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PEDORTHICS FINAL EXAM (
QUESTIONS AND ANSWERS) 2024
LATEST UPDATED GRADED A+.
what midfoot bone is relieved by adding the ST groove? - Solution navicular the triplanar joints of the foot are parallel to the cardinal planes t/f - Solution false - these joints are non-parallel which joint of the foot is a composite joint with 2 different joint axes? - Solution MTJ (midtarsal joint) what is true for the medial foot column? - Solution more flexible than the lateral foot column which joint of the foot is the primary provider of DF and PF? - Solution talocrural joint, TCJ the primary motions of the TCJ is PF and DF. because the joint axis is pitched 10 degrees from the transverse plane, what are the secondary motions? - Solution this ADducts and inverts. Or, it ABducts and everts the "ST modification" prevents the sustentaculum tali from collapsing laterally, which prevents calcaneal varus. t/f - Solution false, this modification helps the outer sides, and stops this problem the lateral column of the foot typically accepts what percentage of force throughout stance phase? - Solution 30% this bony prominence may be a problem of concern for patients with ERD - Solution cuboid the STJ include articulations of which bones? - Solution calcaneus and talus
the subtalar joint usually allows for what degrees of motion in a non- pathological foot? - Solution 30 degrees inversion, 10 degrees eversion internal rotatory deformity (IRD) includes these 3 motions - Solution 1. calcaneal valgus,
- midfoot pronation 3, forefoot abduction external rotatory deformity (ERD) includes these 3 motions - Solution 1. calcaneal varus
- midfoot supination
- forefoot adduction The orthotic synonym of IRD: - Solution pes planus In order to make certain that the foot is in subtalar neutral - Solution there must be equal to no pressure on either side of the talus is it possible to block motion in one cardinal plane without altering motion in either of the other cardinal planes? - Solution no, this isolation of triplanar motion is impossible. extrinsic posting? intrinsic posting? - Solution extrinsic posting? is adding a wedge on the outside intrinsic posting is changing the model itself. if you remove material from the lateral aspect of the heel to reduce varus, it is extrinsic posting? or intrinsic posting? - Solution then this is an intrinsic modification when you add plastic to the lateral plantar side of the foot orthosis heel you are doing: extrinsic posting? intrinsic posting? - Solution an extrinsic modification when you add plaster material to the medial aspect of the metatarsal portion of the mold, then you are doing: extrinsic posting? intrinsic posting?
- Solution an intrinsic modification
the counter is - Solution where the heel rests back upon the footbed is - Solution the curved top in the sole of the shoe the shank is - Solution the metallic slit within the sole sesamoiditis causes pain under 1st MTP during? - Solution toe off and late midstance a goal for treating PTTD is to - Solution stop pronating, forefoot abducting, internal tibial rotating, and calcaneal valgus metatarsalgia treatment 3 types - Solution 1. shear reducing top
- met pad
- met bar is morton toe the same as morton neuroma? - Solution no, these 2 are different morton's neuroma is thickening of the plantar nerve between? - Solution the 3rd and 4th met heads a good treatment for morton neuroma is using a met pad to support? - Solution the transverse arch former stroke patients have what rate more to have vascular disease? - Solution they have 2 to 4 times more 70% of diabetics have some form of? - Solution diabetic neuropathy when assessing for foot orthotics it is important to measure the foot with a?
- Solution a Brannock device why is it important to evaluate an existing shoe? - Solution 1. to assess wear patterns
- to assess size appropriateness
- to consider closure options what purpose do the toe crests serve? - Solution they keep toes extended and fill the space in sulcus keeping the fat pad under the met heads
Orthotic success depends on: - Solution good shoe fit 10 shoe components - Solution 1. toe box
- vamp
- throat
- eyelet
- tongue
- collar
- counter
- heel
- sole
- lace stay 6 shoe components - Solution 1. upper
- foot bed
- insole
- midsole
- steel shank
- outsole EVA Crepe 3 facts: - Solution 1. higher durometer
- heavier
- good for little compression need (posts, higher weight individuals) EVA Cloud 4 facts: - Solution 1. lower durometer
- softer
- shock absorber
- lighter than crepe (good for heel and sole lifts) shoe lasts are: - Solution 1. the model the shoe is made on
- determines the shape of the shoe American shoe scale - Solution 1. women's is 1.5 greater than men's
- child youth continuation of men's EX1: Child or Youth, 1, 2, ...13, 1, 2, ... (varies). EX2: Men's (around) 5, 6, ...15, etc.
