Gait Analysis and Hip Alignment

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Questions and Answers

What is the primary cause of medial whip in a transfemoral amputee?

Misalignment of knee axis at onset of swing (correct)

Excessive internal rotation

Lateral trunk bending over the prosthesis

Improper donning or suspension

What is the result of a foot that is too far inset or externally rotated?

Medial whip (correct)

Insufficient ground clearance

Choppy or segmented midstance

Lateral whip

What is the effect of a toe lever that is either too short or too soft during climbing?

Medial whip

Drop off (correct)

Lateral whip

Excessive knee flexion

What is the primary cause of lateral whip in a transfemoral amputee?

Excessive external rotation Signup and view all the answers

What is the primary cause of choppy or segmented midstance?

Differences in flexibility between prosthetic heel and toes Signup and view all the answers

What is the primary cause of excessive knee flexion/heel rise in early swing?

Hip extensor weakness Signup and view all the answers

What is the primary cause of vaulting?

Too long prosthesis Signup and view all the answers

What is the primary cause of unstable prosthetic knee during stance phase?

Anterior alignment of prosthetic knee Signup and view all the answers

What is the purpose of a hip-leveling guide?

To determine if the pelvis is level Signup and view all the answers

During which phase of the gait cycle does the heel come off the ground?

Pre-swing Signup and view all the answers

What is a common gait deviation caused by excessive inversion or eversion of the foot?

Misalignment of the prosthesis Signup and view all the answers

What is the ideal knee flexion during initial contact?

20 degrees Signup and view all the answers

What is a common cause of lateral trunk bending toward the prosthetic side?

Abducted gait Signup and view all the answers

What is the term for the movement of the femur within the socket during weight bearing?

Lateral displacement Signup and view all the answers

What is the purpose of dynamic alignment during walking?

To make changes for more efficient gait technique Signup and view all the answers

What is the term for the initial contact of the lateral border of the heel?

Initial contact Signup and view all the answers

In the sagittal plane, what is the ideal alignment of the socket in relation to the knee?

Knee flexed 5° to 10° Signup and view all the answers

What is the primary purpose of placing the socket in 2° to 5° of varus (adduction) in the coronal plane?

To protect the head of fibula Signup and view all the answers

What is the ideal foot position in relation to the socket during the gait cycle?

Center of heel and big toe aligned along the socket's midline Signup and view all the answers

What is the purpose of observing the base of support width during dynamic alignment?

To ensure a consistent base of support width Signup and view all the answers

What is the ideal alignment of the transfemoral socket in the anterior view?

Hip in 2° to 5° of adduction Signup and view all the answers

What is the purpose of adjusting the socket in relation to the length of femur and strength of hip muscles?

To ensure proper alignment of the socket with the hip Signup and view all the answers

What is the purpose of external rotation of the foot by 3° to 5°?

To smooth rollover from heel to toe Signup and view all the answers

What is the ideal knee alignment during dynamic alignment?

Knee flexed 5° to 10° Signup and view all the answers

Study Notes

Hip-Leveling Guide

A device that uses a bubble level to determine if the pelvis is level

Dynamic Alignment

Walking in a safe environment, often using parallel bars, to identify and correct gait deviations
Aims to achieve a more efficient gait technique

Prosthetic Gait - Transtibial

Initial contact: lateral border of heel, knee flexed by 20°
Loading response: medial aspect of forefoot touches ground, medial border of foot parallel to line of progression
Midstance: dorsiflexion increases, knee moves over foot
Pre-swing: heel comes off ground, prosthesis rolls forward over toe, and lifts off ground
Sufficient ground clearance is required

Gait Deviations - Transtibial

Excessive inversion or eversion of foot: misalignment of prosthesis
Excessive knee flexion: foot too far posterior, too dorsiflexed, or heel too rigid
Insufficient knee flexion: knee fully extended at heel strike, heel too soft, or foot too far anterior
Excessive varus: socket too far inset, foot too outset, or excessive external rotation
Foot excessive internal rotation: socket excessively adducted

Gait Phases - Transtibial

Initial contact:
- External rotation: foot too far outset or excessive toe-out
- Internal rotation: excessively inset or internally rotated foot
Midstance:
- Abducted gait: lateral trunk bending, lateral gapping of socket
- Choppy or segmented midstance: differences in flexibility, lack of stability
Swing phase:
- Insufficient ground clearance/toe-drag: faulty suspension, plantar flexed foot
- Medial whip: misalignment of knee axis, irregular loading of limb
Climbing hill/ramp:
- Drop off: excessive descent of center of mass, diminished heel rise
- Early heel off: pelvic rise, foot too plantar flexed, toes too stiff

Prosthetic Gait - Transfemoral

Initial contact: heel, compression of prosthetic heel simulates loading response
Midstance: weight bearing forces move anteriorly to medial forefoot
Terminal stance: foot prosthetic simulates toe extension and heel rise
Pre-swing: individual rolls over toe and moves into knee flexion for effective limb clearance

Gait Deviations - Transfemoral

Unstable prosthetic knee during stance phase: hip extensor weakness, hip flexion contracture
Lateral trunk bending: excessive pressure in perineum
Excessive knee flexion/heel rise in early swing: delays extension, lateral whip
Medial whip: foot swing in medial arc, excessive external rotation
Improper donning or suspension: vaulting, too long prosthesis

Bench Alignment - Transtibial

Side view (Sagittal plane):
- Plumb line passes through anatomic knee center and junction point of posterior third and anterior 2/3 of foot
- Socket aligned with knee flexed 5° to 10° to facilitate heel strike and place quadriceps on stretch
- Foot position: center of heel and big toe aligned along line bisecting socket from anterior view
Anterior view (Coronal plane):
- Plumb line passes through mid-patella and center of heel
- Socket placed in 2° to 5° of varus (adduction) to protect head of fibula and encourage lateral shift
- Foot externally rotated by 3° to 5° for smooth rollover from heel to toe

Dynamic Alignment - Transtibial

Smooth rollover from heel to toe with good control of knee
Consistent base of support width: 5-10 cm
Toe clearance in swing phase
Comfortable weight bearing on prosthesis
Level hips
Equal and adequate step length

Bench Alignment - Transfemoral

Aims:
- Stability in double-limb stance
- Adequate lateral shift in single-limb stance
- Narrow base of support (5 cm)
Anterior view:
- Socket adjusted with hip in 2° to 5° of adduction according to length of femur and strength of hip muscles

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Description

Understanding the importance of hip alignment in gait analysis, including the use of hip-leveling guides and dynamic alignment techniques. Identify gait deviations and make changes for more efficient gait technique.