Partial Foot/Symes/Transtibial Flashcards
A ground reaction force medial to the center of the prosthetic socket (weight line) at midstance will create a/an ____ at the knee
a. Flexion moment
b. Extension moment
c. Varus moment
d. Valgus moment
c. Varus moment
SACH foot heel compression at loading response simulates _______.
a. Plantarflexion
b. Dorsiflexion
c. Dynamic response
d. Forefoot supination
a. Plantarflexion
In reference to TT prosthetics excessive adduction of the prosthetic pylon would cause what at midstance in gait:
a. Genu varum
b. Genu valgum
c. Genu flexion
d. Genu extension
b. Genu valgum
A gel liner should always be used with which of the following socket designs?
a. PTB
b. TSB
c. Side joint and lacer
d. Ischial containment
b. TSB
Why is choosing a SACH foot with a firm heel durometer not advised for TT patients with poor prosthetic side knee stability?
a. It will increase knee stability
b. It will decrease knee stability
c. It will increase shock absorption at heel initial contact
d. It will not provide enough keel resistance
b. It will decrease knee stability
Aligning the transtibial socket in slight flexion ____.
a. Increases stabilization in the coronal plane.
b. Provides proper positioning for a varus moment at the knee.
c. Puts hamstrings on stretch.
d. Increases surface area for weight bearing during stance phase of gait.
d. Increases surface area for weight bearing during stance phase of gait.
A major goal in children with a lower extremity amputation is:
a. Encouragement of bony overgrowth
b. Preserve the epiphyses
c. Prevention of verrucous hyperplasia
d. Preservation of exotosis
b. Preserve the epiphyses
Which of the following is not part of a Symes amputation procedure:
a. Removal of the malleoli “distal aspect”
b. Placement of thick heel pad
c. Amputation through the articulation of the ankle
d. Transmetatarsal amputation
d. Transmetatarsal amputation
A transtibial socket that is in excessive ____ will have a pylon with a ____ lean.
a. Extension; lateral
b. Abduction; lateral
c. Flexion; medial
b. Abduction; lateral
The most common cause of transtibial amputation is __.
a. Buergers Disease
b. Frostbite
c. Bacterial meningitis
d. Peripheral vascular disease
d. Peripheral vascular disease
With the mechanical joint center positioned posterior to the AKCR, where would the patient experience pressure between the thigh/corset
and the RL/socket?
Posterior thigh/posterior socket
You have a patient that comes in for a replacement socket due to atrophy, she is active with hobbies of hiking, playing softball, horseback riding and gardening; she
currently works full time as a real-estate agent, and is independent in all her ADLS, and lives alone. What would be her K level classification?
a. K1
b. K2
c. K3
d. K4
c. K3
A new patient states isolated distal pressure on his residual limb. What is the most likely cause?
a. Inadequate sock ply
b. Improper socket alignment
c. Prosthesis is too short
d. Socket is too tight
a. Inadequate sock ply
Where can you expect residual limb pressure if the socket is in too much abduction?
a. distal medial, proximal lateral
b. distal lateral, proximal medial
c. distal anterior, proximal anterior
d. distal posterior, proximal anterior
b. distal lateral, proximal medial
Your patient changes their shoe from their 3/8” heel height athletic shoe to a
cowboy boot with a 1” heel, what type of moment will they experience at their
knee when attempting to walk with the boot?
a. Varus moment
b. Extension moment
c. Valgus moment
d. Flexion moment
d. Flexion moment
Eloise is retired and lives with her husband Gerald in a one-story house in Redlands. She has 8 grandchildren which she sees regularly. She enjoys gardening and uses a cane to help her ambulate more easily. She also likes to walk around her neighborhood in the morning and evening (slowly, she says), which takes about 15-20 minutes.
