CO Patient Assessment & Evaluation 3 — Questions and Answers
Question 1: When using a pressure mapping system to evaluate a patient's plantar pressure distribution, elevated peak pressure under the first metatarsal head most commonly indicates:
- Pes cavus with clawed toes (Correct answer)
- Hallux valgus with metatarsus primus varus
- Rigid flatfoot with heel valgus
- Functional leg length discrepancy
Correct answer: Pes cavus with clawed toes
Pes cavus typically results in elevated peak pressures under the metatarsal heads and heel due to the rigid high-arched foot structure.
Question 2: A patient presents with a positive Thomas test. This finding primarily indicates:
- Weakness of the hip abductors
- Hip flexor contracture or tightness (Correct answer)
- Posterior hip capsule tightness
- Iliotibial band syndrome
Correct answer: Hip flexor contracture or tightness
A positive Thomas test, where the opposite leg rises from the table when the tested hip is fully flexed, indicates hip flexor tightness or contracture.
Question 3: In spinal orthotic assessment, the term 'three-point pressure system' refers to:
- Three separate measurement points taken along the spine
- The biomechanical principle of applying corrective forces at three locations to control spinal motion (Correct answer)
- Three padded components of a TLSO
- A triplanar measurement technique for scoliosis
Correct answer: The biomechanical principle of applying corrective forces at three locations to control spinal motion
The three-point pressure system applies opposing forces at three strategic points to control or correct spinal alignment in orthotic design.
Question 4: When assessing skin integrity prior to fitting a patient with a total contact cast (TCC), which skin condition is a relative contraindication?
- Mild xerosis (dry skin) on the dorsum
- Shallow grade 1 pressure ulcer on the heel
- Superficial maceration between toes
- Active cellulitis with induration and warmth (Correct answer)
Correct answer: Active cellulitis with induration and warmth
Active cellulitis with induration requires antibiotic treatment before total contact casting to avoid sealing in an active infection.
Question 5: A newly referred patient's medical record lists 'equinovarus' foot deformity. During assessment, the orthotist should expect to find:
- Plantarflexion and inversion with forefoot adduction (Correct answer)
- Dorsiflexion and eversion with forefoot abduction
- Plantarflexion and eversion with forefoot pronation
- Dorsiflexion and inversion with metatarsus adductus
Correct answer: Plantarflexion and inversion with forefoot adduction
Equinovarus combines equinus (plantarflexion) and varus (inversion/supination), commonly seen in clubfoot or post-stroke presentations.
Question 6: Which nerve is assessed by testing sensation on the dorsal web space between the first and second toes?
- Sural nerve
- Deep peroneal (fibular) nerve (Correct answer)
- Superficial peroneal (fibular) nerve
- Tibial nerve
Correct answer: Deep peroneal (fibular) nerve
The deep peroneal nerve provides sensory innervation to the dorsal first web space and motor innervation to the anterior compartment muscles.
Question 7: During functional assessment, a patient with a transtibial prosthesis demonstrates lateral trunk lean toward the prosthetic side during stance. In orthotic/prosthetic assessment, this deviation often suggests:
- Prosthetic foot set too far lateral
- Prosthetic socket too long causing discomfort
- Prosthetic foot set in excessive dorsiflexion
- Short prosthetic limb or excessive lateral wall pressure in the socket (Correct answer)
Correct answer: Short prosthetic limb or excessive lateral wall pressure in the socket
Lateral trunk lean toward the prosthetic side (Trendelenburg-like) is commonly caused by a short prosthesis or hip abductor weakness on that side.
CO Patient Assessment & Evaluation 3
When using a pressure mapping system to evaluate a patient's plantar pressure distribution, elevated peak pressure under the first metatarsal head most commonly indicates: