Leg amputees must understand gait. When referring to "gait," we simply mean your manner of walking. When you walk, your leg spends 40 per cent of the time in the swing phase (when you swing the leg through) and 60 per cent of the time in the stance phase (when your foot is in contact with the ground). Over the years, leg amputees have been told time and time again by our doctors, physiotherapists and prosthetists that they have to work at walking properly, or need to develop "good gait." Many leg amputees have developed bad walking habits that are, once developed, difficult to break.
Leg amputees, particularly those with higher levels of amputation, will often have some degree of a limp. When you limp, you are actually bending your upper body sideways in order to put your weight over the artificial leg. In reality, your pelvis should do this work, it naturally moves sideways to keep the body aligned when you walk. After becoming a leg amputee, the natural mechanics of the body are thrown out of whack, so you have to learn to rely on the pelvis to do its job, and not bend or limp to the side instead. That is, admittedly, not easy.
Some common gait deviations that are seen in leg amputees are:
- Abducted gait - where you lift and swing the artificial leg out to the side; it is caused by poor balance, pinching of the stump if the socket is not fitting properly, or fear that the artificial knee will bend too easily and cause a fall.
- Hip hiking - where you lift the hip higher on the side of the amputation in order to ensure the artificial leg clears the floor when you swing it through; it may result if the amputee has problems like osteoarthritis of the hip, is not able to manage the weight of the limb, is taking unequal step lengths, or is not using the knee properly (e.g. walking with the knee stiff so hiking the hip allows the limb to clear the ground).
- Stiff-legged walking - more often seen with amputees with short residual limbs who tend to keep the knee stiff when they walk; due to poor leverage with the short residual limb or fear of falling.
- Uneven step length - some amputees take a longer step with the artificial leg than with the sound limb; possibly due to lack of perception of the amputee, or the amputee's desire to quickly get his/her weight off the artificial limb when walking for fear of falling or due to stump pain. Thus, to compensate for the lesser time spent in stance phase, the amputee takes a longer stride with the artificial limb.
The Importance of Developing Good Gait
Why is it so important to develop as good a gait as you can and, even if you are a longtime amputee, to work at breaking any bad gait habits you have?
The answer is, simply, that having a good gait helps amputees minimize additional stresses to the body. Amputees automatically use more energy to walk. Also, the sound limb naturally has to work harder to compensate for a missing limb. If, in addition, you have a poor gait, you end up using even more energy because your muscles have to work harder to bring your body back into balance and alignment, and you put additional stress on the residual and sound limbs -- and you need to keep both these body parts in the best shape you can!
In order to enable the pelvis to do its job in gait, as outlined earlier, you need to build up the muscles of your buttocks and hip with specific exercises. Initially, the idea of an exercise program may seem daunting, but just a little effort will result in a better gait down the road. Paying close attention to the advice of physical therapists and prosthetists in this area will facilitate proper walking techniques, and reduce the likelihood of poor walking habits. A comfortably fitting and well-aligned artificial limb is, of course, imperative.
A suggestion to help you work on developing a good gait, or to break bad habits, is to watch yourself walking in a mirror. You will see how it feels when you do walk properly and you can then duplicate it when you are not in front of a mirror. Or, you can videotape yourself walking to determine how you are doing. Your physiotherapist, prosthetist, and others on your "team" can offer advice and suggestions on exercises and any gait training programs that might be available to you. Always, of course, consult your doctor before starting a new exercise program.