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C.Ped practice questions

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Question 1Patient Assessment

Which action is the most appropriate first step when beginning a pedorthic assessment of a new patient?

  1. Measure both feet with a Brannock device
  2. Palpate the dorsalis pedis pulse
  3. Ask the patient to describe the problem Correct answer.
  4. Review the previous footwear prescription

Explanation

The assessment opens with an open-ended interview so the patient's own description of the problem, its onset and its functional impact direct the rest of the examination. Objective measurements follow and are interpreted in light of that history.

Question 2Patient Assessment

During a normal walking gait cycle, the stance phase occupies approximately what proportion of the cycle for one limb?

  1. About 20 percent
  2. About 40 percent
  3. About 80 percent
  4. About 60 percent Correct answer.

Explanation

In walking, each limb is in stance for roughly 60 percent of the cycle and in swing for about 40 percent, so the two limbs overlap in double support for part of each cycle. Running reverses this relationship, with swing time exceeding stance time.

Question 3Patient Assessment

A patient's medial longitudinal arch lowers to the ground during standing but reappears when the patient sits and the foot is unloaded. This finding is best described as:

  1. Equinus deformity
  2. Pes cavus
  3. Rigid pes planus
  4. Flexible pes planus Correct answer.

Explanation

An arch that collapses under load but re-forms when weight is removed identifies a flexible deformity, in which the arch exists but cannot resist loading. A rigid flatfoot stays flat in both weight-bearing and non-weight-bearing positions.

Question 4Patient Assessment

Thickened, yellow-brown, crumbly toenails with debris beneath the distal edge most likely indicate:

  1. Subungual hematoma
  2. Psoriatic nail pitting
  3. Onychomycosis Correct answer.
  4. Ingrown toenail

Explanation

Discoloration, thickening and crumbly subungual debris are the classic presentation of fungal nail infection, which is common in patients with diabetes or peripheral vascular disease. Pedorthically it matters because a thickened nail increases dorsal pressure inside the shoe.

Question 5Patient Assessment

Which feature of a patient's worn shoes provides the most information about foot function and gait?

  1. Shoe brand
  2. Upper color
  3. Outsole wear pattern Correct answer.
  4. Lacing style

Explanation

Wear patterns record where load and shear accumulated over many steps, giving a cumulative picture of the patient's contact pattern. The other listed features are stylistic and carry no biomechanical information.

Question 6Patient Assessment

Which entry in the clinical record documents an objective, measurable assessment finding?

  1. Pulse 2+ bilaterally Correct answer.
  2. Feet appear comfortable
  3. Patient states pain is better
  4. Continue current plan

Explanation

Documentation should capture specific, measurable findings that another clinician could interpret and reproduce. Vague impressions and plan statements cannot support clinical decisions or justify the device provided.

Question 7Patient Assessment

Which question best identifies the functional goals that will guide the pedorthic plan?

  1. Do you have any drug or material allergies?
  2. What activities are you unable to do now? Correct answer.
  3. Have you ever broken a bone in your foot?
  4. What size shoe do you normally wear?

Explanation

Functional goals are defined by the tasks the patient needs or wants to perform, so the interview should ask directly about current activity limitation. Allergies, shoe size and injury history inform the plan but do not describe what the patient wants to achieve.

Question 8Patient Assessment

The dorsalis pedis pulse is palpated on which aspect of the foot?

  1. Plantar surface
  2. Dorsum Correct answer.
  3. Lateral border
  4. Posterior heel

Explanation

The dorsalis pedis artery crosses the dorsum of the foot lateral to the extensor hallucis longus tendon and is the most commonly checked pedal pulse. The posterior tibial artery is palpated behind the medial malleolus.

Question 9Patient Assessment

A 10-g Semmes-Weinstein monofilament test is used primarily to evaluate which function?

  1. Protective sensation Correct answer.
  2. Two-point discrimination
  3. Ankle proprioception
  4. Vibratory sense

Explanation

The 10-g monofilament buckles at a fixed force that corresponds to the threshold for protective sensation, and failure to feel it at standard sites marks a foot at high risk of unrecognized injury. Other sensory modalities require different instruments and test different pathways.

Question 10Patient Assessment

An ankle-brachial index of 0.75 in a patient being evaluated for orthotic management most likely indicates:

  1. Normal arterial circulation
  2. Mild to moderate peripheral arterial disease Correct answer.
  3. Chronic venous insufficiency
  4. Falsely elevated pressures from calcified vessels

Explanation

An ankle-brachial index below 0.90 is abnormal; values between roughly 0.50 and 0.89 indicate mild to moderate arterial disease, and values below 0.50 indicate severe disease. A ratio of 0.75 therefore falls in the mild-to-moderate range.

