ORTHOTICS/PROSTHETICS/GAIT QUESTIONS AND
ANSWERS
20. Which of the following orthoses or shoe modifications is used in the conservative
management of plantar fasciitis? (a) Heel lift (b) Posterior night splint (c) Lateral heel
wedge (d) Metatarsal bar - Answers- 20 (b) A heel lift plantarflexes the foot and is used
for Achilles tendinitis. A metatarsal bar is used for metatarsalgia. A lateral heel wedge
can be used for the conservative management of osteoarthritis of the knee. A posterior
night splint dorsiflexed to 5/ is the correct answer.
30. During normal human locomotion, the center of gravity travels through a sinusoidal
pathway that is modified by 6 determinants of gait. Which of the following is not
considered 1 of the 6 determinants? (a) Pelvic extension (b) Foot and ankle
synchronization (c) Knee flexion (d) Lateral pelvic displacement - Answers- 30 (a) The 6
determinants are as follows: lateral displacement that reduces horizontal excursion from
6" down to 1.7"; knee flexion that reduces vertical excursion 7/16"; pelvic rotation that
reduces vertical excursion 3/8"; pelvic tilt that reduces vertical excursion 3/16"; and foot
and ankle synchronization as well as ankle and knee synchronization that both serve to
smooth out the sinusoidal curve but do not decrease excursion.
39. The most common complication after amputation in the immature child is (a)
phantom limb pain. (b) diffuse edema. (c) terminal overgrowth. (d) painful neuroma. -
Answers- 39 (c) Terminal overgrowth at the transected end of a long bone is the most
common complication after amputation in the skeletally immature child. It occurs most
frequently in the humerus, fibula, tibia, and femur, in that order. The oppositional growth
may be so vigorous that the bone pierces the skin. The treatment of choice is surgical
revision.
82. In the orthotic and prosthetic clinic, a patient with Parkinson's disease presents for
gait analysis. The primary gait disturbance found is an alternation in stride length and
altered cadence. A gaittraining program for a person with Parkinson's disease should
include (a) visual cueing techniques. (b) bilateral ankle-foot orthoses. (c) patterning
techniques. (d) vestibular stimulation exercises. - Answers- 82 (a) Treatment options for
gait disturbance in patients with Parkinson's disease include visual and auditory cueing,
in addition to traditional endurance and strengthening exercises.
100. When comparing quadrilateral sockets with ischial containment sockets, a
successful fitting ismore likely in a quadrilateral socket when (a) the adductor
musculature is intact. (b) the residual limb is fleshy. (c) trunk stability demands are high
at mid stance. (d) the residual limb is shorter. - Answers- 100 (a) Chances of a
successful fitting of a quadrilateral socket are best when the residual limb is longer with
a firm residuum and intact adductor musculature. Ischial containment sockets are more
successful than quadrilateral sockets for persons with shorter, fleshy, unstable residual
limbs.
,104. In a patient with bilateral hip flexion contractures, which of the following gait
deviations would bemost likely? (a) Bilateral Trendelenburg gait (b) Early heel rise
during stance (c) Swing-phase circumduction (d) Increased knee flexion in stance -
Answers- 104 (d) In normal gait, hip extension to neutral occurs during stance phase.
When mild hip flexion contractures are present, a compensatory increase in lumbar
lordosis occurs to maintain upright trunk posture. As the extent of the hip flexion
contractures worsens, there is usually an additional compensatory increase in knee
flexion during stance phase.
110. Which of the following knee types provides good stability in early stance phase and
ease of flexionwhile weight bearing during the pre-swing phase (terminal stance) of the
gait cycle? (a) Single axis (b) Stance phase control (c) Polycentric (d) Manual locking -
Answers- 110 (c) Many polycentric knees are designed so that the center of rotation
moves anteriorly very rapidly during the first few degrees of knee flexion, quickly
passing in front of the floor reaction line and facilitating the swing phase. Because the
polycentric knee can be flexed under weight bearing during the terminal stance, when
properly dynamically aligned it can offer both excellent stance stability and ease of
swing-phase flexion. Furthermore, all polycentric knees shorten mechanically to a slight
degree during flexion, adding additional toe clearance during midswing.
