE IS

SHOWN IN FIG ABOVE AND MAY BE SUMMARIZED AS
FOLLOWS:
• STANCE PHASE: 60 % OF THE CYCLE
• SWING PHASE: 40 % OF THE CYCLE
• DOUBLE SUPPORT: 10 % OF THE CYCLE
 GENERAL CHARACTERISTICS
OF THE NORMAL GAIT
• VERTICAL DISPLACEMENT OF THE CENTRE
OF GRAVITY
LATERAL DISPLACEMENT OF THE
CENTRE OF GRAVITY
• LATERAL
DISPLACEMENT OF
THE CENTRE OF
GRAVITY
HEEL WIDTH OF WALKING BASE

• HEEL WIDTH OF WALKING BASE

c m
0
5-1
 HORIZONTAL TILT OF THE PELVIS

• DURING NORMAL
WALKING, THE PELVIS
TILTS LATERALLY, FIRST
AROUND THE ONE
SUPPORTING HIP JOINT,
THEN AROUND THE
OTHER. THE
MAGNITUDE OF
ROTATION FROM THE
HORIZONTAL IS SMALL,
FLEXION OF THE KNEE DURING STANCE
PHASE
• SHORTLY AFTER HEEL STRIKE, THE KNEE BEGINS TO FLEX,
CONTINUING DURING THE EARLY STANCE PHASE UNTIL AN
ANGLE OF ABOUT 20° IS REACHED
 WALKING SPEED
THE NUMBER OF STEPS PER MINUTE CAN BE
INCREASED FROM ABOUT 70 DURING SLOW
WALKING UP TO 130 WHEN WALKING
RAPIDLY. AN ADULT, WALKING AT A RATE OF
ABOUT 90 STEPS PER MINUTE, TRAVELS
ABOUT 4 KM PER HOUR
METHODS OF STUDYING NORMAL HUMAN
LOCOMOTION
• THE PATH THROUGH WHICH THE CENTER OF GRAVITY MOVES
IN THE COURSE OF NORMAL HUMAN LOCOMOTION IS
DETERMINED BY MANY FACTORS.
 THE CONCEPTS
THE MOST IMPORTANT OF THESE ARE:

1.THE FORCE OF GRAVITY ITSELF

2.THE FORCES EXERTED BY MUSCULAR CONTRACTION

3.INERTIAL EFFECTS

4.THE ANGULAR RELATIONSHIP BETWEEN THE

SEGMENTS OF THE LOWER EXTREMITY DURING THE
DIFFERENT PHASES OF THE WALKING CYCLE.
 DISCUSSION OF THESE FACTORS
• WE CAN NOW TURN TO A DISCUSSION OF THESE FACTORS,
WHICH, IN THE LIGHT OF COMPARATIVELY RECENT
INVESTIGATIONS, HAVE THE MOST SIGNIFICANT INFLUENCE ON
THE MOVEMENTS OF THE CENTER OF GRAVITY AND THE BODY
 GROUP OF ANALYSIS SYSTEMS
• THE FIRST IS CONCERNED WITH DESCRIBING THE MOTIONS
AND FORCES OF THE BODY PARTS RELATIVE TO EACH OTHER
DURING THE DIFFERENCE PHASES OF GAIT.
THE ENGINEERING TERM USED TO DESCRIBE SUCH STUDIES ARE
KINEMATICS, KINETICS
 KINEMATICS
• KINEMATICS IS THE DIVISION OF MECHANICS, WHICH
DEALS WITH THE MOTION OF BODIES WITHOUT
REGARD FOR THE FORCES ACTING TO PRODUCE THE
MOTION.
• KINEMATICS DEFINES THE RANGE OF MOTION AND
DESCRIBED THE SURFACE MOTION OF A JOINT IN
THREE PLANES. FRONTAL, SAGITTAL AND
HORIZONTAL
 KINETICS
• KINETICS IS THE DIVISION OF MECHANICS THAT DEALS
WITH FORCES ACTING ON BODIES.
• KINETICS INVOLVED IN BOTH STATIC AND DYNAMICS
ANALYSIS OF THE FORCES AND MOVEMENTS ACTING ON
A JOINT.
(KINETICS IS THE GENERAL TERM GIVEN TO THE STUDY OF FORCES
THAT CAUSE MOVEMENT. FORCE MAY BE DEFINED AS A PUSH OR
A PULL AND IS PRODUCED WHEN ONE OBJECT ACTS ON
ANOTHER.)
 KINETICS

