Proximal deviations

Proximal gait deviations in transfemoral and transtibial amputees.

(Murphy, 2013; Spires, Kelly & Davis, 2013)

Arm swing deviations

Overall decreased arm swing or asymmetrical arm swing

Upper limb guarding

Poor balance

Fear of falling

Habit

Pain

Hip flexion contracture

Poor fit contributing to pain or uneven gait

Forward flexed trunk

Trunk flexed forward with weight line anterior to knees for stability

Hip flexor contracture or spasticity

Knee flexion contracture

Weak hip extensors

Tight ITB

Poor posture

Kyphosed spine

Compensation for poor balance or poor proprioception

Socket discomfort

Inadequate socket flexion (TFA)

Knee axis too anterior (TFA)

Insufficient stability in knee mechanisms (TFA)

Excessive socket flexion (TTA)

Heel height too low (TTA)

Decreased trunk rotation

Decreased rotation of trunk during ambulation, can potentially be a symmetrical deviation

Wide base of support

Decreased arm swing

Lateral trunk bending

Lateral lean of the trunk during stance

Weak hip abductors and extensors

Hip abduction contracture

Poor balance

Decreased weight shift

Decreased confidence

Hip pain

Prosthesis too short

Socket excessively abducted

Medio-lateral dimension of socket too wide

Pain from prosthetic socket

Excessive lumbar lordosis

Exaggerated lumbar lordosis, particularly in prosthetic stance

Most common in TFA patients due to short residual limbs

Hip flexion contracture

Weak hip extensors

Decreased stability of TA and lumbar multifidus

Compensation for maintaining upright posture and keeping weight anteriorly on an unstable knee

Pain avoidance from a high, impinging anterior brim of a TFA socket

Poor posterior socket fit causing pelvic tilt

Discomfort on ischial seat

Heel too high

Inadequate suspension

Decreased anterior pelvic rotation on prosthetic side

Common in LL amputee gait, especially with more proximal amputations. May be seen as “kicking” the prosthesis forward with hip flexors rather than anterior pelvic rotation.

Fear of falling

Poor balance on prosthetic limb

Impinging anterior brim on a TFA socket

Deviations

Amputee causes

Prosthesis causes

Example

Lumbar lordosis (PostureDirect, 2017)

References:

Murphy, D. (2013). Fundamentals of Amputation Care and Prosthetics. New York: Demos Medical Publishing.

PostureDirect (2017). How to fix your hyperlordosis (arched back). Retrieved from: http://posturedirect.com/fix-hyperlordosis-arched-back/

Spires, M. C., Kelly, B., & Davis, A. (2013). Prosthetic restoration and rehabilitation of the upper and lower extremity. New York: Demos Medical Publishing