120. An amputee presents for evaluation of distal blistering and evidence of vascular
congestion. Youdiagnose choke syndrome. Which of the following would NOT be an
acceptable treatment for choke syndrome? (a) Expanding the proximal socket (b)
Increasing the auxiliary suspension to decrease vertical pull (c) Relieving the distal
socket where it interfaces with the choked surface (d) Padding the distal socket where it
corresponds to the choked surface - Answers- 120 (c) The choke syndrome (proximal
soft tissue constriction leading to vascular congestion) may occur with suction sockets
or self-suspending systems. Relieving the proximal socket to allow vascular return,
providing auxiliary suspension to decrease the vertical pull on the residual limb, and
improving the intimacy of the socket-limb interface correct this problem. Relieving the
distal socket where it interfaces with the choked surface would increase the vacuum
effect in this area and thereby increase the choke phenomenon.
130. Which of the following shoe components distinguishes a blucher-style shoe from a
bal-style shoe? (a) Throat (b) Toe box (c) Heel (d) Vamp - Answers- 130 (a) There are
two shoe types, the blucher and the bal. The components of a blucher shoe include the
tongue, lace stay, open throat, toe box, toe spring, vamp, ball, shank, breast, quarter,
and heel. The major difference with a bal style is that the throat is closed, limiting the
ability of the shoe to open and accommodate an orthosis. For this reason, a blucher is
the style of dress shoe most often recommended to patients who require an orthosis.
140. A 35-year-old man experiences a severe S1 radiculopathy. As a result, he loses
essentially allstrength within the posterior compartment of the leg. It is 6 months later,
and you are consulted to provide an orthosis to aid his ambulation. The best
recommendation would be (a) a posterior leaf spring ankle-foot orthosis (AFO). (b) an
, articulating AFO with plantar flexion stop. (c) an articulating AFO with dorsiflexion stop.
(d) an articulating AFO with dorsiflexion assist. - Answers- 140 (c) In this condition, lack
of active plantar flexion occurs, heel-rise is delayed, the mid-stance phase is prolonged,
and push-off force is reduced. A dorsiflexion stop can accommodate for this weakness.
Setting the stop at 5° of dorsiflexion substitutes best for gastrocnemius function.
40. A 79-year-old cachectic woman with coronary artery disease and unstable angina
sustains a right hip fracture after a fall. After an open-reduction internal fixation of the
hip joint with the use of a dynamic hip screw, the orthopedic surgeon determines that
the patient is 25% partial weight bearing to the right side. She has weak upper body
strength and good balance. Which of the following assistive devices is most
appropriate? (a) Standard walker (b) Rolling walker (c) Axillary crutches (d) Quad cane -
Answers- 40 (b) Standard walkers require good standing balance and good upper body
strength. Crutches require good upper body strength and have an increased energy
expenditure of 40%-60%, which would be contraindicated in unstable angina. Quad
canes are not appropriate when significant weight-bearing relief is required. Rolling
walkers are most appropriate for patients who lack upper body strength and provide
safer gait than crutches or canes.
59. In considering selection of a lower limb prosthesis for a child with a congenital
transfemoral amputation, a knee joint should be included (a) at initial fitting. (b) between
3 to 5 years of age. (c) when sports activities are anticipated. (d) when the child pulls to
stand. - Answers- 59 (b) The lower limb deficient child should be fitted with a prosthesis
when he or she is ready to pull up to a standing position, usually between 9 and 12
months. A knee joint is added between 3 and 5 years.
70. What level of amputation has the highest acceptance rate for an upper extremity
prosthesis? (a) Wrist disarticulation (b) Transradial (c) Elbow disarticulation (d)
Transhumeral - Answers- 70 (b) Overall rejection of prosthetic usage occurs in 33%-
38% of unilateral upper extremity amputees. The highest acceptance rate is transradial
at about 93%, and the lowest is wrist disarticulation at about 6%.
80. When considering realistic functional goals for the majority of transhumeral
amputees, the maximal weight (in pounds) that can be carried with the body-powered
prosthesis is (a) 7. (b) 15. (c) 30. (D) 50. - Answers- 80 (b) Handling of heavy objects is
limited in upper extremity amputees. A transhumeral amputee is expected to lift 10lb to
15lb, unless the residual limb is very short or sensitive. A transradial amputee is
expected to lift 20lb to 30lb unless the residual limb is very short or sensitive.