THE FORCES OF MAJOR IMPORTANCE IN

ANALYZING HUMAN LOCOMOTION ARE:
1.THE FORCES EXERTED BY THE PULL OF GRAVITY
(EXTERNALLY GENERATED FORCES)
2.THE FORCES EXERTED BY MUSCULAR
CONTRACTION (INTERNALLY GENERATED
FORCES)
 GAIT ANALYSIS SYSTEMS

THREE MEASUREMENT SYSTEMS

• MOTION ANALYSIS( KINEMATICS)
• DYNAMIC ELECTROMYOGRAPHY ( KINETICS)
• GROUND REACTION FORCE AND VECTOR ANALYSIS (KINETICS& KINEMATICS)
MEASURING THE EXTERNAL FORCES
KINETIC: ANALYSIS MAKES IT POSSIBLE TO
MEASURE THE MAGNITUDE AND DIRECTION OF
THE EXTERNAL FORCES ACTING ON THE LIMB
DURING THE DIFFERENT PHASES OF GAIT.

KINEMATICS: ANALYSIS MAKES IT POSSIBLE TO

DETERMINE THE LOCATION OF THE JOINTS IN
SPACE.
MEASURING THE EXTERNAL FORCES
• THE COMBINATION OF THE ABOVE TWO METHODS OF
ANALYSIS MAKES FEASIBLE THE CALCULATION OF THE
EXTERNALLY GENERATED MOMENTS OF THE FORCES AT THE
VARIES JOINTS
MEASURING THE INTERNAL FORCES
TO DATE, IT HAS NOT
BEEN PRACTICAL TO
QUANTITATIVELY
MEASURE THE
INTERNALLY GENERATED
MOMENTS OF FORCE
EXERTED BY INDIVIDUAL
MUSCLES DURING EACH
INSTANT OF GAIT.
 ANKLE JOINT:

• KINEMATICS ANALYSIS

• KINETIC ANALYSIS
• EXTERNALLY GENERATED FORCES
• INTERNALLY GENERATED FORCES
 KNEE JOINT
 KINEMATICS ANALYSIS

 KINETIC ANALYSIS
• EXTERNALLY GENERATED FORCES
• INTERNALLY GENERATED FORCES
 HIP JOINT
• KINEMATICS ANALYSIS
• KINETIC ANALYSIS
• EXTERNALLY GENERATED FORCES
• INTERNALLY GENERATED FORCES
 PHASES ANALYSIS
• ANALYSIS OF MOTION IN THE SAGITTAL PLANE BETWEEN MID-
STANCE AND TOE-OFF
• ANALYSIS OF MOTION IN THE SAGITTAL PLANE DURING SWING
PHASE
 HEEL STRIKE
REACTION:
• ANTERIOR TO HIP CAUSE
FLEXION MOMENT.
• ANTERIOR TO KNEE
CAUSING EXTENSION
MOMENT.
• POSTERIOR TO ANKLE
CAUSING IN PREVENTING
FURTHER FLEXION
 HEEL STRIKE CONT…
HIP IS FLEXION TO 25
DEGREES .THE GLUTEUS
MAXIMUS AND
HAMSTRINGS ARE ACTIVE
IN PREVENTING FURTHER
FLEXION
KNEE IS IN FULL EXTENSION AT
HEEL STRIKE . THE
EXTENSION MOMENT IS
OVERCOME BY ACTION OF
THE HAMSTRINGS AND THE
ANKLE IS IN
NEUTRAL POSITION
THEN BEGINS TO
PLANTAR FLEX .
THIS
PLANTARFLEXION IS
CONTROLLED BY
ACTION OF THE PRE-
TIBIAL MUSCLES
 AFTER HEEL STRIKE CONT…
REACTION:

• ANTERIOR TO HIP CAUSING

FLEXION MOMENT.

• POSTERIOR TO KNEE
CAUSING FLEXION
MOMENT.

• POSTERIOR TO ANKLE
CAUSING
 AFTER HEEL STRIKE CONT…

• HIP IS HELD IN 250 OF FLEXION BY

ACTION OF GLUTEUS MAXIMUS AND THE
HAMSTRINGS.

• KNEE IS IN 50 OF FLEXION AND

CONTINUES TO FLEX. THE RATE OF
FLEXION IS CONTROLLED BY ACTION OF
THE QUADRICEPS.

• ANKLE IS IN 50 OF PLANTAR FLEXION

AND CONTINUES TO PLANTER FLEX
 FOOT FLAT
REACTION:

• ANTERIOR TO HIP CAUSING

FLEXION MOMENT.