- Mary Jane 3 measurements for shoe fitting principles - Solution 1. overall foot length
- arch length (heel to ball)
- width for shoe fitting principles, both feet need to be: - Solution measured 2 categories of shoe fitting principles exist: - Solution 1. weight bearing
- non-weight bearing when measuring, it is necessary to measure what? - Solution measure foot size only, not necessarily the shoe size. there are differing manufacturer standards 2 measuring devices - Solution 1. Brannock
- Ritz Stick Proper fit guidelines, 10 things: - Solution 1. measure both feet
- check shoes with O&P device if needed
- check fit of both shoes (weight bearing)
- check that ball of foot rests in widest part of shoe
- check for correct toe length (3/8" to 1/2" of space)
- check for proper width (upper material shouldn't be stretched taught)
- check for proper fit over instep
- check for snug heel fit
- check for closure function (laces or velcro)
- patient should walk with shoes before completing delivery upper shoe modifications include 3 things: - Solution 1. donning/doffing aid
- spot relief
- toe box stretch soling shoe modifications include 3 things: - Solution 1. accommodate deformity
- give additional support
- improve function and ease of ambulation 3 facts about shoe modifications: - Solution 1. shoe selection is key
- many commercial shoes have the desirable traits
- most commercial shoes can be modified (difficulty and time varies according to shoe type and soling) rocker soles, 8 facts: - Solution 1. one of the most commonly used
- ___ foot from heel strike to toe off (without shoe bend)
- enhances and eases forward propulsion
- offload areas of high pressure
- reduces bending forces
- replaces and restores lost motion due to injury and deformity
- Midstance: middle portion of rocker sole in contact with ground during stance phase
- Apex: (high point of _____ ____, located at distal end of the midstance (if goal is to offload, then apex must be proximal to pressure area) 9 things about mild rockers: - Solution 1. most basic and widely used
- used to reduce pressure under met heads
- eases forward propulsion
- can reduce motion at 1st MTP joint (metatarsophalangeal)
- can replace motion lost due to addition of steel shank
- common in walking/running shoes
- 8 indications: 1-Metatarsalgia, 2-healed ulcer maintenance, 3- pes cavus foot, 4- minor ankle pain, 5- toe amputation, 6-painful flatfoot, 7- hallux limitus, 8- when AFO is used
- can use with steel shank
- shaping involves 3/8" to 3/4" total apex height (apex behind 5th MT (metatarsal)) 8 things about forefoot rockers: - Solution 1. significant rocker at toe, very mild rocker at heel
- midstance extends all the way to posterior of shoe
- increases weight bearing proximal to metatarsal heads (primary use)
- stable midstance
- reduces need to toe DF (dorsiflexion) on toe off
- 5 indications: 1- hallux rigidus, 2- post-operation (surgical fusion of MP or IP joint), 3- extreme metatarsalgia, 4-offloading of healing ulcer located distal to met heads, 5-relieve callous on distal portion of toes
- may be used with steel shank
- shaping: 3/4"-1" total apex height (apex located 1/2" to 5/8" behind 5th metatarsal
- 3 indications: 1- midfoot prominence maintenance, 2- nodules on bottom midfoot, 3- charcot joint
- shaping: 3/8" to 3/4" total apex height (varies). forefoot apex is at metatarsals. heel apex is 1/6 length of shoe. depression at center of midfoot prominence being unloaded and 1/4" to 1/2" deep. wedges/flares - Solution 1. a medial or lateral extension of sole that provides stabilization
- can be added to heel only, or entire length of shoe
- flares for stabilization, not correction
- wedges are used to help correct flexible deformities of hindfoot or forefoot
- wedges contraindicated for fixed deformities elevations 6 things: - Solution 1. compensate for acquired or congenital limb length discrepancy
- offset discrepancy from O&P device
- ease swing phase of contralateral limb
- can be internal or external
- can be under heel only or entire length of shoe
- up to 1/2" buildup inside shoe, otherwise external buildup steel shank 6 facts: - Solution 1. extended rigid ____ materials: spring steel and carbon
- placed between layers of outsole, extending from heel to medial toe of shoe
- usually used with rocker sole
- eliminates/reduces bending stresses in mid/forefoot
- add to overall strength/stability
- charcot, partial foot upper modifications 3 facts: - Solution 1. stretching of material to increase width or spot stretch, only if material allows for this
- modify/change closure material
- heel counter modification 5 complications necessitating amputation - Solution Keyword In Tin Can
- Infection
- Neoplasm
- Trauma
- Ischemia
- Neuropathy Why is trauma with neuropathy an issue? - Solution 1. patient doesn't know there is a wound
- importance of footwear at all times (no bare feet) (no stocking) metatarsus adductus uses what shoe type? - Solution Markell shoes infection of neuropathic wounds would be by what vector? - Solution bacteria talipes equinovarus is also: - Solution 1. clubfoot
