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PROSTHETICS & ORTHOTICS EXAM
100% DETAILED VERIFIED CORRECT
ANSWERS 2025/2026 STUDY SET
ETIOLOGY OF AMPUTATIONS
#1: VASCULAR DISEASE (DM & PAOD) SEVERELY INCREASES MORTALITY RISK POST-
AMPUTATION
(PAOD AND NOT DM IS POSSIBLE; DM USUALLY INVOLVES PAOD)
- INFECTIONS
- TRAUMA
- CANCER (BETTER TODAY THAN IT USED TO BE; THEY NOW REMOVE THE WHOLE BONE)
- CONGENITAL
STATS: 1.5 AMPUTATIONS PER 1000 PPL —> PREVALENT!
TOE AMPUTATION
AMPUTATE DISTAL TO MT HEADS
NO PROSTHETIC
ORTHOTIC?: SHOE W/FILLER FOR THAT DEAD SPACE; PREVENTS DRIFTING OF
FOOT/MALALIGNMENT
TRANSMETATARSAL ("PARTIAL FOOT" AMPUTATION)
PROX. TO MT HEADS, THROUGH SHAFTS
SUTURE LINE DOESN'T HEAL VERY WELL W/VASCULAR INVOLVEMENT
ORTHOTIC:
- SHOE W/FILLER FOR THAT DEAD SPACE; PREVENTS DRIFTING OF FOOT/MALALIGNMENT
- SHOE W/ROCKER BOTTOM: B/C THEY'VE LOST MTP JTS, FOR GOOD HEEL-TOE GAIT
- SHOES W/LIFT TO ALLOW HEEL-TO-GROUND CONTACT
ROM: MAINTAIN DF ROM! PTS OFTEN HAVE PF CONTRACTURE
SURGICAL OPTIONS FOR TMT AMPUTATION
- MYODESIS (WHERE THEY SUTURE THE MUSCLE/TENDON TO THE REMAINING LIMB/BONE)
- MYOPLASTY (SUTURE TO OTHER SOFT TISSUE)
OR THE SURGEON LETS THE MUSCLES RETRACT
BONE SHAVING / BV LIGATION / NERVE RETRACTION
LISFRANC AMPUTATION
DISARTICULATION OF MID-FOOT BETWEEN TARSAL AND METATARSAL BONES
ORTHOTIC: SHOE W/ROCKER, FILLER & CUSHY HEEL FOR SHOCK-ABSORPTION (STILL NO
PROSTHETICS)
ISSUE: DISRUPTION OF FIBULARIS BREVIS ONTO THE BASE OF THE 5TH METATARSAL LEADS
TO VARUS DEFORMITY
CHOPART AMPUTATION
C - CALCANEUS, T - TALUS
DISARTICULATION OF TALONAVICULAR AND
CALCANEOCUBOID JOINTS.
ORTHOTIC: SHOE W/ROCKER, FILLER & CUSHY HEEL FOR SHOCK-ABSORPTION (STILL NO
PROSTHETICS)
ISSUE: COMMONLY COMPLICATED BY EQUINOVARUS FOOT DEFORMITY
- RESULTS FROM UNOPPOSED TENDON ACTION
- FIX IS ACHILLES' TENDON LENGTHENING
SYME AMPUTATION
DONE THROUGH THE ANKLE JOINT. THE FOOT IS REMOVED BUT THE HEEL PAD IS SAVED SO
PATIENT CAN BEAR WEIGHT.
