1 International Committee of the Red Cross Polypropylene Technology Manufacture of Lower Limb Prostheses in PP TF STATIC ALIGNMENT

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4 SWING PHASE: OSCILLATION OF THE SHIN VISIBLE INTERNAL OR EXTERNAL ROTATION OF KNEE MID SWING PHASE

5 - INCORRECT INITIAL KNEE ROTATION - INCORRECT SOCKET FITTING - INCORRECT SOCKET ALIGNMENT - INSUFFICIENT SUSPENSION OR INCORRECT LOCATION OF THE SILESIAN BELT PROSTHESIS SWING PHASE: OSCILLATION OF THE SHIN VISIBLE INTERNAL OR EXTERNAL ROTATION OF KNEE MID SWING PHASE

6 - WEAK AND FLABBY STUMP PATIENT SWING PHASE: OSCILLATION OF THE SHIN VISIBLE INTERNAL OR EXTERNAL ROTATION OF KNEE MID SWING PHASE

7 WALKING BASE IS TOO WIDE SWING PHASE: ABDUCTED GAIT

8 - 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 WALKING BASE IS TOO WIDE SWING PHASE: ABDUCTED GAIT

9 - SHORT STUMP - ABDUCTORS CONTRACTURE - PAIN IN PERINEAL AREA - INSECURE BALANCE - BAD GAIT HABIT PATIENT WALKING BASE IS TOO WIDE SWING PHASE: ABDUCTED GAIT

10 PROSTHESIS CURVES LATERALLY SWING PHASE: CIRCUMDUCTION

11 - 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 - ANTERIOR DISPLACEMENT OF THE SOCKET - EXCESSIVE KNEE AXIS FRICTION - EXCESSIVE STRENGTH OF THE EXTENSION AID PROSTHESIS PROSTHESIS CURVES LATERALLY SWING PHASE: CIRCUMDUCTION

12 PROSTHESIS CURVES LATERALLY SWING PHASE: CIRCUMDUCTION - ABDUCTORS CONTRACTURE - INSUFFICIENT HIP FLEXION - WEAK QUADRICEPS - FEAR OF TOUCHING THE GROUND - PAIN IN PERINEAL AREA - BAD GAIT HABIT PATIENT

13 EXCESSIVE ELEVATION OF PELVIS AND SHOULDER ON THE PROSTHETIC SIDE SWING PHASE: ELEVATION OF THE PELVIS

14 - PROTHESIS IS TOO LONG - EXCESSIVE PLANTAR FLEXION - ANTERIOR DISPLACEMENT OF THE FOOT - INSUFFICIENT SUSPENSION (PISTONING) - INCORRECT SOCKET FITTING - ANTERIOR DISPLACEMENT OF THE SOCKET - EXCESSIVE KNEE AXIS FRICTION - EXCESSIVE STRENGTH OF THE EXTENSION AID PROSTHESIS EXCESSIVE ELEVATION OF PELVIS AND SHOULDER ON THE PROSTHETIC SIDE SWING PHASE: ELEVATION OF THE PELVIS

15 - INSUFFICIENT HIP FLEXION - WEAK QUADRICEPS MUSCLES - FEAR OF TOUCHING THE GROUND - BAD GAIT HABIT PATIENT SWING PHASE: ELEVATION OF THE PELVIS EXCESSIVE ELEVATION OF PELVIS AND SHOULDER ON THE PROSTHETIC SIDE

16 LATERAL INCLINATION OF THE TRUNK ON THE PROSTHETIC SIDE SWING PHASE: LATERAL TRUNK BENDING

17 - PROSTHESIS IS TOO SHORT - EXCESSIVE ABDUCTION OF THE SOCKET - INSUFFICIENT LATERAL FEMORAL SUPPORT - MEDIAL SHELF IS TOO HIGH PROSTHESIS LATERAL INCLINATION OF THE TRUNK ON THE PROSTHETIC SIDE SWING PHASE: LATERAL TRUNK BENDING

18 - WEAK ABDUCTOR MUSCLES (TRENDELENBURG SYNDROME) OR ABDUCTORS CONTRACTURE - SHORT STUMP - HYPER SENSITIVE STUMP - INSUFFICIENT BALANCE - BAD GAIT HABIT PATIENT SWING PHASE: LATERAL TRUNK BENDING LATERAL INCLINATION OF THE TRUNK ON THE PROSTHETIC SIDE

19 HEEL CONTACT: OSCILLATION OF THE FOOT VISIBLE OSCILLATION OF THE FOREFOOT

20 HEEL CONTACT: OSCILLATION OF THE FOOT - HARD HEEL CUSHION - EXCESSIVE EXTERNAL FOOT ROTATION - INCORRECT SOCKET ALIGNMENT PROSTHESIS VISIBLE OSCILLATION OF THE FOREFOOT

21 HEEL CONTACT: OSCILLATION OF THE FOOT - SHORT STUMP - WEAK AND FLABBY STUMP - EXCESSIVE HEEL STRIKE PATIENT VISIBLE OSCILLATION OF THE FOREFOOT

22 HEEL CONTACT WITH THE GROUND IS TOO SHORT HEEL CONTACT: EARLY HEEL ROLLOVER

23 - ANTERIOR DISPLACEMENT OF THE SOCKET - INSUFFICIENT FLEXION OF THE SOCKET - EXCESSIVE DORSAL FLEXION - HARD HEEL CUSHION PROSTHESIS HEEL CONTACT WITH THE GROUND IS TOO SHORT HEEL CONTACT: EARLY HEEL ROLLOVER