She has recently gained 15 pounds. She is not diabetic but did injure her left ACL a few years ago and has 8 degrees of hyperextension at midstance. She is 5’2” and weighs 155 lbs. Based on the information above, which type of socket design and suspension would you select for Eloise?
a. Hybrid socket with side joint and thigh lacer
b. Total surface bearing (TSB) with gel liner and cushion sleeve
c. Supracondylar suprapatellar (SPSC) with pelite insert and cotton socks
d. Hybrid design with skin fit suc.on suspension
c. Supracondylar suprapatellar (SPSC) with pelite insert and cotton socks
When considering the use of a supra-condylar suspension system what is the minimum difference between the PML and the ML you need to achieve adequate suspension?
a. 2.5cm
b. 1.25”
c. ¼”
d. PML and ML should be the same
c. ¼”
When is a waist belt/fork strap suspension system indicated?
a. Adolescent patients wishing to increase their activity level
b. Elderly patients with limited hand dexterity
c. Post-operative and early stage prosthetic fittings
d. Visually impaired patients
c. Post-operative and early stage prosthetic fittings
___ is the result of loss of distal contact in the socket.
a. Verrucous hyperplasia
b. Atrophy of residual limb
c. Neuropathy
d. Numbness
a. Verrucous hyperplasia
Myoplasty can be described as:
a. A condition associated with the loss of sarcomeres
b. The suturing and permanent attachment of a muscle to a bone
c. The suturing or permanent attachment of a muscle to another muscle
d. A muscle experiencing hypertrophy
c. The suturing or permanent attachment of a muscle to another muscle
Which is NOT an advantage of a multiaxial foot/ankle?
a. Increased energy requirements
b. Accommodates uneven terrain
c. Reduces adverse socket pressures by absorbing torques caused by uneven
terrain
d. Provides additional stability on uneven surfaces
a. Increased energy requirements
How does the prosthetic foot simulate the heel rocker action observed in a natural foot/ankle?
a. Compression of the heel
b. Deflection of the keel (toe)
c. By having a split toe plate
d. Heel rocker cannot be simulated
a. Compression of the heel
Dorsiflexing the prosthetic foot is synonymous with __:
a. Flexing the prosthetic socket
b. Extending the prosthetic socket
c. Switching to a shoe with a lower heel height
d. Switching to a shoe with a wider heel
a. Flexing the prosthetic socket
Which amputation is one performed through the talonavicular and
calcaneocuboid joints?
a. Chopart Amputation
b. Boyd Amputation
c. Lisfranc Amputation
d. Transmetatarsal Amputation
a. Chopart Amputation
The second stage of the two stage Symes amputation is removal of:
a. The heel pad
b. The talus
c. The malleoli
d. The cuboid
c. The malleoli
Which suspension system is most proficient at minimizing vertical movement of the residual limb within the socket?
a. Cuff strap suspension
b. Pin/lock suspension
c. Atmospheric pressure (suction) suspension
d. Knee sleeve suspension
c. Atmospheric pressure (suction) suspension
A dynamic response foot can be identified by its typical _______
a. “J” or “C” shape
b. Articulating “ankle”
c. Split keel
d. Wood and foam construction
a. “J” or “C” shape
One inherent problem with proximal levels of foot amputation is
a. Cosmesis
b. Equinovalgus deformity
c. Dorsiflexion contracture
d. Equinovarus deformity
d. Equinovarus deformity
When performing bench alignment and determining the AP position of the
prosthetic foot under the socket the patients “weight line” should pass through a
point that bisects the socket in the ________ plane and fall ________ the center of the foot bolt.
a. Coronal/ 1” anterior to
b. Sagittal/ through
c. Coronal/ ½” medial to
d. Sagittal/ 1” anterior to
d. Sagittal/ 1” anterior to
When external rotation of the prosthetic foot is needed the toe lever or keel of the foot is relatively:
a. Lengthened
b. Shortened
c. Softened
d. Hardened
b. Shortened
The supra-condylar suspension system primarily suspend over which anatomical
structure?
a. Lateral femoral condyle
b. Medial femoral condyle
c. Patella
d. Medial tibial condyle
b. Medial femoral condyle
Prosthetic alignment refers to ________________
a. Gait deviations observed as a result of poor gait habits by the pa.ent
b. Prevention of vertical movement of the residual limb within the socket
c. The position of the prosthetic foot in relation to the socket
d. Absorption of shear forces by the socket interface material
c. The position of the prosthetic foot in relation to the socket
A prosthetic foot with a heel that is too soft for the patient is likely to cause which type of moment at the knee during loading response?
