CLIICAL SKILLS AND EXIT EXAM REVIEW (Revised 3/1/12)

Please note that you are responsible for all information presented in any orthopedic lecture, lab and/or workshop in written form or via discussion and any knowledge/ information that you are expected have obtained through treating patients on the clinic floor. This review is merely a guide for your study. In no way am I implying that something left off of this review will not appear on the exam.
Review the following: The Disease Management Protocols Booklet handed out to you at orientation All Group assignments Muscles and Tendons Dorsal Foot (origin, insertion, nerve innervation, blood supply , function, how to test for dysfunction) Muscles and Tendons Plantar Foot Arthritities Anatomy of the 1st MPJ and Ankle Forefoot Varus & Supinatus, Tinels & Vallies Sign, Post Static Dsykinesia Thompson , Thomas, Lasegues, Silverskould, and Talar Tilt tests Accessory Bones Nerves and Dermatomes Information from the following lectures/labs/workshops/Presentations Journal Topic Presentations Forefoot Pain Flatfoot Pain Ankle Pain Heel Pain Trouble shooting orthoses Gait Exam 1 & 2 Choosing Orthoses Mini Cases (Ortho) BK Casting Dance Medicine Dr. Novella Adult Biomechanical Exam Casting for Orthotics Padding & Strapping Orthotic Making at Langer Neuromuscular Diseases and Braces Orthotic Materials Eneslow shoes Below Knee Casting

Biomechanical Exam How to do a Biomechanical Exam including ROM of all the joints, what would happened if you had restricted motion in one of the joints (compensation), what causes restricted motion in the joints. Three types of Equinus and how you tell the difference between them clinically Three methods to measure for Limb, Length, Discrepancy, two types of LLD, what are the possible effects of a longer or shorter limb Proper assessment technique for lst ray position and motion. What is the functional significance of these findings How do you evaluate for forefoot varus or supinatus and how do you differentiate between the two How you would determine if a patient has a hallux limitus (structural or functional), the clinical signs and symptoms that may be noted in a patient with a functional hallux limitus. How to test muscle strength of specific muscles/tendons in the foot Be familiar with the axis of the STJ

Gait Exam How you would determine, during gait, whether an individual has a rotational influence coming from the hip? How you would determine if an individual is pronating or supinating at the subtalar joint after heel lift. Technique to determine the neutral calcaneal stance position and the relaxed calcaneal stance position. How you would you determine where an adducted or abducted position is coming from during gait differential diagnoses for a shoulder drop Different types of gait, Whats weak/ causative factor in the various abnormal gaits, conditions presenting with the various abnormal gait patterns

Casting for Orthoses technique for putting on a cast to produce a functional orthotic (the way that Dr. Logan showed you), the advantages and disadvantages of this casting technique versus other casting techniques) Can be found in you black binder You must be able to evaluate the cast. You saw a video on this, we discussed it and there is information that you were told to read in your black binder. know different casting techniques, the indications for using the technique, the advantages and disadvantages of each technique including casting using the STS Slipper Sock How you would determine if you took the proper impression of a patients foot during casting for a functional orthotic. difference between a negative and a positive cast What will happen if you loaded the 2nd and 3rd met heads when applying an off weight bearing cast? When applying an off weight bearing neutral cast, the long axis of the foot and the long axis of the leg should be in what position to each other What would happen to the neutral off-weight bearing cast if the patient had a forefoot varus or a forefoot valgus What is the difference between a forefoot varus and forefoot supinatus Read the articles in your black binder that you were told to read. What is the function of the rear-foot post? There is an article on this in your folders

Padding & Strapping Know the definition of a padding, strapping, and shield Padding any device or material used to supplement the bodys own protective mechanism Strapping a semi-rigid or elastic support that splints soft tissue and limits its function without completely immobilizing the part

Shield an appliance fashioned from some skin or fabric, applied for the purpose of relieving pressure or friction, or to protect a tender part upon the foot. If this is an area of weakness for you, this information can also be found in Dr. Spilkens Padding and Strapping of the Foot. Know what a binder is - It is a covering over a padding or strapping Know the different paddings and strappings we have discussed and their indications. Also know how to apply them properly and skillfully (skiving, rounded corners ,using correct materials, neatly) You should know the following strappings/paddings/shields: Unna boot (with cast padding, stokinette & coflex/coban) Jones Compression (WaWa) Campbells Rest Strap Low Dye J strap (dont forget to include ace bandage done in figure of eight) Reverse J strap (dont forget ace bandage done in figure of eight) Bunion Shield Buddy Splint Crest Pad Orthodigital Splint Removable or non-removable Padding (Longitudinal Arch Pad, Mayo Pad, Met Pad, Met Bar, Dancers Pad, Reverse Dancers Pad, Double Dancers Pad) Remember 1. Strappings are done with adhesive tape 2. Removable paddings are done with elastoplasts 3. If I request extra support in the longitudinal arch, I am asking for a LA pad 4. There is a difference between an LA pad and a Mayo pad. Make sure you know the difference. 5. Do not get confused with tape, elastoplast/tenoplast, and coflex/coban. There are different materials. 6. Know how to properly apply cast padding and an unnaboot. 7. You must demonstrate a figure of 8 pattern throughout the entire strapping/splinting when applying an Ace bandage

