This presentation by from the International Committee of the Red Cross describes transfemoral gait deviations in the lower limb amputee prosthetic fitting.

1. 1

2. 2
SWING PHASE:
OSCILLATION OF THE SHIN
- INCORRECT INITIAL KNEE ROTATION
- INCORRECT SOCKET FITTING
- INCORRECT SOCKET ALIGNMENT
- INSUFFICIENT SUSPENSION OR
INCORRECT LOCATION OF THE
SILESIAN BELT
PROSTHESIS
- WEAK AND FLASKY STUMP
PATIENT
VISIBLE INTERNAL OR EXTERNAL ROTATION OF KNEE
MID SWING PHASE

3. 3
- PROSTHESIS IS TOO LONG
- INSUFFICIENT SOCKET ABDUCTION
- INSUFFICIENT LATERAL FEMORAL
SUPPORT
- MEDIAL SHELF IS TOO HIGH
- EXCESSIVE SUSPENSION OR
INCORRECT LOCATION OF THE
SILESIAN BELT
PROSTHESIS
- SHORT STUMP
- ABDUCTORS CONTRACTURE
- PAIN IN PERINEAL AREA
- INSECURE BALANCE
- BAD GAIT HABIT
PATIENT
WALKING BASE IS TOO WIDE
SWING PHASE:
ABDUCTED GAIT

4. 4
- PROSTHESIS IS TOO LONG
- EXCESSIVE PLANTAR FLEXION
- INSUFFICIENT SUSPENSION (PISTONING)
- INCORRECT SOCKET FITTING
- EXCESSIVE SUSPENSION OR INCORRECT
LOCATION OF THE SILESIAN BELT
- INSUFFICIENT ABDUCTION OF THE
SOCKET
- MEDIAL SHELF IS TOO HIGH
- ANTERIORL DISPLACEMENT OF THE SOCKET
- EXCESSIVE FRICTION IN KNEE AXIS
- EXCESSIVE STRENGTH OF THE
EXTENSION AID
PROSTHESIS
- ABDUCTORS CONTRACTURE
- INSUFFICIENT HIP FLEXION
- WEAK QUADRICEPS MUSCLES
- FEAR OF TOUCHING GROUND
- PAIN IN PERINEAL AREA
- BAD GAIT HABIT
PATIENT
PROSTHESIS CURVES LATERALLY
SWING PHASE:
CIRCUMDUCTION

5. 5
- PROTESIS IS TOO LONG
- EXCESSIVE PLANTAR FLEXION
- ANTERIOR DISPLACEMENT OF THE FOOT
- INSUFFICIENT SUSPENSION
(PISTONING)
- INCORRECT SOCKET FITTING
- ANTERIOR DISPLACEMENT OF THE SOCKET
- EXCESSIVE FRICTION IN KNEE AXIS
- EXCESSIVE STRENGTH OF THE
EXTENSION AID
PROSTHESIS
- INSUFFICIENT HIP FLEXION
- WEAK QUADRICEPS MUSCLES
- FEAR OF TOUCHIG GROUND
- BAD GAIT HABIT
PATIENT
EXCESSIVE ELEVATION OF PELVIS AND SHOULDER
OF THE PROSTHETIC SIDE
SWING PHASE:
ELEVATION OF THE PELVIS

6. 6
- PROSTHESIS IS TOO SHORT
- EXCESSIVE ABDUCTION OF THE SOCKET
- INSUFFICIENT LATERAL FEMORAL
SUPPORT
- MEDIAL SHELF IS TOO HIGH
PROSTHESIS
- WEAK ABDUCTOR MUSCLES
(TRENDELENBURG SINDROM) OR
ABDUCTORS CONTRACTURE
- SHORT STUMP
- HYPER SENSITIVE STUMP
- INSUFFICIENT BALANCE
- BAD GAIT HABIT
PATIENT
LATERAL INCLINATION OF THE TRUNK
TO THE PROSTHETIC SIDE
SWING PHASE:
LATERAL TRUNK BENDING

7. 7
HEEL CONTACT:
OSCILATION OF THE FOOT
- HARD HEEL CUSHION
- EXCESSIVE EXTERNAL FOOT ROTATION
- INCORRECT SOCKET ALIGNMENT
PROSTHESIS
- SHORT STUMP
- WEAK AND FLASKY STUMP
- EXCESSIVE HEEL STRIKE
PATIENT
VISIBLE OSCILATION OF THE FOREFOOT