a. Extension
b. Flexion
c. Varus
d. Valgus
a. Extension
You are doing a gait assessment with your patient that has a below knee prosthesis. You notice that there is lateral trunk bending at mid stance to the prosthetic side. Choose the choice that would NOT be a potential cause of this
gait deviation:
a. Prosthesis too short
b. Residual limb pain
c. Prosthesis too long
d. Weak quadriceps
d. Weak quadriceps
At what phase of gait is it most important for the socket to be comfortable and supportive, the alignment to create stability, and the prosthetic foot to be a stable
weight bearing surface?
a. initial contact
b. loading response
c. midstance
d. swing
c. midstance
At what period during the gait cycle is it most important for the prosthetic foot to be a stable weight bearing surface?
a. Loading response
b. Double limb support
c. Single limb support
d. Terminal swing
c. Single limb support
Excessive abduction of the socket will result in ______
a. Foot outset
b. Foot inset
c. Foot pronation
d. External rotation of the foot
b. Foot inset
The keel of a SACH foot is made of what material?
a. Fiberglass
b. Multi-durometer urethane
c. Semi-rigid lightweight plastic
d. Wood
d. Wood
When performing bench alignment and determining the ML position of the foot
under the socket the patient’s “weight line” should be ½” medial from the bisected
socket in ___ plane and fall ___ the center of the foot
bolt.
a. Sagihal/ 1” anterior to
b. Sagihal/ 1” posterior to
c. Coronal/ ½” medial to
d. Coronal/ through
d. Coronal/ through
Which of the following circumstances would a prosthetic patient report “walking up a hill”?
a. Toe lever is too short
b. Toe lever is too long
c. Foot category is too low for the patient
d. Heel bumper is too stiff
b. Toe lever is too long
With the mechanical joint center positioned inferior to the AKCR, where would the patient experience pressure between the thigh/corset and the RL/socket?
a. Posterior thigh/posterior socket
b. Posterior thigh/anterior socket
c. Anterior thigh/anterior socket
d. Anterior thigh/posterior socket
d. Anterior thigh/posterior socket
Which of the following is NOT a pressure sensitive area of the transtibial residual limb?
a. Patella tendon
b. Medial femoral condyle
c. Distal/anterior tibia
d. Tibial crest
a. Patella tendon
An IPOP does all of the following except:
a. Allow knee flexion
b. Reduces edema and pain
c. Begins desensitizing the limb
d. Protect the residual limb
a. Allow knee flexion
A socket that is aligned in excessive ABduction results in a prosthetic foot that is
excessively _____ in relation to the socket (weight line) once the patient
dons the prosthesis.
a. Out-set
b. In-set
c. Plantarflexed
d. Posterior
b. In-set
The most appropriate foot for a K-3 level prosthetic patient is
a. SAFE foot
b. Seattle Light
c. Dynamic response
d. SACH foot
c. Dynamic response
You receive an order for a patient to be seen at home for prosthetic care. He uses
a cane for added stability, goes shopping for groceries, and leisurely walks through his neighborhood with his wife. What would his K level be classified as?
a. K0
b. K1
c. K2
d. K3
c. K2
Which of the following is a tarsal-metatarsal disarticulation?
a. Lisfranc
b. Chopart
c. Boyd
d. Trans-metatarsal
a. Lisfranc
A conical shaped residual limb is often associated with ____________.
a. A bony limb with little surrounding soft tissues
b. A fleshy residual limb with excessive adipose tissue
c. Post-surgical edema
d. An amputation caused by a traumatic injury
a. A bony limb with little surrounding soft tissues
The bumpers in a single axis foot simulate which function of the foot/ankle?
a. Provides active plantarflexion and dorsiflexion throughout the gait cycle
b. Controls plantarflexion in early stance and provides resistance to
dorsiflexion in late stance
c. Simulates inversion and eversion accommodating uneven terrain
d. Allows for extension of the MTP joint at terminal stance and pre-swing
b. Controls plantarflexion in early stance and provides resistance to dorsiflexion in late stance
Myodesis can be described as
a. A condition associated with calcification of muscle fibers
b. The suturing and permanent attachment of a muscle to a bone
c. The suturing or permanent attachment of a muscle to another muscle
d. A muscle going through atrophy
b. The suturing and permanent attachment of a muscle to a bone
For BK bench alignment, how many degrees of rotation should there be at the foot?
