Patient Assessment and Evaluation
What the exam expects
Assessment questions test whether you can build a defensible picture of the patient before any device decision. Know the components of a structured evaluation: history (diagnosis, onset, prior devices, surgeries, comorbidities), vascular status (pulses, capillary refill, skin temperature, Doppler or ABI where indicated), neurologic and sensory status (protective sensation, proprioception), skin integrity (erythema, scars, grafts, ulcer stage and location), musculoskeletal findings (range of motion, contracture, limb length, alignment), and functional status (ambulation potential, transfers, balance, endurance).
Traps
- Confusing a finding with an impairment statement. "Absent pedal pulses" is a finding; the impairment is impaired perfusion that constrains device choice and wearing schedule.
- Skipping contralateral limb assessment - the sound limb is often the future at-risk limb.
- Treating a doppler signal as equivalent to adequate perfusion without considering skin condition and history.
- Ignoring patient goals and cognition; a device that fits the limb but not the life fails.
- Assuming a stable limb volume on a first visit; edema and postoperative change are expected.
Rule of thumb
Document in a repeatable order: History → Vascular → Neuro/sensory → Skin → Musculoskeletal → Functional → Goals. If any of the first five reveals a red flag (non-healing wound, absent protective sensation with pressure areas, acute ischemia signs), the plan pauses for referral rather than proceeding to casting.
Worked example
A patient with diabetes reports numbness and has a callus over the first metatarsal head with intact but dry skin, palpable pulses, and no ulcer. The correct reasoning: protective sensation is likely impaired (callus plus neuropathy history), so pressure redistribution and offloading are priorities, and the assessment must document the callus location as a pressure-risk site. Proceeding straight to a standard accommodative insole without documenting risk would be the wrong answer.