PROSTHETIC: 1ST PROSTHETIC: SACH FOOT IS MOST COMMON (SOLID ANKLE CUSHY HEEL)
- HARD TO GET GOOD PROSTHETIC FITTING
- POOR ALIGNMENT BTN PROSTHETIC AND
TRANSFEMORAL AMPUTATION
ABOVE KNEE AMPUTATION (AKA)
SURGERY: WANT IT TO BE AS LONG AS POSSIBLE (DON'T NEED TO STAY AWAY FROM LOWER
¼ LIKE BK'S); DON'T WANT TO GO ANY HIGHER THAN LESSER TROCHANTER
KINEMATICS:
[W/C FOR LEVELS 8 AND UP CAN BE GOOD (D/T HIGH ENERGY EXPENDITURE, QOL CAN BE
IMPROVED)]
TRANSFEMORAL AMPUTATION (AKA) KINEMATICS
HIP EXT TO CREATE KNEE EXT
HIP FLEX TO CREATE KNEE FLEX
LONGER LEVER IMPORTANT IN CONTROLLING PROSTHETIC KNEE
AND LESS DISRUPTIVE TO YOUR COG (THE MORE MASS THAT'S LOST, THE MORE COG
DISRUPTION)
MORE SURFACE AREA = BETTER BALANCE, BETTER FOR AVOIDING PRESSURE SORES
TRANSFEMORAL AMPUTATION (AKA) EARLY ISSUES
ROM: HIP-FLEXION CONTRACTURES COMMON —> HAVE THEM LAY ON THEIR STOMACH!
[LOTS HAVE VASCULAR ISSUES, THEY'RE OFTEN IN CHAIR TO HELP]
ROM: HIP-ABDUCTION CONTRACTURES —> ESP. SHORT STUMPS, B/C ADD TUBERCLE
ATTACHMENTS (NEAR GREATER TROCHANTERS) ARE LOST
WORK ON ADD. ISOMETRICS
TRANSFEMORAL AMPUTATION (AKA) PROSTHETICS
GERIATRIC LOCKED KNEE IF PT IS WEAK, VS. FREE KNEE UNITS
"C-LEGS" (COMPUTER LEGS) ARE AMAZING, BUT VERY EXPENSIVE
HIP DISARTICULATION
SURGERY: FEMORAL HEAD COMES OUT, EVERYTHING DISTAL IS GONE
GLUTE TISSUE, WRAP ANTERIORLY
PROSTHESIS:
PROSTHESIS HAS SHELF FOR WB ON STUMP AND ISCHIAL TUBEROSITY
KINEMATICS: POST. PELVIC TILT FOR LEG SWING
CAN BE FUNCTIONAL, BUT HIGH ENERGY EXPENDITURES
HEMIPELVECTOMY
COMPLETE HEMIPELVECTOMY IS REMOVAL OF HALF PELVIS.
POPULATION: CANCER IN PELVIS
HEMICORPORECTOMY
BODY BELOW THE WAIST IS AMPUTATED, TRANSECTING THE LUMBAR SPINE.
- REMOVES THE LEGS, THE GENITALIA (INTERNAL AND EXTERNAL), URINARY SYSTEM, PELVIC
BONES, ANUS, AND RECTUM
PROSTHESIS: LIKE A BUCKET, YOU CAN THEN SET PT INTO W/C
PRE-OP PT
CAN WORK ON TRANSFERS, HOPPING W/WALKER
BED POSITIONING
RESIDUAL LIMB LENGTH (SHORT VS. LONG)
SHORT = <40%
LONG = >60%
SURGICAL FLAP: AK VS. BK
PORE
- PAIN MGMT (PRE-MEDICATION) —> BIG ISSUE EARLY ON
- OOB TOLERANCE: MORE SUSCEPTIBLE TO CLOTS/PNEUMONIA/PRESSURE SORES IF THIS
ISN'T GOOD
- RESPIRATORY CARE: INCENTIVE SPIROMETERS
- EDEMA & SUTURE LINE HEALING (E.G., DO THEY NEED A MORE ABSORPTIVE DRESSING?)