- 70 male, 30 female
- bilateral in 50% of cases
- idiopathic
- secondary to spina bifida ischemia is: - Solution restricted blood flow why is ischemia an issue? - Solution no blood influx means no healing or defending neoplasm is: - Solution cancerous proliferation of cell 2 types of neoplasm: - Solution 1. non-malignant
- malignant percutaneous tenotomy is: - Solution a lengthening of the achilles tendon limb salvage 5 facts: - Solution 1. hospitalization
- higher cost in healthcare
- increase in demand/interest
- newer procedures for healing make it possible
- avoid detriment to psychology of amputation toe amputations are more common in: - Solution older patients ray resection - Solution surgery of choice for problems of 4th and 5th rays
The tarsus consists of the..? - Solution Calcaneus, Talus, Navicular, Cuboid, Cuneiforms The calcaneus has _____ articular surfaces. It also contains an insertion point for the _______ tendon. - Solution 6, achilles An ST modification is performed to prohibit the sustentaculum tali from collapsing _______ preventing Calcaneal ________ - Solution medially, valgus The talus is the ______ largest tarsal bone, it has no muscle attachment, and lacks ________ which makes it harder to heal - Solution 2nd, good blood supply The navicular articulates with 4 bones through the proximal and distal facet. Sometimes it also articulates with the ________ through the lateral facet - Solution cuboid The 6 hot spots of the foot are the..? - Solution Medial Malleolus, Lateral Malleolus, Navicular, Base of 5th Metatarsal, 5th metatarsal head, and 1st metatarsal head The ankle joint is also called the _______ joint - Solution talocrural T or F, the talocrural joint is made up of the distal end of the fibula? - Solution True, the lateral malleolus is the distal end of the fibula The talocrural joint is made up of the..? - Solution distal end of tibia, medial malleolus, lateral malleolus, trochlea of talus The subtalar joint mainly produces __________ motion - Solution Inversion/Eversion The subtalar joint mainly consists of the articulation of the _______ and ________ - Solution talus, calcaneous (the posterior navicular also makes up a part of the joint) The upper surface of the plantar calcaneonavicular spring ligament can be found at the _____________ articulation - Solution Talocalcaneonavicular
The transverse tarsal joint or _________ is made up of the _________ and ________ articulation - Solution Mid-tarsal joint, calcaneocuboid, Talocalcaneonavicular The _________ ligament or "spring" ligament maintains the _______ longitudinal arch. - Solution Plantar Calcaneonavicular, medial The _______ ligament goes from medial malleolus to tarsal bones. It maintains the medial longitudinal arch and prevents __________ - Solution deltoid, eversion The ________ produces the ________, which occurs when the toes extend and the medial longitudinal arch is raised - Solution Plantar Aporneurosis (Plantar fascia), Windlass Effect The main functions of the foot are..? - Solution Shock absorption, Adaptation to surfaces, Propulsion The articulations of the foot are _______, which allows simultaneous movement in all 3 planes. - Solution triplanar T or F, it is possible to impact the movement of the triplanar foot articulations in one plane without altering the other two planes? - Solution False, their is simultaneous movement in all 3 planes if you impact one you impact them all. The talocrural joint allows for _______ degrees of dorsiflexion and _______ degrees of plantar flexion. The motion is not pure because their is movement in the transverse plane (10 degrees) and frontal plane (20- degrees). - Solution 12-20, 50- The Midtarsal Joint is a composite joint made up of attachments between the _________ and the _________ - Solution Talus/Navicular, Calcaneous/Cuboid The Midtarsal Joint has two separate axes which provide forefoot _______ and forefoot ________. - Solution Plantar Flexion/Dorsiflexion, Adduction/Abduction
T or F, FOs can only control forefoot transverse motion with a shoe? - Solution True Foot Orthoses use ground reaction forces in a ________ kinetic chain to control foot deformities. - Solution closed What are the two ways orthotists use ground reaction forces in orthoses? - Solution Posting, locking out the ankle joint Adding or removing material from the mold is an ________ modification - Solution intrinsic Adding or removing material from the orthoses is an example of a ________ modification - Solution extrinsic If a patient has a rigid first ray, an orthoses can be made with extrinsic posting on the _______ side - Solution lateral If a patient has calcaneal valgus, an extrinsic and intrisic post can be placed on the ________ side to put the calcaneous in neutral - Solution medial The foot is ______ for shock absorption and _______ for propulsion - Solution flexible, rigid Initial contact of the foot creates a vertical force that is _______ of body weight - Solution 80 percent Loading response of the foot places a force ______ of body weight. - Solution 115 percent Heel lift from the floor creates a force that is _______ of body weight. - Solution 110 percent ________ joint motion creates simultaneous movement in cardinal planes - Solution Triplanar T or F, if abnormalities are caused by muscle imbalance, FOs and posting are not enough - Solution True
