CTO Patient Evaluation & Measurement 3 — Questions and Answers
Question 1: When evaluating forefoot varus using a subtalar neutral casting technique, the patient's subtalar joint should be positioned:
- In full inversion
- In full eversion
- In the neutral position (Correct answer)
- At the end range of dorsiflexion
Correct answer: In the neutral position
Casting or measurement of forefoot alignment is performed with the subtalar joint in neutral to isolate intrinsic forefoot deformity from rearfoot compensation.
Question 2: A patient's skin integrity evaluation reveals grade 2 pressure injury over the fibular head. What is the appropriate next step before orthotic fitting?
- Proceed with fitting using extra padding
- Delay fitting and notify the prescribing clinician (Correct answer)
- Apply a skin protectant and continue fitting
- Reduce overall orthosis height to avoid the area
Correct answer: Delay fitting and notify the prescribing clinician
An existing pressure injury is a contraindication to immediate orthotic application; the prescribing clinician must be notified to address wound management first.
Question 3: During volumetric water displacement measurement of a residual limb, the primary purpose is to:
- Assess edema changes over time (Correct answer)
- Determine prosthetic socket shape
- Measure total limb girth for coding
- Calculate limb weight for suspension
Correct answer: Assess edema changes over time
Volumetric water displacement provides an accurate, reproducible measure of limb volume to track edema fluctuations across clinical visits.
Question 4: Observation of a patient walking reveals an equinus gait pattern. Which functional range-of-motion deficit is the primary contributor?
- Insufficient knee extension
- Inadequate ankle dorsiflexion (Correct answer)
- Limited hip extension
- Reduced subtalar eversion
Correct answer: Inadequate ankle dorsiflexion
Equinus gait results from insufficient ankle dorsiflexion, preventing the tibia from advancing over the foot during midstance and terminal stance.
Question 5: For a pediatric patient being measured for a hip abduction orthosis, which key measurement determines abduction angle settings?
- Greater trochanter to medial condyle distance
- Hip flexion contracture measured by Thomas test
- Radiographic center-edge angle of Wiberg (Correct answer)
- Intertrochanteric width
Correct answer: Radiographic center-edge angle of Wiberg
The center-edge angle from radiographs indicates acetabular coverage of the femoral head, directly guiding the abduction angle needed to maintain reduction.
Question 6: A patient is referred for cervical orthosis fitting after a C5 fracture. Which measurement is used to determine the proper chin-rest height?
- Ear-to-shoulder distance
- Chin-to-sternum distance in neutral (Correct answer)
- Tragus-to-shoulder length
- Neck circumference at C4
Correct answer: Chin-to-sternum distance in neutral
Chin-to-sternum distance in neutral head position determines the vertical dimension of the anterior section to maintain cervical alignment in a cervical orthosis.
Question 7: Sensation testing during patient evaluation for an insensate foot reveals absent protective sensation. This finding most critically influences orthotic design by requiring:
- Use of a more rigid shell material
- Inclusion of a total-contact fit to distribute pressure (Correct answer)
- Prescription of a higher trim line
- Selection of a softer, compressible liner
Correct answer: Inclusion of a total-contact fit to distribute pressure
Insensate feet cannot perceive early pressure warning signals, making total-contact design essential to distribute load and prevent focal pressure injuries.
CTO Patient Evaluation & Measurement 3
When evaluating forefoot varus using a subtalar neutral casting technique, the patient's subtalar joint should be positioned: