Orthotics CPM Exam Study Guide 2024 with
Complete Solutions
AFO casting - Correct Answer 1. Don gloves and gather materials
2. Take measurements either on form or calf circumference, ankle circumference, fib head height, foot
length
3. apply 2 layers of stockinette
4. mark landmarks: fib head/neck, tibial crest, malleoli, calcaneal tuberosity if prominent, base of 5th
met head, navicular, cuboid, met heads 1 and 5, to sulcus, any other prominent/painful areas
5. apply cut tube anteriorly and insert into cut slits of stockinette
6. wrap with fiberglass, ensure fib head is captured
7. Use foot board to align foot as neutrally as possible
8. As fiberglass sets draw vertical cut line and horizontal match lines
9. Use cast saw to cut the cast off. Warn patient of vibration and loud noise. Use 2 hands and thumb as a
guide
10. cut top layer of stockinette and remove cast
11. clean patients leg and remove 2nd layer stockinette. don shocks and shoes
12. Clean area and answer questions about patient considerations
KAFO: Knee joint too distal - Correct Answer 1. pressure at anterior distal and posterior proximal thigh
2. thigh band shifts proximal
3. cant rotate as much as anatomical knee
KAFO: knee joint too proximal - Correct Answer 1. pressure at posterior distal and anterior proximal of
thigh
2. thigh band shifts distal
3. bends too much
KAFO: knee joint too posterior - Correct Answer 1. pressure at anterior proximal and posterior distal
thigh
2. orthosis shifts proximally
,KAFO: knee joint too anterior - Correct Answer 1. pressure at anterior distal and proximal posterior thigh
2. orthosis shifts distally
KAFO: proper knee joint location - Correct Answer 1. bisection of adductor tubercle and medial tibial
plateau
2. 60:40 anterior: posterior
KAFO Trimlines: - Correct Answer 1. medial proximal 30 mm distal to perinneum
2. proximal lateral distal to greater trochanter
3. proximal posterior thigh set at 15 deg slant connecting lateral to medial
4. popliteal region allows 105 deg knee flexion
KAFO knee joint clearances - Correct Answer 6mm medial 3 mm lateral
KAFO ankle clearances - Correct Answer 6 mm medial and 5 mm lateral
KAFO analysis - Correct Answer 1. Correct side and foot plate
2. proper strapping materials
3. plastic thickness
4. rivets-- speedy rivets not durable for attaching metal uprights
5. plastazote /p-cell packs down quickly
6. check measurements
7. Check proper ankle and knee joints
8. If KAFO doesn't meet patient's needs do not deliver
KAFO : varus moment control - Correct Answer AFO section: 3 pt pressure 1) prox medial (medial chafe
at tibial strap) 2) proximal lateral malleoli (lateral flange) 3) 1st met head (encompass)
,KAFO hyperextension control after delivery - Correct Answer 1) add padding to calf section
2) increase dorsiassist power (stiffer joints, adjust double action)
3) increase plantarflexion resistance (pf stop, adjust double action)
4) add heel wedge to AFO
KAFO joints that prevent hyperextension (without limiting ADLs) - Correct Answer 1. posterior offset
KAFO correct genuvarum/genuvalgum after delivery - Correct Answer 1. add pull strap proximal and
distal to the knee joint so line of pull corrects deformity
2. add padding proximal and distal to KC (if valgus add padding medially, and if varus add padding
laterally) to increase corrective force
KAFO: pain at at posterior distal thigh indicates what? - Correct Answer knee joint is too proximal
KAFO: pain at anterior distal thigh and posterior proximal thigh indicates what? - Correct Answer knee
joint is too distal
KAFO: what may be the issue if knee joints will not fully lock? - Correct Answer 1. drop locks may be
upside down
2. mechanical KC not aligned with anatomical KC
3. The joints are not squared properly
4. excursion length are uneven
Scenario: pt with metal and leather KAFO with drop locks and double action ankle joints feels unsteady
and trips easily going down ramps. what adjustments? - Correct Answer 1. allow more plantarflexion at
the ankle
2. provide dorsiassist with a spring in the posterior channel (will resist pf and smooth the foot flat
transition)
3. add cushioned heel to shoe
AFO 3 point force system for dorsiflexion weakness (resist PF in swing): - Correct Answer 1. anteriorly
directed force at posterior calf
, 2. posterior and distal force at dorsum of ankle (shoe, instep strap)
3. superiorly directed force at met heads (foot plate)
AFO 3 point force system for plantarflexion weakness (resist DF in stance): - Correct Answer 1. posterior
directed force at tibia
2. anterior and proximal force at heel
3. distal directed force at met heads
AFO Full length footplate considerations - Correct Answer 1. claw toes, hammer toes, toe grasping
2. mid foot fracture
3. tone/spasticity
AFO hyperextension adjustments - Correct Answer 1. heel wedge
2. taller proximal trimline
3. sent 3-4 deg dorsiflexion
4. footplate too rigid-- shorten to sulcus or metheads
AFO 3 point force system for valgus correction/ reduce pronation - Correct Answer 1. medially directed
force at lateral proximal calf band (lateral chafe for tibial strap)
2. lateral directed force at medial supramalleolus (medial flange)
3. medially directed force at 5th methead (encapsulate)
AFO 3 point force for varus correction/ reduce supination - Correct Answer 1. lateral directed force at
medial proximal calf band (medial chafe for tibial strap)
2. medial directed force at lateral supramalleolus (lateral flange)
3. laterally directed force at 1st methead (encompass)
AFO patient: valgus presentation - Correct Answer 1. forefoot abduction
2. calcaneal valgus