POST-OP ACUTE CARE THEREX
- BED MOB.: SUPINE <--> SIT, ROLLING ONTO INTACT SIDE, U/L BRIDGE
- SITTING BALANCE: STATIC & DYNAMIC
- TRANSFERS: SLIDE BOARD LAT. TRANSFER, STAND-PIVOT (TOWARD INVOLVED SIDE)
TO ID WHICH ONE
GENERALLY: IF STAND-PIVOT IS >MOD ASSIST, LAT. TRANSFER IS BETTER; JUST KEEP
WORKING TOWARD STAND-PIVOT
THEN WORK ON TOILET TRASFERS, ETC.
POST-OP EVAL
- PMHX
- REASON FOR AMPUTATION
- SOCIAL/OCCUPATIONAL STATUS
- COGNITIVE STATUS (VASCULAR DISEASE AFFECTS BRAIN - VERY IMPORTANT FOR KNOWING
IF GOOD CANDIDATE)
- HOME SET-UP
- PATIENT GOALS
- PRE-ACTIVITY LEVEL
EVALUATION
- ALWAYS START W/ VITALS (HR, BP, SPO2)
- SKIN INSPECTION
- SENSATION
--EXTEROCEPTIVE (LIGHT TOUCH, TEMP)
--PROPRIOCEPTIVE (VIBRATION, JT. POSITION)
--PROTECTIVE SENSATION (ON INTACT SIDE)
--PAIN
--PHANTOM PAIN / PHENOMENA (NOT PAINFUL - JUST FEEL IT IS THERE)
EVALUATION: SKIN/WOUND INSPECTION
- CHECK CONTRALATERAL EXTREMITY (SYSTEMIC DISEASES)
- SHAPE (CYLINDRICAL, BULBOUS, CONICAL)
- DISCOLORATION
- SUTURE LINE: OOZING/DRAINAGE?
- GIRTH
- LENGTH VS. INTACT SIDE
TX FOR PHANTOM PAIN
- MIRROR THERAPY: DECREASES PAIN - CORTICAL REORGANIZATION. TRICK BRAIN THAT
EVERYTHING IS OK.
- PHARMA
ASSESSMENT FOR ROM
- NUMERICAL VALUES AT RESIDUAL LIMB TO BE ABLE TO SHOW INCREASES - CONTRACTURES.
DOCUMENT FROM _ - _.
- FLEXIBILITY TESTS: THOMAS, SLR, OBER, ELY
THOMAS: QUADS.
SLR: LOOK AT KNEE EXTENSION RANGE IN SITTING AND SUPINE.
ELY: PRONE AND FLEX KNEE UP (RF)
OBER: TFL -
EVALUATION OF MUSCLE STRENGTH
- KEY MUSCLES:
UE: ELBOW EXTENSORS (TRICEPS), SHOULDER DEPRESSORS (LATS), FINGERS AND WRISTS
NO PILLOW UNDER LEG IN BED - AVOID HIP FLEXION
AVOID KEEPING LEG ABDUCTED - STRENGTHEN ADDUCTORS
USE AN EXTENSION BOARD IN WC - PROMOTES EXTENSION
LAY ON YOUR STOMACH PERIODICALLY (OR THOMAS POSITION)
INITIAL PATIENT EDUCATION: INSPECTION
SUDDEN INCREASE IN PAIN OR SWELLING
RESIDUAL LIMB INSPECTION
INITIAL PATIENT EDUCATION: GENERAL TIPS
CONTROLLED COMPRESSION DEVICES
GOOD DIET FOR HEALING / NO SMOKING / HYDRATE
MOVING IN BED
ACTIVE EXERCISE
INITIAL BED ACTIVITIES
POST-OP: ROLLING TO INTACT SIDE, THEN WORK ON OPP. AFTER ACUTE PHASE
ACTIVE EXERCISE: EXERCISES IN BED
INTACT FOOT:
"SO YOU DON'T BECOME A B/L AMPUTEE!" (~50% DO 5 YEARS LATER!)