The talocrural joint is pitched _______ degrees from the transverse plane. - Solution 10 The secondary motions of the talocrural joint are forefoot ______ with plantar flexion, and forefoot ________ with dorsiflexion. - Solution Adduction/Inversion, Abduction/Eversion The ______ ligament and _______ ligament stabilize the motion of the talocrural joint - Solution medial (deltoid), lateral collateral The angle between the axis of the ankle joint and long axis of tibia is tilted medially _______. - Solution 80 degrees The ankle axis is externally rotated _________ degrees in relation to the knee - Solution 20- The ankle is ______ degrees internally rotated in relation to the foot - Solution 6 The subtalar joint axis goes from anterosuperior to posteroinferior it has a ______ degree pitch angle in relation to the transverse plane, ________ degree pitch angle from sagittal, and ________ degree pitch angle from frontal plane. - Solution 42, 16, 48 The subtalar joint can provide about _______ degrees of inversion with slight DF/ADD of talus. The subtalar joint can provide about _______ degrees of eversion with PF/ABD - Solution 30 Stance phase eversion is normally _____ degrees, _______ degrees with pes planus - Solution 8, 12 ________ feet exhibit less subtalar motion. - Solution Cavus The Midtarsal joint is supported by the _____ and ______ plantar ligaments and the calcaneonavicular ligament - Solution short, long The transverse tarsal joint has 2 axes. One is directed _________ and the other is __________ - Solution longitudinally, oblique
At initial contact the forefoot is ________ - Solution supinated The eccentric tibialis anterior _______ plantar flexion in the forefoot. - Solution decelerates During the loading response the midtarsal joint becomes fully _______, due to eversion of the subtalar joint and ground reaction forces. - Solution supinated The extensor digitorum longus and peroneous tertius muscles ________ the forefoot preparing it to receive midstance loading forces - Solution abduct and dorsiflex During Midstance the subtalar joint is in max ________ and then it begins to _________. The midtarsal joint is also locked in _________ and begins to _________. - Solution pronation, resupinate, pronation, resupinate At midstance, STJ supination causes the ________ axis of the Midtarsal joint to supinate. This maximizes joint stability and converts the foot to a rigid lever arm. - Solution oblique During the propulsion phase the ________ of the foot comes into contact with the ground making it rigid - Solution lateral column Supination of the subtalar joint requires concentric activity of..? - Solution tibialis posterior, flexor hallucis longus, flexor digitorum longus, soleus, and antagonistic peroneal brevis muscle For extrinsic posting the first number in 4/4 denotes..? - Solution The degrees of lateral grind on the post that holds the front edge everted before forefoot loading For extrinsic posting the second number in 4/4 denotes..? - Solution The amount of motion the orthosis has when the front edge comes down to the ground. What does a 0/0 post designate? - Solution The post is ground parallel to the front edge of the orthotic, and is intended to keep the front edge flat in the shoe regardless of movement.
A 4/0 post is only necessary for a patient with _______. - Solution uncompensated rearfoot varus Diabetic shoes are unique because they have..? - Solution extra depth/width , special foams, flexible vamps Diabetic shoes are extra deep to accomodate for.. - Solution toe fillers, toe deformities, and edema Diabetic Shoes are extra wide to accomodate for.. - Solution bunions, toe deformities, toe fillers, edema, orthotic inserts When ordering a diabetic shoe from a custom fabrication facility you generally must supply a.. - Solution semi weight bearing plaster mold on a foam block and a tracing of the foot What is Hallux Valgus? - Solution A lateral deviation of the proximal phalanx of the big toe (Bunion). Possibly an inflammation of bursa over the medial aspect of MTP 1. Orthotic Interventions for Hallux Valgus are.. - Solution full length orthosis, controlling pronation during loading response, offload high pressure areas, toe separator Footwear accomodations for hallux valgus are.. - Solution extra wide shoes, spot stretch, high toe box, stiff sole to limit ROM, low heel What is Hallux Rigidus? - Solution Degenerative Arthritic changes in the 1st MTP The orthotic interventions for Hallux Rigidus are..? - Solution Full length orthosis, mortons extension, carbon fiber footplate What are the footwear solutions for Hallux Rigidus? - Solution Low heel, stiff sole to limit 1st MTP ROM, High Toe Box, Rocker bottom sole, rigid extended sole bar What is Sesamoiditis - Solution Inflammation of the Sesamoid Bones, Discomfor plantar to 1st MTP
