CFO Patient Assessment & Diagnosis 2 — Questions and Answers
Question 1: During a gait analysis, a patient exhibits excessive lateral trunk lean toward the stance leg. This compensation is most commonly associated with which condition?
- Trendelenburg gait due to hip abductor weakness (Correct answer)
- Steppage gait due to foot drop
- Antalgic gait due to knee pain
- Scissors gait due to spasticity
Correct answer: Trendelenburg gait due to hip abductor weakness
Lateral trunk lean (compensated Trendelenburg) occurs when the patient shifts weight over the weak hip abductor side to reduce the demand on those muscles.
Question 2: A certified fitter orthotics reviews a patient's referral noting 'pes planovalgus.' Which clinical finding is MOST expected during the standing assessment?
- Medial longitudinal arch collapse with calcaneal eversion (Correct answer)
- High medial arch with forefoot supination
- Calcaneal inversion with lateral column overload
- Fixed plantarflexion with rigid forefoot
Correct answer: Medial longitudinal arch collapse with calcaneal eversion
Pes planovalgus (flatfoot with valgus) is characterized by medial arch collapse and outward tilting of the calcaneus (eversion).
Question 3: When measuring leg length discrepancy, the 'apparent' leg length is measured from which landmarks?
- Umbilicus to medial malleolus (Correct answer)
- Anterior superior iliac spine to medial malleolus
- Greater trochanter to lateral malleolus
- Posterior superior iliac spine to lateral malleolus
Correct answer: Umbilicus to medial malleolus
Apparent leg length is measured from the umbilicus to the medial malleolus and reflects the perception of discrepancy often caused by pelvic obliquity.
Question 4: A patient presents with a chief complaint of lateral ankle instability and a history of multiple inversion sprains. Which special test is MOST appropriate to assess ligamentous laxity?
- Anterior drawer test of the ankle (Correct answer)
- Thompson test
- Homans' sign
- Tinel's sign at the ankle
Correct answer: Anterior drawer test of the ankle
The anterior drawer test assesses the integrity of the anterior talofibular ligament (ATFL), the most commonly injured ligament in inversion ankle sprains.
Question 5: Which standardized functional outcome tool is specifically designed to measure foot and ankle disorders and is commonly used in orthotic patient assessments?
- Foot and Ankle Ability Measure (FAAM) (Correct answer)
- Oswestry Disability Index (ODI)
- Harris Hip Score
- DASH Questionnaire
Correct answer: Foot and Ankle Ability Measure (FAAM)
The FAAM is a validated patient-reported outcome measure specifically designed to assess functional limitations in people with foot and ankle disorders.
Question 6: During manual muscle testing of ankle dorsiflexion, the patient can move through full range of motion against gravity but fatigues with minimal resistance. This corresponds to what MMT grade?
- Grade 4 (Good) (Correct answer)
- Grade 3 (Fair)
- Grade 5 (Normal)
- Grade 2 (Poor)
Correct answer: Grade 4 (Good)
MMT Grade 4 (Good) indicates full range of motion against gravity with some but not full resistance, distinguishing it from Grade 5 which tolerates maximal resistance.
Question 7: A patient reports numbness and tingling in the plantar aspect of the foot that worsens with prolonged standing. Tapping posterior to the medial malleolus reproduces symptoms. This is consistent with compression of which structure?
- Posterior tibial nerve (tarsal tunnel syndrome) (Correct answer)
- Sural nerve
- Peroneal nerve at the fibular head
- Saphenous nerve
Correct answer: Posterior tibial nerve (tarsal tunnel syndrome)
Tarsal tunnel syndrome involves compression of the posterior tibial nerve as it passes beneath the flexor retinaculum posterior to the medial malleolus, producing plantar paresthesias.
CFO Patient Assessment & Diagnosis 2
During a gait analysis, a patient exhibits excessive lateral trunk lean toward the stance leg.
This compensation is most commonly associated with which condition?