Orthotic CPM Exam - Oral Questions
And Answers
Which muscle group is most likely affected if you observe a patient with a shortened step on
the sound side (assuming the patient is unilaterally involved)? - ANSplantarflexors
What type of AFO would you use for a patient with a tibial nerve lesion? - ANSPlantarflexion
free, dorsiflexion stop
Evaluation of a patient with a gunshot wound to the hip reveals weak hip flexors. What
peripheral nerve is injured? - ANSfemoral nerve
A patient exhibits hallux rigidus, at which part of stance phase will the patient have the most
discomfort? - ANSLate stance phase
What does the term foot progression angle refer to? - ANSRelationship between line of
progression and long axis of foot
At which joint and in which plane does the motion of inversion and eversion occur? -
ANSSubtalar (or talocalcaneonavicular) joint, coronal plane
What motion and at what phase of gait does a cushioned heel simulate? - ANSplantarflexion
at heel strike, initial contact
Injury to which nerve presents as paralytic equinus during swing phase? - ANScommon
peroneal nerve
If the ankle is 90 degrees at initial contact, what type of moment do you have at the knee? -
ANSKnee flexion moment
If the ankle is in 3 degrees of plantarflexion at midstance, what type of moment do you have
at the knee? - ANSknee extension moment
During which phase of gait does the ankle achieve the greatest amount of dorsiflexion in a
healthy individual which normal ROM and muscle functionality? - ANSterminal stance
Which ligament maintains the medial arch? - ANSspring ligament (plantarcalcanealnavicular
ligament)
What percentage of the gait cycle is spent in double limb support? - ANS20%
The dorsiflexion stop performs the function of which muscle? - ANSgastricnemius/soleus
The functions of the tibialis anterior muscles are? - ANSdorsiflexion and inversion
, What moment at the knee is created in stance phase of gait in a solid thermoplastic AFO set
to neutral with a rigid full length footplate? Additionally, where in stance would be this most
noticed by the patient? - ANSincrease the knee extension moment, terminal stance
Decrease the alignment at the ankle, knee and hips for crouch gait pattern? - ANSflexed
hips, flexed knees, dorsiflexed ankles
A single gait cycle defined as? - ANSHeel strike on one side to heel strike on the ipsilateral
side
For which diagnoses would you recommend a rocker bottom shoe? - ANSdiabetes, arthritis,
ankle fusion, etc. Whenever a patient requires a solid AFO
How can you prevent a knee orthosis from migrating down? - ANSSupracondylar wedge,
suprapatellar strap, attach a footplate, lightweight belt
What is the best position for a patient to be in when being fitted with a tibial fracture
orthosis? - ANSsitting with legs dangling, knees at 90 degrees
What adjustment to a metal AFO would best accommodate excessive tibial torsion? -
ANSdeflection of sidebars
Patient reports pain and redness at the lateral aspect of the forefoot upon weight bearing
which worsens with ambulation - what adjustments would you make? - ANS-is trimline
bisecting the 5th MTP?
-does forefoot require additional support of extended lateral footplate to control forefoot
abduction?
Patient reports pain and redness at the medial malleolus upon weight bearing which
worsens with ambulation - what adjustments would you make? - ANS-does patient have
adequate clearance at medial joint space?