Heel Pain and Arthritis Pain Know differential diagnoses for plantar & posterior heel pain Know conditions that present with plantar heel spurs Know conditions causing burning, tingling, or pins & needles symptoms in the heel (not diabetic neuropathy) Know the different Arthrities effecting the foot, their hallmark and manifestation in the foot

Forefoot & lst MPJ pain Know about hyperkeratotic lesions and what may have contributed to them Differential diagnosis for forefoot pain Differential diagnosis for 1st MPJ pain

Flatfoot, Cavus Foot and Ankle pain Describe a foot type and give etiologies that may cause a patient to acquire a particular foot type Know pathology associated with Pronated (flatfoot) and Cavus foot Know anatomy and key exam points around the ankle.

Know the technique for determining the presence of a positive Tinels sign. Know how to test for weakness of muscles (i.e. Posterior Tibial, Anterior Tibial (Tibialis Anterior) Peroneals, Gastrocnemius, Soleus, etc)

Be familiar with the following conditions: Gastroc soleus Equinus Forefoot varus Forefoot valgus Internal tibial torsion Osteochondritis Peroneal tendon tear Chronic ankle instability Chronic regional pain syndrome Plantar fasciitis/heel spur syndrome/heel spur Management of chronic ankle arthritis Metatarsalgia Tarsal Tunnel Syndrome Peroneal Tendinitis Posterior Tibial Tendinitis Achilles Tendinitis Sinus Tarsi Syndrome Hammertoe deformity - Pathophysiology Claw toe deformity Pathophysiology Adducted gait Seen with what conditions Steidas process fracture Paralysis of Abductor Digiti Minimi muscle Osteoarthritis Psoriatic Arthritis Gouty Arthritis & Acute Gouty Attack Rheumatoid Arthritis Reiters Syndrome Orthotic modifications for flatfoot Mortons neuroma Freibergs Disease (NOT Friedbergs Disease) Stress Fracture Retrocalcaneal Bursitis Structures supporting the medial Longitudinal Arch Prescriptions You must know how to properly write prescriptions for Systemic Medications and orthopedic Shoes.

Case Summaries You will have case summaries on the practical exam for which you will have to give differential diagnoses. The case summaries will be similar to those that you had during the Problem Based Learning. History & Physical Exam: (as done in the problem based learning group session) Also, please remember how critical and helpful getting this information under your belt now is for your CAPSTONE exam. History: History of Chief Complaint (NLDOCAT) Patient Medical History Medications, Allergies Surgical History, Social History, Family History SHOE HISTORY REVIEW OF SYSTEMS Physical Exam: Vascular Exam: (Pulses, Temp Gradient, Capillary Filling Time, Venous Filling Time, Elevation/Dependency) Neurologic Exam: (Protective Sensation, Vibratory Sensation, Deep Tendon Reflexes, Position Sense, Sharp/Dull, Light Touch) Dermatology Exam: Hyperkeratotic lesions, open lesions (ulcers, lacerations, etc), pigmented and non-pigmented lesions, excoriations, edema (non-vascular), discoloration, etc., etc., etc. Orthopedic / Biomechanical Exam :(ROM all joints foot and ankle, Testing for Muscle Power of individual muscles, off and on weight bearing evaluation, Gait Exam), Examination of the shoe ON YOUR PRACTICAL EXAM YOU WILL ONLY BE ABLE TO USE A TYPE OF CONDITION ONCE WITH IN THE SAME QUESITON. For example you cannot say Osteoarthritis and Rheumatoid Arthritis, or Fracture of the cuboid and Fracture of the 5th metatarsal, or bursitis, capsulitis & synovitis. On your practical exam there is a time limit for answering each question. YOU WILL BE RESPONSIBLE FOR SPELLING CORRECTLY. YOU WILL LOSE POINTS FOR MISSPELLED WORDS ON YOUR EXAMS. YOU MUST WRITE/PRINT LEGIBLE. IF I CAN NOT READ OR UNDERSTAND AN ANSWER IT WILL BE MARKED WRONG. The only abbreviations that you may use are the names of the Joints of the foot. All other words must be spelled out.