Les défauts de marche des amputés tibiaux Les défauts de marche les plus communs sont: 1) Marche asymétrique: le pas prothétique est plus court 7) Marche en abduction 2) Marche asymétrique : pas plus court du côté sain 8) Marche en hyper- extension de genou 3) Inclinaison latérale du côté prothétique 9) Flexion du genou non controlée 4) Inclinaison latérale du coté jambe saine 10) Delayed knee flexion 5) Rotation du talon lors du contact talonnier 11) Excessive flexion 6) Marche en Adduction 12) Lateral shift of the prosthesis

1) Marche asymétrique: raccourcissement de la longueur du pas du côté de la prothèse. Phase du cycle de marche: après plusieurs cycles de marche Observation: plan sagittal Les causes La prothèse - Emboîture positionnée trop en flexion. - Pied placé trop en arrière Le patient - Contracture des ischio jambiers - Douleur - Moignon court

2) Marche asymétrique: raccourcissement de la longueur du pas du côté de la jambe saine. Phase du cycle de marche: après plusieurs cycles de marche Observation: plan sagittal Les causes La prothèse - L'emboîture est trop en extension - Le pied est trop en flexion plantaire - Le pied est trop antérieur Le patient - Manque d'équilibre - pas de mise en charge sur la prothèse

3) Lateral trunk bending on prosthesis side Phase of gait cycle: stance phase Assessment done from: from in front or from behind CAUSES a) Prosthesis - Socket too much in abduction - Foot too far lateral - Pylon too much in abduction. - Socket loose. b) Patients - Lack of balance - Weak trunk muscle - Weak hip abductor - Pain inside the socket - Bad habit

4) Inclinaison du tronc du côte de la jambe saine Phase of gait cycle: stance phase Assessment done from: frontal view CAUSES a) Prosthesis - Prosthesis too long - Socket loose - Foot too far medial. - Socket too much in adduction b) Patients - Hip pain - Bad habit - Pain inside the socket (lack of weight bearing) - Weakness of gluteus maximus (on prothesis side)

5) Rotation of the foot at heel strike Phase of gait cycle: heel strike Assessment done from: frontal View CAUSES a) Prosthesis - Heel bumper too hard - Poor socket fit - Poor suspension b) Patients - Weak hip muscles - Knee joint instability and weak knee muscle - Pain inside the socket

6) Narrow based gait CAUSES a) Prosthesis b) Patients Definition: The space between the line of progression and the foot print on the prosthesis side is smaller than the sound side Phase of gait cycle: few gait cycles Assessment done from: frontal view CAUSES a) Prosthesis - Mis-alignment of the foot: too much medial ( A ) - Mis-alignment of the pylon: Too much in adduction ( B) - Medial wall not tight enough b) Patients - Knee instability - Pain on the medial distal and lateral proximal part of the stump - Stump in adduction - Lack of balance

7) Wide based gait CAUSES a) Prosthesis b) Patients Definition: The space between the line of progression and the foot print on the prosthesis side is bigger than the sound side. Phase of gait cycle: few gait cycle Assessment done from: frontal view CAUSES a) Prosthesis - Mis-alignment: Foot too much lateral. - Mis-alignment: Pylon too much in abduction. - Prosthesis too long. b) Patients - Stump in abduction - Lack of balance - Knee instability - Pain on the medial proximal and lateral distal part of the stump

8) Knee Hyper extension CAUSES a) Prosthesis Definition: The knee is pushed in too much extension during the stance phase Phase of gait cycle: mid stance Assessment done from: sagittal view CAUSES a) Prosthesis - Heel bumper too soft - Socket too large - Foot: too much in plantar flexion Not enough socket flexion - Socket set too far backward

Knee in Hyper extension b) Patients - Weak quadriceps( shift the gravity line forward ) - Knee joint instability - Stump discomfort in the socket - Short stump - Bad habit (use of tight laser) Knee in Hyper extension

- Foot too much dorsi flexion 9) Too fast Knee flexion Definition: The foot is going directly from heel strike to foot flat. Phase of gait cycle: stance phase Assessment done from: sagittal view CAUSES a) Prosthesis - Foot too much dorsi flexion b) Patients - Contracture not compensated enough - Hamstring contracture - Socket set too far forward. - Knee instability - Weak quadriceps - Bad habit

- Inadequate suspension 10) Delayed knee during swing phase Definition: Phase of gait cycle: swing phase Assessment done from : sagittal view CAUSES a) Prosthesis - Inadequate suspension - Mis-alignment: Socket too far backward. b) Patients - Lack of coordination between the hip ad the knee - Knee joint stiffness - Bad habit due to old prosthesis thigh lacer

11) Excessive Knee flexion Definition: Phase of gait cycle: stance phase Assessment done from: sagittal view CAUSES a) Prosthesis - Heel bumper too hard - Suspension incorrectly positioned :strap too tight - Foot too much in dorsi flexion - Socket too much in flexion - Socket too much forward over the foot - Too high heel height. patient has changed his shoe type - Prosthesis too long

- Hip or knee joint fixed (stiff) in flexion- b) Patients - Hip or knee joint fixed (stiff) in flexion- Excessive flexion - Weak quadriceps - Weak hip extensor - Pain inside the socket - Bad habit

- Mis alignment: foot set too far medial - Lateral Knee instability 12) Lateral shift of the prosthesis Phase of gait cycle: the stance phase Assessment done : frontal view CAUSES a) Prosthesis - Mis alignment: foot set too far medial - Mis alignment: socket too abducted ( pylon adducted ) (NB: same as lateral trunk bending and wide based gait ) b) Patients - Lateral Knee instability - Stump pain