8. 8
- ANTERIOR DISPLACEMENT OF THE SOCKET
- INSUFICIENT FLEXION OF THE SOCKET
- EXCESSIVE DORSAL FLEXION
- HARD HEEL CUSHION
PROSTHESIS
- WEAK GLUTEAL MUSCLES
PATIENT
HEEL CONTACT WITH THE GROUND IS TOO SHORT
HEEL CONTACT:
EARLY HEEL ROLLOVER

9. 9
- SOFT HEEL CUSHION
- EXCESSIVE PLANTAR FLEXION
PROSTHESIS
- WEAK HIP EXTENSORS, NOT
PROVIDING SUFFICIENT ANTERIOR
KNEE STABILITY
PATIENT
SLAP OF THE FOREFOOT TO THE GROUND
HEEL CONTACT:
FOOT SLAP

10. 10
DECELERATION PHASE:
TERMINAL IMPACT
- INSUFFICIENT FRICTION IN KNEE AXIS
- EXCESSIVE STRENGTH OF THE
EXTENSION AID
- EXTENSION BUFFER IS TOO HARD
PROSTHESIS
- EXCESSIVE ACCELERATION FORCE
- BAD GAIT HABIT
PATIENT
VISIBLE SHOCK IN THE KNEE

11. 11
HEEL RAISE PHASE:
LUMBAR HYPER LORDOSIS
- INSUFFICIENT FLEXION OF THE SOCKET
- PROSTHESIS IS TOO LONG
- ISCHIAL SEAT IS TOO HIGH OR
ANTERIORLY INCLINED
PROSTHESIS
- HIP FLEXORS CONTRACTURE
- PAIN AT ISCHIUM
- PROBLEM OF ATTITUDE (POSE)
- BAD GAIT HABIT
PATIENT
VISIBLE ANTERIOR LUMBAR BEND

12. 12
MID SWING PHASE:
VAULTING
- PROSTHESIS IS TOO LONG
- EXCESSIVE PLANTAR FLEXION
- INSUFICIENT SUSPENSION (PISTONING)
- INCORRECT SOCKET FITTING
- MEDIAL SHELF IS TOO HIGH
- ANTERIOR DISPLACEMENT OF THE SOCKET
- EXCESSIVE FRICTION IN KNEE AXIS
- EXCESSIVE STRENGTH OF THE
EXTENSION AID
PROSTHESIS
- FEAR OF TOUCHING GROUND
- VERY SENSITIVE OR
PAINFUL STUMP
- BAD GAIT HABIT
PATIENT
RAISE OF THE BODY BY EARLY EXCESSIVE PLANTAR FLEXION ON SOUND SIDE

13. 13
ACCELERATION PHASE:
UNEVEN AND RAPID HEEL RAISE
- INSUFICIENT FRICTION IN
THE KNEE AXIS
- INSUFFICIENT STRENGTH OF
THE EXTENSION AID
- POSTERIOR DISPLACEMENT OF
THE SOCKET
PROSTHESIS
- GAIT IS TOO FAST
- EXCESSIVE HIP FLEXION
- BAD GAIT HABIT
PATIENT
EXCESSIVE AND RAPID ELEVATION OF THE HEEL

14. 14
TRANSVERSAL VIEW:
UNEVEN STEP LENGTH
- ANTERIOR DISPLACEMENT OF TH SOCKET
- EXCESSIVE FLEXION OF THE SOCKET
- PISTONING ACTION
- EXCESSIVE FRICTION IN
THE KNEE AXIS
- EXCESSIVE STRENGTH OF
THE EXTENSION AID
PROSTHESIS
- SHORT, WEAK OR PAINFUL STUMP
- GAIT FEAR
- LIMITED HIP FLEXION -EXTENSION
- WEAK QUADRICEPS MUSCLES
PATIENT
SHORT STEP ON PROSTHETIC SIDE

15. 15
- INSUFICIENT FLEXION OF THE SOCKET
- EXCESSIVE PLANTAR FLEXION
- INSUFFICIENT FLEXION OF THE KNEE
- EXCESSIVE STRENGTH OF
THE EXTENSION AID
PROSTHESIS
- SHORT, WEAK OR PAINFUL STUMP
- HIP EXTENSORS CONTRACTURE
- LIMITED HIP FLEXION - EXTENSION
- INSUFFICIENT STABILITY
- PROBLEMS WITH SOUND LEG
PATIENT
SHORT STUMP ON SOUND SIDE
TRANSVERSAL VIEW:
UNEVEN STEP LENGTH