Les défauts de marche des amputés tibiaux

Les défauts de marche les plus communs sont:

1) Marche asymétrique: le pas prothétique est plus court

2) Marche asymétrique : pas plus court du côté sain

3) Inclinaison latérale du côté prothétique

4) Inclinaison latérale du coté jambe saine

5) Rotation du talon lors du contact talonnier

6) Marche en Adduction

7) Marche en abduction

8) Marche en hyper- extension de genou

9) Flexion du genou non controlée

10) Delayed knee flexion

11) Excessive flexion

12) Lateral shift of the prosthesis

1) Marche asymétrique: raccourcissement de la longueur du pas du côté de la prothèse.

- Emboîture positionnée trop en flexion.

- Pied placé trop en arrière

- Contracture des ischio jambiers

- Douleur

- Moignon court

Phase du cycle de marche: après plusieurs cycles de marche

Observation: plan sagittal

La prothèse

Les causes

Le patient

2) Marche asymétrique: raccourcissement de la longueur du pas du côté de la jambe saine.

- Manque d'équilibre

- L'emboîture est trop en extension

- pas de mise en charge sur la prothèse

- Le pied est trop antérieur

- Le pied est trop en flexion plantaire

Phase du cycle de marche: après plusieurs cycles de marche

Observation: plan sagittal

La prothèse

Les causes

Le patient

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: stance phase

3) Lateral trunk bending on prosthesis side

Assessment done from: from in front or from behind

- Socket loose.

- Socket too much in abduction

- Foot too far lateral

- Pylon too much in abduction.

- Lack of balance

- Weak trunk muscle

- Weak hip abductor

- Pain inside the socket

- Bad habit

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: stance phase

4) Inclinaison du tronc du côte de la jambe saine

Assessment done from: frontal view

- Foot too far medial.

- Prosthesis too long

- Socket loose

- Socket too much in adduction

- Bad habit

- Pain inside the socket (lack of weight bearing)

- Hip pain

- Weakness of gluteus maximus (on prothesis side)

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: heel strike

5) Rotation of the foot at heel strike

Assessment done from: frontal View

- Heel bumper too hard

- Poor socket fit

- Poor suspension

- Weak hip muscles

- Knee joint instability and weak knee muscle

- Pain inside the socket

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: few gait cycles

6) Narrow based gait

Assessment done from: frontal view

- Medial wall not tight enough

- Mis-alignment of the foot: too much medial ( A )

- Mis-alignment of the pylon: Too much in adduction ( B)

- Pain on the medial distal and lateral proximal part of the stump

- Stump in adduction

- Lack of balance

- Knee instability

Definition: The space between the line of progression and the foot print on the prosthesis side is smaller than the sound side

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: few gait cycle

7) Wide based gait

Assessment done from: frontal view

Definition: The space between the line of progression and the foot print on the prosthesis side is bigger than the sound side.

- Prosthesis too long.

- Pain on the medial proximal and lateral distal part of the stump

- Stump in abduction

- Lack of balance

- Knee instability

- Mis-alignment: Foot too much lateral.

- Mis-alignment: Pylon too much in abduction.

CAUSES

a) Prosthesis

Phase of gait cycle: mid stance

8) Knee Hyper extension

Assessment done from: sagittal view

Definition: The knee is pushed in too much extension during the stance phase

- Heel bumper too soft

- Socket set too far backward

-Not enough socket flexion

- Foot: too much in plantar flexion

- Socket too large

- Weak quadriceps( shift the gravity line forward )

Knee in Hyper extension

- Short stump

- Stump discomfort in the socket

- Knee joint instability

- Bad habit (use of tight laser)

b) Patients

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: stance phase

9) Too fast Knee flexion

Assessment done from: sagittal view

Definition: The foot is going directly from heel strike to foot flat.

- Foot too much dorsi flexion

- Contracture not compensated enough

- Socket set too far forward.

- Knee instability

- Bad habit

- Hamstring contracture

- Weak quadriceps

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: swing phase

10) Delayed knee during swing phase

Assessment done from : sagittal view

Definition:

- Inadequate suspension

- Mis-alignment: Socket too far backward.

- Lack of coordination between the hip ad the knee

- Bad habit due to old prosthesis thigh lacer

- Knee joint stiffness

CAUSES

a) Prosthesis

Phase of gait cycle: stance phase

11) Excessive Knee flexion

Assessment done from: sagittal view

Definition:

- Heel bumper too hard

- Prosthesis too long

- Socket too much forward over the foot

- Socket too much in flexion

- Foot too much in dorsi flexion

- Too high heel height. patient has changed his shoe type

- Suspension incorrectly positioned :strap too tight

b) Patients

Excessive flexion

- Hip or knee joint fixed (stiff) in flexion-

- Pain inside the socket

- Bad habit

- Weak hip extensor

- Weak quadriceps

CAUSES

a) Prosthesis

b) Patients

Phase of gait cycle: the stance phase

12) Lateral shift of the prosthesis

Assessment done : frontal view

- Mis alignment: foot set too far medial

- Mis alignment: socket too abducted ( pylon adducted )

- Lateral Knee instability

- Stump pain

(NB: same as lateral trunk bending and wide based gait )