SKIN INSPECTION
INTACT FOOT
- REG INSPECTION
- MOISTURIZE (NOT BETWEEN TOES)
- WEAR WHITE SOCKS
- PROPER SHOES / NO BAREFOOT WALKING
- INSPECT SHOES
- FOOT CARE BY PODIATRIST
- WARNING SIGNS OF INFECTION
WRAPPING OF LIMB
ACE WRAP WITH CRISS CROSS PATTERN W/ 4" WIDTH FOR BK AND 6" FOR AK
BK: START ON LATERAL SIDE ABOVE FEMORAL CONDYLES TO ANCHOR WRAP X2 AROUND,
THEN MEDIALLY AND DISTAL AROUND END OF LIMB. THEN LATERAL NEXT TIME AROUND SO
DIAGONAL AND AROUND BOTH SIDES.
AK: OVER ILIAC CREST ON AMPUTATED SIDE AND WRAP AROUND WASTE X2, THEN PASS
INSIDE UNDERWEAR AND MEDIALLY AND POSTERIORLY AND WRAP AROUND DISTAL END
COMING BACK AROUND LATERALLY
ADL TRAINING: BED MOBILITY
FX PUSHUPS TO SCOOT UP/DOWN, SIDE TO SIDE, BRIDGE
ROLL TO INTACT SIDE
(WORK ON ROLLING TO OTHER SIDE TOO EVENTUALLY, MORE CHALLENGING)
PUSH-UP TO SIT
SITTING BALANCE
ADL TRAINING: SITTING BALANCE
TRIANGULAR PILLOWS: THEY CAN RECLINE, COME BACK UP TO SIT
FX TASK TO WORK ON THAT CHANGES THEIR COG
UE EXERCISES
REACHING FOR TARGETS, PEG BOARDS WHERE PTS MOVE PEGS FROM PT. A TO B
SITTING ON FOAM/BOSU
USE MIRROR FOR FEEDBACK
ADL TRAINING: TRANSFERS
STEPS FOR STAND PIVOT:
COME TO EDGE
HOP SO YOU'RE PARALLEL TO MAT
BRING FOOT BACK AS FAR AS POSSIBLE W/FOOT ON GROUND
CAN USE RW
LAT. TRANSFER:
CAN USE BOX/PILLOW FOR PROGRESSIVE BUMP UP
USING ESCALATOR
THEREX: STRETCHING GENERAL GUIDELINES
- FIRM SURFACE
- DON'T HOLD BREATH
- GRADUAL AND PROLONGED PREFERRED
- WATCH FOR SUBSTITUTIONS
- KNOW NORMAL ROM / FLEXIBILITY
- 15 SEC TO 2 MIN (120 SEC), HOLD BASED ON TOLERANCE
10 SEC REST, REPEAT BASED ON # REPS
THEREX: STRETCHING CONTRAINDICATIONS
1. JT INSTABILITY
2. RECENT SUTURES
3. BYPASS SX IN LE —> MAY NOT WANT TO BE IN FLEXED POSITION, KINK THE VESSELS
STRETCHING
SUPINE
HIP ADD
HIP EXT
HIP ER AND ABDUCTORS
KNEE FLEX (BK)
THOMAS HIP FLEXOR
PRONE
HIP FLEX
KNEE EXT (BK)
SIDE-LYING
HIP ABDUCTORS (OBER TEST)
STRENGTHENING: +/- OF ISOMETRICS
+ SAFE NO SPECIAL EQUIPMENT
+ POSSIBLE WHEN IMMOBILIZED
+ LESS TRAUMATIC TO THE JOINTS
- RANGE OF MOTION SPECIFIC
- TENDENCY TO VALSALVA
- FUNCTIONAL APPLICATION
ISOMETRIC W/ CKC
HIP EXT IN SUPINE
HIP ABD IN SIDE-LYING (RESIDUAL LIMB DOWN)
HIP ADD IN SIDE-LYING (RESIDUAL LIMB UP)