a. 3-5 degrees external rotation
b. 3-5 degrees internal rotation
c. 5-10 degrees external rotation
d. 5-10 degrees internal rotation
a. 3-5 degrees external rotation
What is the maximum amount of knee flexion contracture that could be fit with a traditional TT PTB socket:
a. 10 degrees
b. 15 degrees
c. 25 degrees
d. 35 degrees
c. 25 degrees
A TT patient is seen in clinic. Upon examining gait you notice a mild extension
moment at the knee in stance phase. What could be the cause? Note: alignment is proper
a. Prosthetic keel too short
b. Prosthetic heel is too firm
c. Prosthetic Keel is too soft
d. Prosthetic heel is too soft
d. Prosthetic heel is too soft
Which of the following suspension systems is most proficient at preventing vertical motion of the residual limb within the socket?
a. Knee sleeve
b. Atmospheric pressure
c. Pin/lock
d. Waist belt and fork strap
b. Atmospheric pressure
When removing endoskeletal prosthetic componentry for adjustment, how do you
save your original alignment:
a. Completely back out two opposing bolts
b. Completely back out three adjacent bolts
c. Completely back out two adjacent bolts
d. Completely back out all bolts
c. Completely back out two adjacent bolts
If the socket is too posterior, how might the patient describe what they are feeling during ambulation?
a. “feels like i’m walking uphill”
b. “feels like i’m walking downhill”
c. “feels like my knee is buckling”
d. “feels like my foot is squishy”
a. “feels like i’m walking uphill”
For BK bench alignment, how many degrees of socket flexion is required?
a. 5 degrees
b. 3-5 degrees
c. no socket flexion required
d. 1/2 inch
a. 5 degrees
Which of the following is NOT an advantage of a gel liner interface
a. Gel flows from areas of high pressure to areas of low pressure
b. Gel material moves with skin and absorbs shear forces
c. Gel liners can accommodate irregular shaped residual limbs
d. Gel liners can make the patient hot and increase perspiration of the
residual limb
d. Gel liners can make the patient hot and increase perspiration of the
residual limb
Which level(s) of amputation may lead to an equinus gait deformity
a. Lisfranc amputation
b. Chopart amputation
c. Symes amputation
d. Transmetatarsal amputation
b. Chopart amputation
When determining correct static alignment in the coronal plane, how do you know whether the issue is related to socket alignment vs. pylon alignment?
a. ensure the foot is flat on the ground to determine if the pylon is vertical
b. check the pylon first
c. check the socket first
d. as the patient walks, ensure the socket is properly flexed
a. ensure the foot is flat on the ground to determine if the pylon is vertical
What is the purpose of the split toe plate on a dynamic response foot?
a. Reduced the weight of the foot
b. Accommodates uneven terrain by simulating inversion/eversion
c. Allows the patient to easily change the heel height of their foot and
therefore wear shoes with different heel heights
d. Cosmesis
b. Accommodates uneven terrain by simulating inversion/eversion
Excessive adduction of the socket will result in ____________________
a. Foot outset
b. Foot inset
c. Plantarflexion of the foot
d. External rotation of the foot
a. Foot outset
A socket with excessive ____________ can result in a prosthetic foot that is
excessively outset.
a. Extension
b. Abduction
c. Flexion
d. Adduction
d. Adduction
In the coronal plane, when the prosthetic foot is placed more medially than the socket, the foot is considered to be in a position of:
a. Outset
b. Inlet
c. Outlet
d. Inset
d. Inset
What K-level is best indicated for a SACH foot?
a. K3
b. K1
c. K2
d. K4
b. K1
In clinic a TT patient is seen with a traditional exoskeletal PTB
prosthesis with a SACH foot. Patient states that she feels like the prosthesis is
throwing her knee forward as soon as the heel firmly contacts the ground. She has worn this prosthesis comfortably for two years until one month ago. What should be the first clinical action you take at this time?