• POSTERIOR TO KNEE
CAUSING FLEXION MOMENT.

• POSTERIOR TO ANKLE
CAUSING PLANTARFLEXION
MOMENT.
 FOOT FLAT CONT…
HIP : IS IN 250 OF FLEXION THEN
BEGINS TO EXTEND BY ACTION OF
GLUTEUS MAXIMUS AND THE
HAMSTRINGS.
KNEE: REACHES 150 OF FLEXION
AND CONTINUES TO FLEX UNTIL IT
REACHES 200 SHORTLY AFTER FOOT
FLAT .IT THEN BEGINS TO
EXTEND .THE QUADRICEPS ARE
ACTIVE IN CONTROLLING TO
ANGLE OF FLEXION.
 FOOT FLAT CONT…
• ANKLE : IS IN 100 OF
PLANTARFLEXION . THE
PLANTERFLEXION MOMENTS
REDUCE AS THE REACTION MOVES
ALONG THE FOOT AND THE
PRETIBIAL MUSCLE ACTIVITY
FALLS OFF .AS THE GROUND
REACTION PASSES ANTERIOR FOR
TO THE ANKLE JOINT THE
SEGMENTS OF THE SUPPORTING
LIMB BEGINS TO ROTATE OVER THE
 MID STANCE
REACTION:

• PASSES THROUGH HIP

JOINT ,NO MOMENT .
• POSTERIOR TO KNEE
CAUSING A FLEXION
MOMENT.
• ANTERIOR TO ANKLE
 MID STANCE CONT…
HIP : IS IN 100 OF FLEXION AND
BEGINS TO EXTEND AS THE
GROUND REACTION MOVES
POSTERIOR TO THE HIP JOINT
SHORTLY AFTER MID STANCE .
KNEE: REACHES 100 OF FLEXION
AND CONTINUES TO EXTEND.
QUADRICEPS ACTION HAS FALLEN
OFF AND IT IS SUSPECTED THAT
THE SOLEUS IS ACTIVE IN
CONTROLLING KNEE FLEXION .
 MID STANCE CONT…
ANKLE : 50 OF
DORSIFLEXION AND
CONTINUES TO
DORSIFLEX DUE TO
GROUND REACTION
BY THE CALF GROUP
OF MUSCLE
 HEEL OFF

REACTION:

• POSTERIOR TO HIP
CAUSING EXTENSION
MOMENT.

• ANTERIOR TO KNEE
CAUSING EXTENSION
MOMENT.

• ANTERIOR TO ANKLE
CAUSING DORSIFLEXION
 HEEL OFF CONT…
HIP : REACHES ABOUT 13 DEGREES OF
EXTENSION THEN BEGINS TO FLEX.
THE ILIACUS AND OPSOAS MAJOR ARE
ACTIVE IN CONTROLLING EXTENSION
AND INITIATING FLEXION.
KNEE: IS FLEXED TO ABOUT 2 DEGREES
WHICH IS THE MAXIMUM EXTENSION
REACHED AT THIS POINT IN THE GAIT
CYCLE . THE GASTROCNEMIUS MAY
BE ACTIVE IN PREVENTING FURTHER
EXTENSION.
 HEEL OFF CONT…
• ANKLE : REACHED 15
DEGREES OF
DORSIFLEXION AFTER
WHICH IT
PLANTARFLEXION DUE TO
A POWERFUL
CONTRACTION OF THE
CALF MUSCLES WHICH
COUNTERACTS THE
DORSIFLEXION MOMENT
AND ASSISTS IN
 TOE OFF
• REACTION: BY THE
TOE –OFF THE
REACTION HAS LOST
MOST OF ITS
SIGNIFICANCE AS THE
MAJORITY OF WEIGHT
IS BORNE BY THE
OTHER FOOT
 TOE OFF CONT…
HIP: IS IN 10 DEGREES OF
EXTENSION AND
CONTINUES TO FLEX DUE
TO THE PLANTARFLEXION
OF THE FOOT AND
ACTIVITY OF THE RECTUS
FEMORIS.