3. 1st methead pain and callus
Complete Solutions
AFO casting - Correct Answer 1. Don gloves and gather materials
2. Take measurements either on form or calf circumference, ankle circumference, fib head height, foot
length
3. apply 2 layers of stockinette
4. mark landmarks: fib head/neck, tibial crest, malleoli, calcaneal tuberosity if prominent, base of 5th
met head, navicular, cuboid, met heads 1 and 5, to sulcus, any other prominent/painful areas
5. apply cut tube anteriorly and insert into cut slits of stockinette
6. wrap with fiberglass, ensure fib head is captured
7. Use foot board to align foot as neutrally as possible
8. As fiberglass sets draw vertical cut line and horizontal match lines
9. Use cast saw to cut the cast off. Warn patient of vibration and loud noise. Use 2 hands and thumb as a
guide
10. cut top layer of stockinette and remove cast
11. clean patients leg and remove 2nd layer stockinette. don shocks and shoes
12. Clean area and answer questions about patient considerations
KAFO: Knee joint too distal - Correct Answer 1. pressure at anterior distal and posterior proximal thigh
2. thigh band shifts proximal
3. cant rotate as much as anatomical knee
KAFO: knee joint too proximal - Correct Answer 1. pressure at posterior distal and anterior proximal of
thigh
2. thigh band shifts distal
3. bends too much
KAFO: knee joint too posterior - Correct Answer 1. pressure at anterior proximal and posterior distal
thigh
2. orthosis shifts proximally
,KAFO: knee joint too anterior - Correct Answer 1. pressure at anterior distal and proximal posterior thigh
2. orthosis shifts distally
KAFO: proper knee joint location - Correct Answer 1. bisection of adductor tubercle and medial tibial
plateau
2. 60:40 anterior: posterior
KAFO Trimlines: - Correct Answer 1. medial proximal 30 mm distal to perinneum
2. proximal lateral distal to greater trochanter
3. proximal posterior thigh set at 15 deg slant connecting lateral to medial
4. popliteal region allows 105 deg knee flexion
KAFO knee joint clearances - Correct Answer 6mm medial 3 mm lateral
KAFO ankle clearances - Correct Answer 6 mm medial and 5 mm lateral
KAFO analysis - Correct Answer 1. Correct side and foot plate
2. proper strapping materials
3. plastic thickness
4. rivets-- speedy rivets not durable for attaching metal uprights
5. plastazote /p-cell packs down quickly
6. check measurements
7. Check proper ankle and knee joints
8. If KAFO doesn't meet patient's needs do not deliver
KAFO : varus moment control - Correct Answer AFO section: 3 pt pressure 1) prox medial (medial chafe
at tibial strap) 2) proximal lateral malleoli (lateral flange) 3) 1st met head (encompass)
,KAFO hyperextension control after delivery - Correct Answer 1) add padding to calf section
2) increase dorsiassist power (stiffer joints, adjust double action)
3) increase plantarflexion resistance (pf stop, adjust double action)
4) add heel wedge to AFO
KAFO joints that prevent hyperextension (without limiting ADLs) - Correct Answer 1. posterior offset
KAFO correct genuvarum/genuvalgum after delivery - Correct Answer 1. add pull strap proximal and
distal to the knee joint so line of pull corrects deformity
2. add padding proximal and distal to KC (if valgus add padding medially, and if varus add padding
laterally) to increase corrective force
KAFO: pain at at posterior distal thigh indicates what? - Correct Answer knee joint is too proximal
KAFO: pain at anterior distal thigh and posterior proximal thigh indicates what? - Correct Answer knee
joint is too distal
KAFO: what may be the issue if knee joints will not fully lock? - Correct Answer 1. drop locks may be
upside down
2. mechanical KC not aligned with anatomical KC
3. The joints are not squared properly
4. excursion length are uneven
Scenario: pt with metal and leather KAFO with drop locks and double action ankle joints feels unsteady
and trips easily going down ramps. what adjustments? - Correct Answer 1. allow more plantarflexion at
the ankle
2. provide dorsiassist with a spring in the posterior channel (will resist pf and smooth the foot flat
transition)
3. add cushioned heel to shoe
AFO 3 point force system for dorsiflexion weakness (resist PF in swing): - Correct Answer 1. anteriorly
directed force at posterior calf
, 2. posterior and distal force at dorsum of ankle (shoe, instep strap)
3. superiorly directed force at met heads (foot plate)
AFO 3 point force system for plantarflexion weakness (resist DF in stance): - Correct Answer 1. posterior
directed force at tibia
2. anterior and proximal force at heel
3. distal directed force at met heads
AFO Full length footplate considerations - Correct Answer 1. claw toes, hammer toes, toe grasping
2. mid foot fracture
3. tone/spasticity
AFO hyperextension adjustments - Correct Answer 1. heel wedge
2. taller proximal trimline
3. sent 3-4 deg dorsiflexion
4. footplate too rigid-- shorten to sulcus or metheads
AFO 3 point force system for valgus correction/ reduce pronation - Correct Answer 1. medially directed
force at lateral proximal calf band (lateral chafe for tibial strap)
2. lateral directed force at medial supramalleolus (medial flange)
3. medially directed force at 5th methead (encapsulate)
AFO 3 point force for varus correction/ reduce supination - Correct Answer 1. lateral directed force at
medial proximal calf band (medial chafe for tibial strap)
2. medial directed force at lateral supramalleolus (lateral flange)
3. laterally directed force at 1st methead (encompass)
AFO patient: valgus presentation - Correct Answer 1. forefoot abduction
2. calcaneal valgus
3. 1st methead pain and callus