24 - WEAK GLUTEAL MUSCLES PATIENT HEEL CONTACT: EARLY HEEL ROLLOVER HEEL CONTACT WITH THE GROUND IS TOO SHORT

25 SLAP OF THE FOREFOOT ON THE GROUND HEEL CONTACT: FOOT SLAP

26 - SOFT HEEL CUSHION - EXCESSIVE PLANTAR FLEXION PROSTHESIS SLAP OF THE FOREFOOT ON THE GROUND HEEL CONTACT: FOOT SLAP

27 - WEAK HIP EXTENSORS, NOT PROVIDING SUFFICIENT ANTERIOR KNEE STABILITY PATIENT HEEL CONTACT: FOOT SLAP SLAP OF THE FOREFOOT ON THE GROUND

28 DECELERATION PHASE: TERMINAL IMPACT VISIBLE KNEE SHOCK

29 DECELERATION PHASE: TERMINAL IMPACT - INSUFFICIENT FRICTION OF KNEE AXIS - EXCESSIVE STRENGTH OF THE EXTENSION AID - EXTENSION BUFFER IS TOO HARD PROSTHESIS VISIBLE KNEE SHOCK

30 DECELERATION PHASE: TERMINAL IMPACT - EXCESSIVE ACCELERATION FORCE - BAD GAIT HABIT PATIENT VISIBLE KNEE SHOCK

31 HEEL RAISE PHASE: LUMBAR HYPER LORDOSIS VISIBLE ANTERIOR LUMBAR BEND

32 HEEL RAISE PHASE: LUMBAR HYPER LORDOSIS - INSUFFICIENT FLEXION OF THE SOCKET - PROSTHESIS IS TOO LONG - ISCHIAL SEAT IS TOO HIGH OR ANTERIORLY INCLINED PROSTHESIS VISIBLE ANTERIOR LUMBAR BEND

33 HEEL RAISE PHASE: LUMBAR HYPER LORDOSIS - HIP FLEXORS CONTRACTURE - ISCHIUM PAIN - POSTURAL PROBLEM - BAD GAIT HABIT PATIENT VISIBLE ANTERIOR LUMBAR BEND

34 MID SWING PHASE: VAULTING RAISE OF THE BODY BY EARLY EXCESSIVE PLANTAR FLEXION ON THE SOUND SIDE

35 MID SWING PHASE: VAULTING - PROSTHESIS IS TOO LONG - EXCESSIVE PLANTAR FLEXION - INSUFFICIENT 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 RAISE OF THE BODY BY EARLY EXCESSIVE PLANTAR FLEXION ON THE SOUND SIDE

36 MID SWING PHASE: VAULTING - FEAR OF TOUCHING GROUND - VERY SENSITIVE OR PAINFUL STUMP - BAD GAIT HABIT PATIENT RAISE OF THE BODY BY EARLY EXCESSIVE PLANTAR FLEXION ON THE SOUND SIDE

37 ACCELERATION PHASE: UNEVEN AND RAPID HEEL RAISE EXCESSIVE AND RAPID ELEVATION OF THE HEEL

38 ACCELERATION PHASE: UNEVEN AND RAPID HEEL RAISE - INSUFICIENT FRICTION OF THE KNEE AXIS - INSUFFICIENT STRENGTH OF THE EXTENSION AID - POSTERIOR DISPLACEMENT OF THE SOCKET PROSTHESIS EXCESSIVE AND RAPID ELEVATION OF THE HEEL

39 ACCELERATION PHASE: UNEVEN AND RAPID HEEL RAISE - GAIT IS TOO FAST - EXCESSIVE HIP FLEXION - BAD GAIT HABIT PATIENT EXCESSIVE AND RAPID ELEVATION OF THE HEEL

40 TRANSVERSAL VIEW: UNEVEN STEP LENGTH SHORT STEP ON PROSTHETIC SIDE

41 TRANSVERSAL VIEW: UNEVEN STEP LENGTH - ANTERIOR DISPLACEMENT OF THE SOCKET - EXCESSIVE FLEXION OF THE SOCKET - PISTONING ACTION - EXCESSIVE FRICTION OF THE KNEE AXIS - EXCESSIVE STRENGTH OF THE EXTENSION AID PROSTHESIS SHORT STEP ON PROSTHETIC SIDE

42 TRANSVERSAL VIEW: UNEVEN STEP LENGTH - SHORT, WEAK OR PAINFUL STUMP - GAIT FEAR - LIMITED HIP FLEXION -EXTENSION - WEAK QUADRICEPS MUSCLES PATIENT SHORT STEP ON PROSTHETIC SIDE

43 SHORT STEP ON SOUND SIDE TRANSVERSAL VIEW: UNEVEN STEP LENGTH

44 - INSUFFICIENT FLEXION OF THE SOCKET - EXCESSIVE PLANTAR FLEXION - INSUFFICIENT FLEXION OF THE KNEE - EXCESSIVE STRENGTH OF THE EXTENSION AID PROSTHESIS SHORT STEP ON SOUND SIDE TRANSVERSAL VIEW: UNEVEN STEP LENGTH

45 - SHORT, WEAK OR PAINFUL STUMP - HIP EXTENSORS CONTRACTURE - LIMITED HIP FLEXION - EXTENSION - INSUFFICIENT STABILITY - PROBLEMS WITH SOUND LEG PATIENT TRANSVERSAL VIEW: UNEVEN STEP LENGTH SHORT STEP ON SOUND SIDE