Pause Here First

When we assess gait, the instinct is to take in the whole picture. Watch the full cycle, track every phase, catch every deviation. That can work, but it can also get overwhelming, especially when you’re still training your eye or trying to figure out where to focus your interventions.

If you need a place to start or troubleshoot, start here: mid-stance on the prosthetic side.

This is one of the highest demand points of the gait cycle on the prosthetic side. For a brief moment, the patient has to fully load the prosthesis, control their body over it, and trust that it will support them. There’s a lot of information available in that single moment: alignment, socket fit, weight shifting strategy, posture, mobility, strength, base of support, confidence in the prosthesis, and how much they’re offloading through an assistive device.

Most of what you need to understand is showing up right there.

Start with the pylon. At mid-stance, you generally want to see it vertical. If it isn’t, something is worth investigating. Figuring out the cause is a separate conversation, but mid-stance is often where you first notice that the system needs a closer look.

From there, watch how they load and transition over the prosthetic side. Can they move their body over the prosthesis and control that position, or are they staying behind it and rushing through stance? Their base of support will tell you something too. A wider base may be the strategy they need right now, but it can also tell you they don’t fully trust the prosthesis enough to narrow their stance and move over it efficiently.

Make sure you’re watching from both the side and the front. The sagittal plane may show you how they’re moving over the foot, while the frontal plane may show you how they’re controlling the pelvis, trunk, base of support, and lateral weight shift. You’ll get better information when you look at both.

If they’re using an assistive device, mid-stance is where you can see how much the arms are helping. There is a big difference between using a walker or cane for balance and using it to offload the prosthesis. Heavy reliance through the arms can disguise what’s actually happening because the patient never has to fully shift over the prosthetic side.

You don’t have to physically stop the patient at mid-stance. Sometimes the best first step is to keep them walking and take a mental snapshot of that exact moment in the gait cycle. But if you need to slow it down even more, recreate the position statically by having them stand on the prosthesis with the sound side foot up on a box.

It’s not exactly the same as walking, but it mimics the demand of prosthetic side stance and forces them to spend more time there than they ever would during normal gait. That gives you a chance to assess and address the same issues in a more controlled way. If they can learn to own that position statically, there’s a good chance you can start asking them to control it briefly during the gait cycle.

Deviations can happen in every phase of gait, and you still need to watch the full pattern. But if you’re looking for the highest return-on-investment place to start, prosthetic side mid-stance is hard to beat.