This presentation by from the International Committee of the Red Cross describes problems and corrections for transtibial dynamic alignment in lower limb amputee prosthetic fitting.

1. 1
WARNING!!!
OBSERVE THE GAIT CAREFULLY FROM
ANTERIOR, POSTERIOR AND LATERAL VIEWS.
LISTEN TO THE PATIENT.
PROCEED WITH ONE ADJUSTMENT AT A TIME.
ADJUST WITH A SMALL RANGE.

2. 2
SOCKET IS COMFORTABLE
NORMAL ALIGNMENT
(NO DEVIATIONS OBSERVED)
TT DYNAMIC ALIGNMENT: ANTERIOR VIEW
EQUAL SUPRACODYLAR
COMPRESION
PLUMBLINE IS IN THE CENTER
TUBE IS VERTICAL
FOOT IS FLAT
OBSERVATION DURING
MID STANCE PHASE WITH
FULL WEIGTH BEARING
ON PROSTHESIS

3. 3
PROBLEMS!!!
EXCESSIVE PRESSURE AT
MEDIAL PROXIMAL AND
LATERAL DISTAL AREAS.
GAP AT LATERAL
SUPRACONDYLAR AREA.
LATERAL INSTABILITY.
P
P
CORRECTION:
1 - ADDUCTION OF THE SOCKET
2 - TRANSLATION MEDIALLY
Avoid doing two different
adjustments at the same time!
1
2CAUSE:
EXCESSIVE ABDUCTUION
OF THE SOCKET.
TT DYNAMIC ALIGNMENT: ANTERIOR VIEW
DEVIATION OBSERVED
DURING MID STANCE PHASE
WITH FULL WEIGTH BEARING
ON PROSTHESIS
GAP
PLUMBLINE IS
LATERALLY DISPLACED
TUBE IS LATERALLY
INCLINED
FOOT IS SUPINATED
(VARUM GAIT)
FORCES

4. 4
P
P
TT DYNAMIC ALIGNMENT: ANTERIOR VIEW
CORRECTION:
TRANSLATION MEDIALLY
GAP
TUBE IS VERTICAL
PLUMBLINE IS
LATERALLY DISPLACED
PROBLEMS!!!
EXCESSIVE PRESSURE AT
MEDIAL PROXIMAL AND
LATERAL DISTAL AREAS.
GAP AT LATERAL
SUPRACODYLAR AREA.
LATERAL INSTABILITY.
FORCES
CAUSE:
LATERAL DISPLACEMENT
OF THE SOCKET.
DEVIATION OBSERVED
DURING MID STANCE PHASE
WITH FULL WEIGTH BEARING
ON PROSTHESIS.
FOOT IS FLAT

5. 5
P
P
1
2
TT DYNAMIC ALIGNMENT: ANTERIOR VIEW
CORRECTION:
1 - ABDUCTION OF THE SOCKET
2 - TRANSLATION MEDIALLY
Avoid doing two different
adjustments at the same time!
GAP
CAUSE:
EXCESSIVE ADDUCTION
OF THE SOCKET.
PROBLEMS!!!
EXCESSIVE PRESSURE AT
LATERAL PROXIMAL AND
MEDIAL DISTAL AREAS.
GAP AT MEDIAL
SUPRACONDYLAR AREA.
MEDIAL INSTABILITY.
TUBE IS MEDIALLY
INCLINED
PLUMBLINE IS
MEDIALLY DISPLACED
FOOT IS PRONATED
(VALGUM GAIT)
FORCES
DEVIATION OBSERVED
DURING MID STANCE PHASE
WITH FULL WEIGTH BEARING
ON PROSTHESIS.

6. 6
P
P
TT DYNAMIC ALIGNMENT: ANTERIOR VIEW
CORRECTION:
TRANSLATION LATERALLY
GAP
PROBLEMS!!!
EXCESSIVE PRESSURE AT
LATERAL PROXIMAL AND
MEDIAL DISTAL AREAS.
GAP AT MEDIAL
SUPRACONDYLAR AREA.
MEDIAL INSTABILITY.
CAUSE:
MEDIAL DISPLACEMENT
OF THE SOCKET.
TUBE IS VERTICAL
PLUMBLINE IS
MEDIALLY DISPLACED
DEVIATION OBSERVED
DURING MID STANCE PHASE
WITH FULL WEIGTH BEARING
ON PROSTHESIS.
FORCES
FOOT IS FLAT

7. 7
PROBLEMS!!!
RAPID AND PREMATURE
KNEE FLEXION.
PREMATURE FOREFOOT
CONTACT (SLAP FOOT).
EXCESSIVE PRESSURE AT
POSTERIOR PROXIMAL AND
ANTERIOR DISTAL AREAS.
P
P1
FORCES
TT DYNAMIC ALIGNMENT: LATERAL VIEW
DEVIATION OBSERVED
DURING HEEL STRIKE PHASE.
CORRECTION:
1 - EXTENTION OF THE SOCKET
2 - TRANSLATION POSTERIORLY
Avoid doing two different
adjustments at the same time!
CAUSE 1:
EXCESSIVE FLEXION
OF THE SOCKET.
CAUSE 2:
ANTERIOR DISPLACEMENT
OF THE SOCKET .
2
SLAP FOOT

8. 8
PROBLEMS!!!
HYPEREXTENSION OF KNEE.
PAIN AT PATELLA AREA.
EXCESSIVE PRESSURE AT
PATELLAR TENDON AND
POSTERIOR DISTAL AREAS.
CAUSE 1 :
POSTERIOR DISPLACEMENT
OF THE SOCKET.
CORRECTION:
1- TRANSLATION ANTERIORLY
2 - USE A FIRMER HEEL CUSHION
Avoid doing two different adjustments
at the same time!
FORCES
P
P
1
TT DYNAMIC ALIGNMENT: LATERAL VIEW
CAUSE 2 :
TOO SOFT HEEL CUSHION.
DEVIATION OBSERVED
DURING MID STANCE PHASE.
FOREFOOT IS RAISED
(DORSAL FLEXION)

9. 9
CORRECTION :
FLEXION OF THE SOCKET
P
P
TT DYNAMIC ALIGNMENT: LATERAL VIEW
DEVIATION OBSERVED
DURING MID STANCE PHASE.
FORCES
PROBLEMS!!!
HYPEREXTENSION OF KNEE.
PAIN AT PATELLA AREA.
EXCESSIVE PRESSURE AT
PATELLAR TENDON AND
POSTERIOR DISTAL AREAS.
CAUSE :
INSUFFICIENT FLEXION
OF THE SOCKET.
HEEL IS RAISED
(PLANTAR FLEXION)

10. 10
CORRECTION:
1 - EXTENSION OF THE SOCKET
2 - TRANSLATION POSTERIORLY
Avoid doing two different adjustments
at the same time!
P
1
2
FORCES
TT DYNAMIC ALIGNMENT: LATERAL VIEW
DEVIATION OBSERVED
DURING HEEL OFF PHASE.
PROBLEMS!!!
ABNORMAL PERMANENT FLEXION
OF KNEE.
PATIENT FEELS LIKE WALKING
"DOWN THE HEEL".
EXCESSIVE PRESSURE AT
POSTERIOR PROXIMAL AREA.
CAUSE 1 :
EXCESSIVE FLEXION
OF THE SOCKET.
CAUSE 2 :
ANTERIOR DISPLACEMENT
OF THE SOCKET.