a. Plantarflex the foot
b. Dorsiflex the foot
c. Check to see if the patient switched to a shoe with a higher heel height
d. Check to see if the patient switched to a shoe with a lower heel height
c. Check to see if the patient switched to a shoe with a higher heel height
One of the characteristics of the TT total surface bearing socket is
a. Emphasizing pressure on the patellar ligament
b. Emphasizing pressure equalization across all residual limb surfaces
c. Emphasizing pressure distribution on the tibia fibula interosseus membrane to prevent residual limb scissoring
d. Emphasizing pressure adjacent to the bony anatomy
b. Emphasizing pressure equalization across all residual limb surfaces
Your transtibial patient has a flexion contracture of 20 deg, what gait deviation
would you expect to see as a result?
a. Lateral leaning pylon
b. Short prosthetic step
c. Medial leaning pylon
d. Long prosthetic step
b. Short prosthetic step
Where can you expect residual limb pressure if the socket is in too much
extension?
a. distal posterior, proximal anterior
b. proximal posterior, distal anterior
c. distal lateral, proximal medial
d. distal medial, proximal lateral
a. distal posterior, proximal anterior
What are the standard socket angles for bench alignment of a transtibial socket?
a. 0 deg flexion, 0 deg AB/ADduction
b. Up to 20 deg flexion , match adduction to user
c. 5 deg flexion, match adduction to user
d. 5 deg extension, 5 deg abduction
c. 5 deg flexion, match adduction to user
What is not an advantage of a Symes amputation?
a. Increased proprioception
b. Distal weight-bearing
c. Large foot selection
d. Anatomical suspension
c. Large foot selection
PTB SCSP socket design is contraindicated for what patient population?
a. Short residual limbs
b. Mild mediolateral stability in stance phase
c. Patients with mild genu recurvatum
d. Obese patients with no condyle purchase
d. Obese patients with no condyle purchase
A lateral leaning pylon will cause socket pressures in which locations on the
residual limb?
a. Anterior/distal tibia
b. Proximal/lateral & distal/medial
c. Proximal/medial & distal/lateral
d. Anterior/proximal & posterior/distal
c. Proximal/medial & distal/lateral
Which of the following is NOT a pressure tolerant area of the transtibial residual
limb?
a. Medial flare
b. Popliteal fossa
c. Lateral pretibial muscles
d. Fibula head
d. Fibula head
Where will the patient feel pressure in their socket if the foot is positioned with
excessive outset?
a. Proximal/lateral & distal/medial
b. Proximal/medial & distal/lateral
c. Proximal/anterior & distal/posterior
d. Proximal/posterior & distal/medial
a. Proximal/lateral & distal/medial
Inset of the prosthetic foot increases pressure on the ______ aspects of
the limb at midstance.
a. Medial-distal and lateral-proximal
b. Medial-proximal and distal-lateral
c. Lateral-proximal and lateral-distal
d. Lateral-distal and medial-proximal
b. Medial-proximal and distal-lateral
90% of amputations in the United States are associated with ______.
a. Traumatic incidences
b. Vascular disease
c. Heart disease
d. Cancer
b. Vascular disease
For bench alignment, what is the standard AP/ML foot position?
a. Weight line 1” anterior to foot bolt, weight line directly through foot bolt
b. Weight line directly through foot bolt, weight line lateral to foot bolt up to ½”
c. Weight line 1” anterior to foot bolt, weight line medial to foot bolt up to ½”
d. Weight line 1” posterior to foot bolt, weight line medial to foot bolt up to
½”
a. Weight line 1” anterior to foot bolt, weight line directly through foot bolt
When measuring you patient’s sound side limb to determine the required overall height for the prosthesis, the measurement is taken from the _______ to the floor.
a. Adductor tubercle
b. Mid patella tendon
c. Fibula head
d. Tibial tubercle
b. Mid patella tendon
The cuff tabs for the supracondylar cuff are connected to the medial and lateral walls of the socket _____” proximal to MTP and _____” posterior to the vertical A-P line.
a. 1/2; 1
b. 1; 2
c. 1/3; 1/2
d. 1/2; 1/2
d. 1/2; 1/2
What K level is a single axis foot indicated for?
a. K1
b. K2
c. K3
d. K4
b. K2