HIP FLEX IN PRONE
HIP EXT / ADD AND TRUNK EXT IN PRONE
INTACT LEG BRIDGE IN HOOK-LYE
ABDOMINAL ISOMETRIC IN SUPINE - IF WEAK - PELVIC TILT OR SITTING AND LEANING
KNEE EXT IN PRONE
KNEE FLEX IN SUPINE
CONCENTRIC EXERCISES
SLR IN SUPINE
LLR IN SIDE-LYE
MLR IN SIDE-LYE
RLR IN PRONE
HAMSTRING CURL IN PRONE
TKE IN SUPINE
SIT-UPS / ABDOMINAL CRUNCHES IN SUPINE
FUNCTIONAL ACTIVITIES FOR AN INDIVIDUAL WITH A R TRANSFEMORAL AMPUTATION
SUPINE TO SIT
STAND PIVOT TRANSFER MAT TO WC
COMPRESSING IT AROUND MID-STANCE/HEEL RISE AND RELEASING COMPRESSION AT TOE
OFF/PRE-SWING
TYPES: SEATTLE AND CARBON COPY
FLEXFOOT
LESS SUPPORT BUT BETTER ENERGY STORAGE
FLEXWALK
COLLEGE PARK TRUSTEP
ALLOWS MOTION IN ALL PLANES OF MOVEMENT. (MULTIAXIAL). FULL LENGTH TOE LEVERS.
MIMICS ARCHES OF FOOT.
TYPES OF SHANKS
CONNECTING POINT BETWEEN PROSTHETIC FOOT AND SOCKET.
1. ENDOSKELETON - METAL POLE (RIGHT) WITH FOAM COVERING OVER
BENEFIT: LIGHTER WEIGHT - MORE ADJUSTABILITY
2. EXOSKELETON - HARD PLASTIC LAMINATE (LEFT)
BENEFIT: MORE DURABLE
TRANSTIBIAL SUSPENSION OPTIONS
1. ATMOSPHERIC PRESSURE (NEG PRESSURE)
OVER THE KNEE SLEEVE / LOCKING LINER / HYPOBARIC GEL SOCKS
2. ANATOMICAL CONTOUR
SC WALL / SC SP WALL
3. STRAPS
SC CUFF (WAIST BAND WITH FORK STRAP)
HINGES
4. THIGH CORSET
BK SOCKET (CONCAVE AND CONVEX)
CONVEXITY = WB FORCES
- POSTERIOR FOR POPLITEAL BULGE (PROVIDES ANTERIORLY DIRECTED FORCE TO KEEP
INFRAPATELLA TENDON ON PATELLAR TENDON SHELF.)
CONCAVITY = PRESSURE RELIEF TO SENSITIVE AREAS
- ANTERIOR FOR TIBIAL CREST, TIBIAL TUBEROSITY
- POSTERIOR FOR HAMSTRING TENDONS
BK SOCKET TYPES
MOST COMMON: PTBS (INDENTATION LINES UP WITH INFRAPATELLAR TENDON)
TSB: PROVIDE WB THROUGHOUT RESIDUAL LIMB. BETTER FOR NON-PAINFUL RESIDUAL
LIMB. CAN HAVE PATELLA TENDON SHELF BUT NOT PROMINENT.
TYPES OF LINERS
*1. GEL/SILICONE: MORE COMMON. *
BENEFITS:
- LESS PISTONING (UP/DOWN MOVEMENT).
- MORE COMFORTABLE
- BETTER FOR PRESSURE DISTRIBUTION
2. PELITE LINER: FOAM
BENEFITS:
- BETTER FOR DURABILITY
- EASIER TO PUT ON
- CHEAPER
- LESS SWEATING
SC CUFF VS. SC WALL
SUPRACONDYLAR CUFF - NOT AS ACTIVE.
SC WALL - JUST GOES HIGHER UP.
DECELERATION)
4. "C-LEG" - COMPUTERIZED KNEE UNITS THAT INTERACT WITH FOOT/ANKLE.
