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, Tinel’s & Vallies’ Sign, Post Static Dsykinesia Thompson , Thomas, Lasegue’s, 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, What’s 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 SockHow you would determine if you took the proper impression of a patient’s 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 body’s 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. Spilken’s “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) Campbell’s Rest Strap Low Dye J strap (don’t forget to include ace bandage done in figure of eight) Reverse J strap (don’t 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, Dancer’s

Pad, Reverse Dancer’s Pad, Double Dancer’s Pad) Remember

1. Strappings are done with adhesive tape2. Removable paddings are done with elastoplasts3. If I request extra support in the longitudinal arch, I am asking for a LA pad4. 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 Tinel’s 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 EquinusForefoot varusForefoot valgusInternal tibial torsionOsteochondritisPeroneal tendon tearChronic ankle instabilityChronic regional pain syndromePlantar fasciitis/heel spur syndrome/heel spurManagement of chronic ankle arthritisMetatarsalgiaTarsal Tunnel SyndromePeroneal TendinitisPosterior Tibial TendinitisAchilles TendinitisSinus Tarsi SyndromeHammertoe deformity - PathophysiologyClaw toe deformity – PathophysiologyAdducted gait –Seen with what conditionsSteida’s process fractureParalysis of Abductor Digiti Minimi muscle

OsteoarthritisPsoriatic ArthritisGouty Arthritis & Acute Gouty AttackRheumatoid ArthritisReiter’s SyndromeOrthotic modifications for flatfootMorton’s neuromaFreiberg’s Disease (NOT Friedberg’s Disease)Stress FractureRetrocalcaneal BursitisStructures 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 HistoryMedications, AllergiesSurgical History, Social History, Family HistorySHOE HISTORYREVIEW 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 MIS-SPELLED 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.