-addition of pad in medial longitudinal arch/proximal to the medial malleolus
-dynamic slotted medial instep strap to provide valgus correction intrinsic medial heel post
If you have a total contact UCBL intrinsically, but you still have calcaneal valgus, what
modifications do you need to make? - ANSadd extrinsic medial wedge
Patient was fit one week ago with a solid ankle AFO and reports that they feel like their knee
flexes rapidly at heel strike. What adjustment do you make? - ANSaddition of shoe with
cushioned heel
Patient presents to your office for an adjustment to their articulated AFO - they state that
they are having pain in the posterior compartment of the knee with prolonged standing or
ambulation. Upon ambulating, you notice a significant knee extension moment. What
adjustments do you make? What do you need to consider prior to making adjustments? -
ANS-heel lift to decrease knee extension moment
-adjust double action joints if available
And Answers
Which muscle group is most likely affected if you observe a patient with a shortened step on
the sound side (assuming the patient is unilaterally involved)? - ANSplantarflexors
What type of AFO would you use for a patient with a tibial nerve lesion? - ANSPlantarflexion
free, dorsiflexion stop
Evaluation of a patient with a gunshot wound to the hip reveals weak hip flexors. What
peripheral nerve is injured? - ANSfemoral nerve
A patient exhibits hallux rigidus, at which part of stance phase will the patient have the most
discomfort? - ANSLate stance phase
What does the term foot progression angle refer to? - ANSRelationship between line of
progression and long axis of foot
At which joint and in which plane does the motion of inversion and eversion occur? -
ANSSubtalar (or talocalcaneonavicular) joint, coronal plane
What motion and at what phase of gait does a cushioned heel simulate? - ANSplantarflexion
at heel strike, initial contact
Injury to which nerve presents as paralytic equinus during swing phase? - ANScommon
peroneal nerve
If the ankle is 90 degrees at initial contact, what type of moment do you have at the knee? -
ANSKnee flexion moment
If the ankle is in 3 degrees of plantarflexion at midstance, what type of moment do you have
at the knee? - ANSknee extension moment
During which phase of gait does the ankle achieve the greatest amount of dorsiflexion in a
healthy individual which normal ROM and muscle functionality? - ANSterminal stance
Which ligament maintains the medial arch? - ANSspring ligament (plantarcalcanealnavicular
ligament)
What percentage of the gait cycle is spent in double limb support? - ANS20%
The dorsiflexion stop performs the function of which muscle? - ANSgastricnemius/soleus
The functions of the tibialis anterior muscles are? - ANSdorsiflexion and inversion
, What moment at the knee is created in stance phase of gait in a solid thermoplastic AFO set
to neutral with a rigid full length footplate? Additionally, where in stance would be this most
noticed by the patient? - ANSincrease the knee extension moment, terminal stance
Decrease the alignment at the ankle, knee and hips for crouch gait pattern? - ANSflexed
hips, flexed knees, dorsiflexed ankles
A single gait cycle defined as? - ANSHeel strike on one side to heel strike on the ipsilateral
side
For which diagnoses would you recommend a rocker bottom shoe? - ANSdiabetes, arthritis,
ankle fusion, etc. Whenever a patient requires a solid AFO
How can you prevent a knee orthosis from migrating down? - ANSSupracondylar wedge,
suprapatellar strap, attach a footplate, lightweight belt
What is the best position for a patient to be in when being fitted with a tibial fracture
orthosis? - ANSsitting with legs dangling, knees at 90 degrees
What adjustment to a metal AFO would best accommodate excessive tibial torsion? -
ANSdeflection of sidebars
Patient reports pain and redness at the lateral aspect of the forefoot upon weight bearing
which worsens with ambulation - what adjustments would you make? - ANS-is trimline
bisecting the 5th MTP?
-does forefoot require additional support of extended lateral footplate to control forefoot
abduction?
Patient reports pain and redness at the medial malleolus upon weight bearing which
worsens with ambulation - what adjustments would you make? - ANS-does patient have
adequate clearance at medial joint space?
-addition of pad in medial longitudinal arch/proximal to the medial malleolus
-dynamic slotted medial instep strap to provide valgus correction intrinsic medial heel post
If you have a total contact UCBL intrinsically, but you still have calcaneal valgus, what
modifications do you need to make? - ANSadd extrinsic medial wedge
Patient was fit one week ago with a solid ankle AFO and reports that they feel like their knee
flexes rapidly at heel strike. What adjustment do you make? - ANSaddition of shoe with
cushioned heel
Patient presents to your office for an adjustment to their articulated AFO - they state that
they are having pain in the posterior compartment of the knee with prolonged standing or
ambulation. Upon ambulating, you notice a significant knee extension moment. What
adjustments do you make? What do you need to consider prior to making adjustments? -
ANS-heel lift to decrease knee extension moment
-adjust double action joints if available