5. WEIGHT ACTIVATING - ANY TIME IN WB IT LOCKS
6. SAFETY KNEE - ANY TIME KNEE FLEXES TO 20° AND WB IT WILL LOCK
7. EXTENSION AIDE - SPRING OR STRAP THAT HELPS GET TERMINAL EXTENSION
2 TYPES OF SOCKETS FOR AKS
1. QUADRILATERAL - WIDER MEDIAL TO LATERAL THAN A TO P = A LOT LIKE PTB FOR BK
(INFRAPATELLAR TENDON TO BK IS ISCHIAL T FOR AK)
SCARPAS BULGE ABOVE (FEMORAL TRIANGLE) IS SIMILAR TO POPLITEAL BULGE IN BK.
DISTRIBUTES PRESSURE MORE TO ISCHIAL.
2. ISCHIAL CONTAINMENT SOCKET - MORE SYMMETRICAL = LIKE TSB FOR BK (DISTRIBUTE
PRESSURE THROUGHOUT WHOLE LIMB)
TYPES OF SUSPENSIONS FOR AK
1. TES (TOTAL ELASTIC SUSPENSION) BELT SIMILAR TO NEOPRENE SLEEVE.
2. SILESIAN USED WITH SUCTION. NOT BY ITSELF.
3. SUCTION SUSPENSION
4. PELVIC BAND (LIKE BI-CORSET) - SECURE BUT HEAVY. ONLY ONE NOT USING SUCTION
BK PROSTHETIC BIOMECHANICS: TILT
TILTED 5° ANTERIORLY
AKA FLEXING THE SOCKET
- IMPROVES WBING TO TOLERANT AREAS (PATELLA TENDON)
- PROMOTES KNEE FLEXION IN EARLY STANCE
- ACCOMMODATION FOR KNEE FLEXION CONTRACTURE
BK PROSTHETIC BIOMECHANICS: ANKLE POSITION
ANKLE FOOT SET SLIGHTLY POSTERIOR
- PROMOTE KNEE FLEXION IN E STANCE
- SET BREAST OF HEEL ¼ INCH POSTERIORLY
ANKLE FOOT SET SLIGHTLY MEDIAL
- CREATES INCREASED VARUS MOMENT
- IMPROVES PRESSURE DISTRIBUTION TO PROXIMAL MED/DISTAL LAT RESIDUAL LIMB
PROXIMAL MEDIAL AND DISTAL LATERAL ALLOWS FOR BEST PRESSURE TOLERANCE. SO IF
THIS IS TOO MUCH PRESSURE, WOULD MOVE IT MORE LATERAL (CLOSER TO MIDLINE)
AK PROSTHETIC BIOMECHANICS: TILT
POSTERIOR
- ACCOMMODATE FOR TIGHT HIP FLEXORS
- MAINTAIN BETTER LENGTH TENSION ON EXTENSORS
- HELP TO ACHIEVE SHANK / FOOT POSITION IN LATE STANCE
- IMPROVE WBING TOLERANCE ON ISCHIAL SHELF
AK PROSTHETIC BIOMECHANICS: LATERAL WALL
LATERAL WALL SLOPES MEDIALLY FROM PROXIMAL TO DISTAL (ADDUCTING). DO THIS TO
KEEP RESIDUAL LIMB FROM GOING INTO ABDUCTION TO IMPROVE MECHANICAL
ADVANTAGE OF GLUTEUS MEDIUS - LENGTHENS IT.
AK PROSTHETIC BIOMECHANICS: TKA LINE
K SET POSTERIOR TO THAT PINK LINE.
CREATES GREATER EXTENSION MOMENT AT THE KNEE (STABILITY)
4 PHASES OF BK / AK PROSTHETIC CHECKOUT
1. LOOK AT IT BEFORE APPLYING IT
2. SITTING
3. STANDING
4. WALKING - LOOK FOR GAIT DEVIATION.
4 PHASES OF BK/AK PROSTHETIC CHECKOUT: BEFORE APPLYING