150. A 75-year-old woman falls and fractures her distal humerus. In the process, the
ulnar nerve is damaged. She presents 6 months later with weakness in the fourth and
fifth digits, claw deformity, and loss of grip power. Which of the following orthotic
components could benefit this patient and, therefore, should be included in the orthotic
prescription? (a) Dorsal outrigger (b) C bar (c) Lumbrical bar (d) Opponens bar -
Answers- 150 (c) A dorsal metacarpophalangeal extension stop (also called a lumbrical
ANSWERS
20. Which of the following orthoses or shoe modifications is used in the conservative
management of plantar fasciitis? (a) Heel lift (b) Posterior night splint (c) Lateral heel
wedge (d) Metatarsal bar - Answers- 20 (b) A heel lift plantarflexes the foot and is used
for Achilles tendinitis. A metatarsal bar is used for metatarsalgia. A lateral heel wedge
can be used for the conservative management of osteoarthritis of the knee. A posterior
night splint dorsiflexed to 5/ is the correct answer.
30. During normal human locomotion, the center of gravity travels through a sinusoidal
pathway that is modified by 6 determinants of gait. Which of the following is not
considered 1 of the 6 determinants? (a) Pelvic extension (b) Foot and ankle
synchronization (c) Knee flexion (d) Lateral pelvic displacement - Answers- 30 (a) The 6
determinants are as follows: lateral displacement that reduces horizontal excursion from
6" down to 1.7"; knee flexion that reduces vertical excursion 7/16"; pelvic rotation that
reduces vertical excursion 3/8"; pelvic tilt that reduces vertical excursion 3/16"; and foot
and ankle synchronization as well as ankle and knee synchronization that both serve to
smooth out the sinusoidal curve but do not decrease excursion.
39. The most common complication after amputation in the immature child is (a)
phantom limb pain. (b) diffuse edema. (c) terminal overgrowth. (d) painful neuroma. -
Answers- 39 (c) Terminal overgrowth at the transected end of a long bone is the most
common complication after amputation in the skeletally immature child. It occurs most
frequently in the humerus, fibula, tibia, and femur, in that order. The oppositional growth
may be so vigorous that the bone pierces the skin. The treatment of choice is surgical
revision.
82. In the orthotic and prosthetic clinic, a patient with Parkinson's disease presents for
gait analysis. The primary gait disturbance found is an alternation in stride length and
altered cadence. A gaittraining program for a person with Parkinson's disease should
include (a) visual cueing techniques. (b) bilateral ankle-foot orthoses. (c) patterning
techniques. (d) vestibular stimulation exercises. - Answers- 82 (a) Treatment options for
gait disturbance in patients with Parkinson's disease include visual and auditory cueing,
in addition to traditional endurance and strengthening exercises.
100. When comparing quadrilateral sockets with ischial containment sockets, a
successful fitting ismore likely in a quadrilateral socket when (a) the adductor
musculature is intact. (b) the residual limb is fleshy. (c) trunk stability demands are high
at mid stance. (d) the residual limb is shorter. - Answers- 100 (a) Chances of a
successful fitting of a quadrilateral socket are best when the residual limb is longer with
a firm residuum and intact adductor musculature. Ischial containment sockets are more
successful than quadrilateral sockets for persons with shorter, fleshy, unstable residual
limbs.
,104. In a patient with bilateral hip flexion contractures, which of the following gait
deviations would bemost likely? (a) Bilateral Trendelenburg gait (b) Early heel rise
during stance (c) Swing-phase circumduction (d) Increased knee flexion in stance -
Answers- 104 (d) In normal gait, hip extension to neutral occurs during stance phase.
When mild hip flexion contractures are present, a compensatory increase in lumbar
lordosis occurs to maintain upright trunk posture. As the extent of the hip flexion
contractures worsens, there is usually an additional compensatory increase in knee
flexion during stance phase.
110. Which of the following knee types provides good stability in early stance phase and
ease of flexionwhile weight bearing during the pre-swing phase (terminal stance) of the
gait cycle? (a) Single axis (b) Stance phase control (c) Polycentric (d) Manual locking -
Answers- 110 (c) Many polycentric knees are designed so that the center of rotation
moves anteriorly very rapidly during the first few degrees of knee flexion, quickly
passing in front of the floor reaction line and facilitating the swing phase. Because the
polycentric knee can be flexed under weight bearing during the terminal stance, when
properly dynamically aligned it can offer both excellent stance stability and ease of
swing-phase flexion. Furthermore, all polycentric knees shorten mechanically to a slight
degree during flexion, adding additional toe clearance during midswing.
