CFO Clinical Application & Adjustment 2 — Questions and Answers
Question 1: A patient with drop foot presents for AFO fitting. During gait assessment you notice the AFO causes excessive knee flexion in mid-stance. What adjustment is most appropriate?
- Increase the ankle plantarflexion angle
- Decrease the ankle dorsiflexion stop
- Add a posterior trim line extension
- Increase the ankle dorsiflexion angle (Correct answer)
Correct answer: Increase the ankle dorsiflexion angle
Increasing the dorsiflexion angle of the AFO moves the ground reaction force anteriorly, reducing excessive knee flexion in mid-stance.
Question 2: When fitting a supramalleolar orthosis (SMO) for a pediatric patient with hypotonia, which trim line position best controls subtalar pronation while allowing sagittal plane motion?
- Anterior trim lines ending proximal to the malleoli
- Posterior trim lines ending distal to the malleoli
- Medial and lateral trim lines ending at malleolar height (Correct answer)
- Trim lines extending well proximal to the malleoli
Correct answer: Medial and lateral trim lines ending at malleolar height
Medial and lateral trim lines at malleolar height provide subtalar control while preserving sagittal plane ankle motion needed for normal gait.
Question 3: A patient reports lateral knee pain 2 weeks after receiving an unloading knee orthosis for medial compartment OA. What is the most likely cause?
- Insufficient valgus correction angle
- Excessive valgus correction creating lateral compartment overload (Correct answer)
- Improper thigh cuff positioning
- Insufficient posterior support
Correct answer: Excessive valgus correction creating lateral compartment overload
Excessive valgus correction shifts load too far to the lateral compartment, causing lateral knee pain as an overcorrection complication.
Question 4: During follow-up, a patient with a TLSO reports difficulty breathing when the orthosis is worn for extended periods. Which adjustment should be made first?
- Widen the abdominal window (Correct answer)
- Reduce the height of the anterior panel
- Increase thoracic extension padding
- Increase lumbar lordosis in the orthosis
Correct answer: Widen the abdominal window
Widening the abdominal window reduces compression on the diaphragm, directly addressing breathing difficulty caused by the TLSO.
Question 5: A patient fitted with a foot orthosis for plantar fasciitis continues to report heel pain. Examination reveals a tight Achilles tendon. Which modification is most appropriate?
- Add a metatarsal pad
- Increase medial arch height
- Add a heel lift to reduce Achilles tension (Correct answer)
- Add lateral forefoot posting
Correct answer: Add a heel lift to reduce Achilles tension
A heel lift reduces tension on the Achilles tendon and plantar fascia by decreasing the demand for dorsiflexion during the gait cycle.
Question 6: Which finding during diabetic shoe fitting requires immediate referral before orthotic delivery?
- Mild hammertoe deformity with adequate shoe depth
- Non-healing ulcer on the plantar surface (Correct answer)
- Mild bunion without skin breakdown
- Hallux valgus with intact skin
Correct answer: Non-healing ulcer on the plantar surface
A non-healing ulcer indicates active wound requiring medical management before any orthotic fitting to prevent further injury or infection.
Question 7: A patient with spastic cerebral palsy is fitted with solid AFOs but reports toe clawing during ambulation. What is the most likely cause?
- Excessive dorsiflexion angle in the AFO
- Footplate does not extend to the metatarsal heads (Correct answer)
- Insufficient heel cup depth
- Excessive ankle plantarflexion angle
Correct answer: Footplate does not extend to the metatarsal heads
When the footplate ends proximal to the metatarsal heads, toes cannot rest on a supportive surface, triggering a grasp reflex and toe clawing.
CFO Clinical Application & Adjustment 2
A patient with drop foot presents for AFO fitting.
During gait assessment you notice the AFO causes excessive knee flexion in mid-stance.
What adjustment is most appropriate?