KNEE: IS FLEXED TO ABOUT

40 DEGREES AND
CONTINUES TO FLEX
UNDER THE SMALL
GROUND REACTION
MOMENT AND
PLANTARFLEXION OF THE
FOOT
 TOE OFF CONT…
ANKLE: HAS REACHED
200 OF
PLANTARFLEXION
DUE TO CONTRACTION
OF THE CALF
MUSCLES. THESE
MUSCLES BECOME
INACTIVE DIRECTLY
AFTER TOE OFF.
 ACCELERATION
HIP: IS IN 100 OF EXTENSION AND
FLEXES AS THE HIP FLEXORS
ACCELERATE THE LIMB
FORWARD

KNEE: IS IN 200 OF
PLANTARFLEXION DIRECTLY
AFTER TOE OFF. IT THEN BEGIS
TO DORSIFLEX UNDER ACTION OF
THE PRETIBIAL GROUP OF
MUSCLES.
 MID SWING
• HIP IS FLEXED ABOUT 200 AND
CONTINUES TO FLEX
• KNEE: REACHED ABOUT 650 OF
FLEXION THEN BEGINS TO
EXTEND UNDER PENDULUM
ACTION.
• ANKLE: HAS REACHED ITS
NEUTRAL POSITION AND IS
HELD THERE BY SLIGHT
ACTIVITY OF THE PRETIBIAL
 DECELERATION
HIP: REACHED 25 DEGREES OF
FLEXION AND IS RESTRAINED
BY GLUTEUS MAXIMUS AND
THE HAMSTRINGS

KNEE: IS IN FULL EXTENSION

AND RESTRAINED BY THE
HAMSTRINGS.

ANKLE: IS STILL HELD IN THE

NEUTRAL POSITION BY ACTION
OF THE PRETIBIAL MUSCLES.
 MAIN TF
AMPUTATION
GAIT DEVIATIONS
MAIN TF AMPUTATION GAIT DEVIATIONS

DEVIATION AMPUTEE CAUSE PROSTHETIC CAUSE

Abducted gait at stance 1. Contracture of the hip in abduction 1. Prosthesis too long
2. Pain 2. Socket too adducted
3. Weakness of hip muscles 3. Pain on pubis area
4. Increase security with wide base
support

Circumduction at swing 1. Hip contracture in abduction 1.Prosthesis too long

2. Weakness of hip adductors
3. Lack of confidence
Internal or external whip 1. Habit because of discomfort 1. Excessive internal or external
at beginning of swing 2. Weakness of hip rotators rotation of the knee
Lateral bending of the 1. Hip contracture in abduction 1. Prosthesis too short
trunk during stance 2. Very short stump 2. Socket too adducted
towards prosthesis 3. Weakness of hip abductors 3. Medial brim causing pain
4. Trunk weakness 4. Pain at distal area
MAIN TF AMPUTATION GAIT DEVIATIONS

DEVIATION AMPUTEE CAUSE PROSTHETIC CAUSE

Trunk flexion during stance 1. Weakness of hip extensors 1. Not enough initial flexion
2. Hip contracture in flexion of socket
3. Kyphosis 2. Pain
4. Patient looking at feet 3. Prosthetic knee instability
Lumbar lordosis during 1. Hip contracture in flexion 1. Not enough flexion in
stance 2. Weakness hip extensors socket alignment
3. Weakness abdominal 2. Discomfort on ischial
muscles weight bearing
4. Help to control knee stability 3. Heel of shoe on
prosthesis too high
4. Insufficient knee stability

Foot rotation at initial contact 1. Weakness of hip extensors 1. Socket too loose
(Heel strike) and internal rotators 2. Too much toe out
2. Floppy stump
Vaulting 1. Fear of catching toes of 1. Prosthesis too long
The amputee rises up on the prosthesis
toe of the remaining leg to 2. Weakness of hip flexors
swing the prosthesis through 3. Limb discomfort
form toe off to heel strike
MAIN TF AMPUTATION GAIT DEVIATIONS

DEVIATION AMPUTEE CAUSE PROSTHETIC CAUSE

Prosthetic knee Instability 1. Hip contracture 1. Knee joint anterior to COG

2. Weakness of hip extensors line
2. Not enough socket flexion

Uneven step length 1. Hip flexion contracture 1. Prosthesis too long

2. Weakness of hip and back 2. Bad socket fitting
extensors 3. Socket too flexed
3. Lack of confidence
4. Habit and compensation

Uneven steps timing 1. Lack of confidence 1. Bad socket fitting causing

Stance on prosthesis short 2. Lack of balance discomfort
3. Weakness at stump and trunk
4. Habit
5. Pain on ischial tuberosity

Uneven arm swing Lack of balance Bad socket fitting causing

Lack of confidence discomfort
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (1)
Gait default Amputee cause Prosthesis cause

Prosthetic step • Lack of confidence, fear • Socket aligned in too much flexion
too short • Pain in the stump/socket • Discomfort in the socket

Prosthetic step • Used to walk with a walking frame • Not enough flexion in alignment of
socket
too long
• Prosthesis too long