120. An amputee presents for evaluation of distal blistering and evidence of vascular
congestion. Youdiagnose choke syndrome. Which of the following would NOT be an
acceptable treatment for choke syndrome? (a) Expanding the proximal socket (b)
Increasing the auxiliary suspension to decrease vertical pull (c) Relieving the distal
socket where it interfaces with the choked surface (d) Padding the distal socket where it
corresponds to the choked surface - Answers- 120 (c) The choke syndrome (proximal
soft tissue constriction leading to vascular congestion) may occur with suction sockets
or self-suspending systems. Relieving the proximal socket to allow vascular return,
providing auxiliary suspension to decrease the vertical pull on the residual limb, and
improving the intimacy of the socket-limb interface correct this problem. Relieving the
distal socket where it interfaces with the choked surface would increase the vacuum
effect in this area and thereby increase the choke phenomenon.
130. Which of the following shoe components distinguishes a blucher-style shoe from a
bal-style shoe? (a) Throat (b) Toe box (c) Heel (d) Vamp - Answers- 130 (a) There are
two shoe types, the blucher and the bal. The components of a blucher shoe include the
tongue, lace stay, open throat, toe box, toe spring, vamp, ball, shank, breast, quarter,
and heel. The major difference with a bal style is that the throat is closed, limiting the
ability of the shoe to open and accommodate an orthosis. For this reason, a blucher is
the style of dress shoe most often recommended to patients who require an orthosis.
140. A 35-year-old man experiences a severe S1 radiculopathy. As a result, he loses
essentially allstrength within the posterior compartment of the leg. It is 6 months later,
and you are consulted to provide an orthosis to aid his ambulation. The best
recommendation would be (a) a posterior leaf spring ankle-foot orthosis (AFO). (b) an
, articulating AFO with plantar flexion stop. (c) an articulating AFO with dorsiflexion stop.
(d) an articulating AFO with dorsiflexion assist. - Answers- 140 (c) In this condition, lack
of active plantar flexion occurs, heel-rise is delayed, the mid-stance phase is prolonged,
and push-off force is reduced. A dorsiflexion stop can accommodate for this weakness.
Setting the stop at 5° of dorsiflexion substitutes best for gastrocnemius function.
40. A 79-year-old cachectic woman with coronary artery disease and unstable angina
sustains a right hip fracture after a fall. After an open-reduction internal fixation of the
hip joint with the use of a dynamic hip screw, the orthopedic surgeon determines that
the patient is 25% partial weight bearing to the right side. She has weak upper body
strength and good balance. Which of the following assistive devices is most
appropriate? (a) Standard walker (b) Rolling walker (c) Axillary crutches (d) Quad cane -
Answers- 40 (b) Standard walkers require good standing balance and good upper body
strength. Crutches require good upper body strength and have an increased energy
expenditure of 40%-60%, which would be contraindicated in unstable angina. Quad
canes are not appropriate when significant weight-bearing relief is required. Rolling
walkers are most appropriate for patients who lack upper body strength and provide
safer gait than crutches or canes.
59. In considering selection of a lower limb prosthesis for a child with a congenital
transfemoral amputation, a knee joint should be included (a) at initial fitting. (b) between
3 to 5 years of age. (c) when sports activities are anticipated. (d) when the child pulls to
stand. - Answers- 59 (b) The lower limb deficient child should be fitted with a prosthesis
when he or she is ready to pull up to a standing position, usually between 9 and 12
months. A knee joint is added between 3 and 5 years.
70. What level of amputation has the highest acceptance rate for an upper extremity
prosthesis? (a) Wrist disarticulation (b) Transradial (c) Elbow disarticulation (d)
Transhumeral - Answers- 70 (b) Overall rejection of prosthetic usage occurs in 33%-
38% of unilateral upper extremity amputees. The highest acceptance rate is transradial
at about 93%, and the lowest is wrist disarticulation at about 6%.
80. When considering realistic functional goals for the majority of transhumeral
amputees, the maximal weight (in pounds) that can be carried with the body-powered
prosthesis is (a) 7. (b) 15. (c) 30. (D) 50. - Answers- 80 (b) Handling of heavy objects is
limited in upper extremity amputees. A transhumeral amputee is expected to lift 10lb to
15lb, unless the residual limb is very short or sensitive. A transradial amputee is
expected to lift 20lb to 30lb unless the residual limb is very short or sensitive.
150. A 75-year-old woman falls and fractures her distal humerus. In the process, the
ulnar nerve is damaged. She presents 6 months later with weakness in the fourth and
fifth digits, claw deformity, and loss of grip power. Which of the following orthotic
components could benefit this patient and, therefore, should be included in the orthotic
prescription? (a) Dorsal outrigger (b) C bar (c) Lumbrical bar (d) Opponens bar -
Answers- 150 (c) A dorsal metacarpophalangeal extension stop (also called a lumbrical
