CFO Clinical Application & Adjustment 3 — Questions and Answers
Question 1: A patient with post-polio syndrome presents with knee hyperextension during stance phase. Which orthotic intervention most directly addresses this gait deviation?
- AFO with dorsiflexion assist
- KAFO with knee joint set in slight flexion (Correct answer)
- AFO with plantarflexion stop at neutral
- SMO with rigid ankle
Correct answer: KAFO with knee joint set in slight flexion
A KAFO with the knee joint set at 5-10° of flexion prevents hyperextension while providing the stability needed for stance phase.
Question 2: When dispensing a new rigid thoracolumbar orthosis (TLSO), the patient reports a pressure area over the iliac crest after 30 minutes of wear. What is the appropriate first step?
- Advise the patient to wear a thicker undershirt
- Trim or flare the offending edge of the orthosis (Correct answer)
- Apply additional padding over the pressure point
- Discontinue wear and refer back to the prescribing physician
Correct answer: Trim or flare the offending edge of the orthosis
Trimming or flaring the edge that contacts the iliac crest redistributes pressure and eliminates the source of the focal pressure area.
Question 3: A pediatric patient with myelomeningocele at L3-L4 level is being evaluated for ambulation. Which orthosis is most appropriate for household ambulation?
- Bilateral solid AFOs
- Reciprocating gait orthosis (RGO) (Correct answer)
- Bilateral KAFOs with locked knees
- Bilateral SMOs
Correct answer: Reciprocating gait orthosis (RGO)
An RGO uses hip flexion on one side to drive hip extension on the other, enabling reciprocal gait for patients with high lumbar-level lesions.
Question 4: A patient fitted with a cervical collar complains of difficulty swallowing. Which collar feature is most likely responsible?
- Excessive occipital support height
- Excessive mandibular support height (Correct answer)
- Insufficient chin support
- Excessive cervical flexion positioning
Correct answer: Excessive mandibular support height
A mandibular support that is too high elevates the jaw, compresses the hyoid region, and impairs the swallowing mechanism.
Question 5: During dynamic gait analysis with an articulated AFO, you observe forefoot contact at initial contact instead of heel strike. This is most consistent with:
- Excessive dorsiflexion stop resistance
- Insufficient plantarflexion resistance
- Excessive plantarflexion stop resistance (Correct answer)
- Insufficient dorsiflexion resistance
Correct answer: Excessive plantarflexion stop resistance
Excessive resistance to plantarflexion prevents the foot from landing heel-first, forcing an initial forefoot or flat-foot contact pattern.
Question 6: A patient with a new below-knee prosthetic socket presents to the orthotics clinic for residual limb padding review. This is outside the scope of the CFO. Which referral is correct?
- Certified Orthotist (CO)
- Certified Prosthetist Orthotist (CPO)
- Certified Prosthetist (CP) (Correct answer)
- Physical Therapist
Correct answer: Certified Prosthetist (CP)
Prosthetic socket management falls within the scope of a Certified Prosthetist (CP) or CPO, not a Certified Fitter Orthotics (CFO).
Question 7: A patient with rheumatoid arthritis presents with MTP subluxation and metatarsalgia. Which forefoot orthotic modification most directly reduces plantar pressure under the metatarsal heads?
- Metatarsal pad placed just proximal to the metatarsal heads (Correct answer)
- Heel pad with extra cushioning
- Full-length EVA foot orthosis without modification
- Lateral wedge posting
Correct answer: Metatarsal pad placed just proximal to the metatarsal heads
A metatarsal pad placed just proximal to the metatarsal heads redistributes pressure away from the heads by loading the metatarsal shafts instead.
CFO Clinical Application & Adjustment 3
A patient with post-polio syndrome presents with knee hyperextension during stance phase.
Which orthotic intervention most directly addresses this gait deviation?