Sound leg step • Limited extension of the hip on • Not enough flexion in alignment of
prosthetic side socket
too short • Weakness of hip and trunk muscles on • Prosthetic knee unstable
prosthetic side

Uneven timing of • Lack of confidence, fear • Discomfort in socket

the steps • Lack of balance • Prosthetic knee unstable
• Weakness of hip and trunk muscles
• Pain on the ischial seat
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (2)
Gait default Amputee cause Prosthesis cause

Rotation of the • Weakness of extensors and rotators • Alignment of foot too much in
of the hip external rotation
foot at heel
• Socket too loose
strike • Heel cushion too hard

Foot slap on the • Pushing heel too much into the floor • Alignment of foot too much in plantar
to ensure knee lock flexion or too posterior
floor
• Inadequate shoes for the prosthetic • Alignment of knee too anterior
foot (heel height too small) • Foot heel too soft

Abduction of the • Contracture of hip abductors • Prosthesis too long

prosthesis • Pain in the crotch area • Alignment of socket too much in
• Lack of balance adduction
during stance • Medial brim of socket too high
• Lateral wall of socket giving poor
support to femur
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (3)
Gait default Amputee cause Prosthesis cause

Knee flexion • Hip contracture • Alignment of knee too anterior

during stance • Weakness of hip extensors • Not enough flexion in alignment of
socket
• Prosthesis too long

Drop off • Inadequate shoes for the prosthetic • Foot aligned in too much dorsiflexion
foot (too big heel height) • Alignment of socket too much
Downward movement
of the body at weight anterior on the foot
transfer over the
prosthetic foot during
heel off
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (4)
Gait default Amputee cause Prosthesis cause

Lateral bending • Contracture of hip abductors • Lateral wall of socket giving poor
• Short stump support to femur
of the trunk • Prosthesis too short
• Weakness of hip abductors
towards • Alignment of socket in too much
prosthetic side adduction
during stance • Medial brim of socket too high

Forward • Weakness of hip extensors • Alignment of socket not enough in

• Contracture of hip flexors flexion
bending of the
• Lack of confidence, fear, patient • Inadequate socket fit
trunk during looking at his feet
stance

Lumbar • Contracture of hip flexors • Alignment of socket not enough in

• Weakness of hip extensors and flexion
lordosis during
abdominal muscles • Discomfort on ischial seat
stance • Lack of balance: moving forward • Alignment of foot too much in
body centre of gravity to increase dorsal flexion
stability
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (5)
Gait default Amputee cause Prosthesis cause

Excessive heel • Using too much force of hip flexors • Not enough tension in the knee
to swing the prosthesis through extensor strap
rise during • Lack of control of the prosthetic • Prosthetic knee flexes too easily
initial swing knee (swing control too loose)
• Alignment of the knee too anterior

Not enough • Lack of confidence, fear • Prosthetic knee flexion too hard
(swing control too tight)
knee flexion • Too much tension in the knee
during swing extensor strap

Circumduction • Contracture of hip abductors • Prosthesis too long

of the • Weakness of hip adductors • Alignment of socket too much in
• Short stump adduction
prosthesis • Medial brim of socket too high
during swing • Lateral wall of socket giving poor
support to femur
• Locked knee
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (6)
Gait default Amputee cause Prosthesis cause

Hip hiking • Weakness of hip flexors • Prosthesis too long

during swing • Short stump • Pistoning, Inadequate suspension
(shoulder belt too loose)
• Knee misaligned or too much
friction on flexion
• Locked knee

Medial or lateral • Discomfort in the socket • Knee aligned in excessive internal

• Bad habit or external rotation
whip of the heel
• Problem of the sound leg • Knee aligned in excessive valgus
during swing of varus
• Poor socket fit (too tight or too
loose)

Vaulting • Fear of catching the prosthetic • Prosthesis too long

toes on the ground • Prosthetic knee flexion too hard
Patient rises on toes
of sound leg to swing • Very short stump • Pistoning, Inadequate suspension
the prosthesis through • Weakness of hip flexors (shoulder belt too loose)
• Locked knee
 COMMON GAIT DEVIATIONS
OF AK AMPUTEES (7)
Gait default Amputee cause Prosthesis cause

Uneven arm • Lack of confidence, fear • Inadequate socket fitting causing

• Lack of balance discomfort
swing
Usually, the arm on the
prosthetic side is held
stiff at the side of the
body Uneven arm swing, uneven step length and uneven timing of the steps are often
combined and a result of the same causes
ASANTE