Question 11Patient Assessment

Normal non-weight-bearing ankle dorsiflexion range of motion is approximately:

  1. 0 to 5 degrees
  2. 0 to 10 degrees
  3. 0 to 45 degrees
  4. 0 to 20 degrees Correct answer.

Explanation

Ankle dorsiflexion normally reaches about 20 degrees, while plantarflexion reaches approximately 50 degrees. Dorsiflexion limited below about 10 degrees becomes functionally significant for gait.

Question 12Patient Assessment

In a patient with diabetes, a thick plantar callus beneath the first metatarsal head is clinically important mainly because:

  1. it usually signals a developing infection
  2. it is normal and rarely needs attention
  3. it indicates hypermobile ankle motion
  4. it marks a site at risk of ulceration Correct answer.

Explanation

Callus forms where repeated high pressure and shear act on the skin, and in a neuropathic foot that same site is where ulceration typically begins. Callus reduction combined with pressure redistribution is therefore preventive care.

Question 13Patient Assessment

Pitting edema of the lower leg is graded primarily by which feature?

  1. Depth of the pit and how long it lasts Correct answer.
  2. Calf circumference measured in centimeters
  3. Presence of hair on the toes
  4. Skin temperature over the shin

Explanation

Pitting edema is graded on a scale according to how deep the indentation is and how quickly it resolves, which reflects the amount of interstitial fluid. Circumference measures limb volume but not the pitting response.

Question 14Patient Assessment

Moderate wear on the lateral edge of the heel in an otherwise intact shoe most likely represents:

  1. Excessive pronation at heel strike
  2. Forefoot supination during swing
  3. A normal lateral heel-strike pattern Correct answer.
  4. A significant leg-length discrepancy

Explanation

The heel normally contacts the ground slightly lateral to the midline before the foot pronates through loading, so modest lateral heel wear is expected. Marked asymmetry between shoes or extreme wear is what warrants further evaluation.

Question 15Patient Assessment

A healthy, pain-free 4-year-old with a mobile flatfoot and no shoe-wear problems is best managed by:

  1. Immediate rigid custom orthoses
  2. A UCBL orthosis for all waking hours
  3. Surgical referral
  4. Observation with routine reassessment Correct answer.

Explanation

Mobile flatfoot is a normal developmental variant in young children, and asymptomatic cases are observed because the arch usually develops with growth. Intervention is reserved for pain, functional limitation or progression.

Question 16Patient Assessment

Hairless, shiny, thin skin with thickened nails and cool toes most suggests:

  1. Acute soft-tissue infection
  2. Lymphedema
  3. Chronic venous insufficiency
  4. Arterial insufficiency Correct answer.

Explanation

Chronically reduced arterial perfusion produces trophic skin changes including hair loss, shiny atrophic skin, nail thickening and coolness. Venous disease instead produces warmth, edema and pigmentary stasis changes.

Question 17Patient Assessment

A full-thickness plantar ulcer that extends to tendon but shows no abscess or bone involvement corresponds to which Wagner grade?

  1. Grade 0
  2. Grade 1
  3. Grade 2 Correct answer.
  4. Grade 4

Explanation

The Wagner system grades 0 as intact skin over a deformity, 1 as a superficial ulcer, 2 as an ulcer penetrating to tendon or capsule, 3 as deep ulceration with abscess or osteomyelitis, and 4 to 5 as localized or extensive gangrene. A clean ulcer reaching tendon is therefore grade 2.

Question 18Patient Assessment

While observing gait, the patient's pelvis drops on the side of the swinging limb. This most suggests weakness of which muscle?

  1. Gastrocnemius of the swing limb
  2. Tibialis anterior of the stance limb
  3. Gluteus medius of the stance limb Correct answer.
  4. Gluteus maximus of the swing limb

Explanation

The hip abductors of the stance limb, chiefly the gluteus medius, hold the pelvis level while the opposite leg swings. When they are weak, the pelvis drops toward the unsupported side, producing a Trendelenburg gait.

Question 19Patient Assessment

When measuring a patient's foot for footwear, the most appropriate approach is to measure:

  1. The foot with the ankle held in maximal plantarflexion
  2. The larger foot, weight-bearing, late in the day Correct answer.
  3. Only the smaller foot, early in the morning before swelling
  4. Both feet while the patient is seated and unloaded

Explanation

Feet lengthen and widen under load and swell over the course of the day, so fitting to the larger foot while weight-bearing late in the day reduces the risk of a shoe that is too short. Both feet are still measured for comparison.

Question 20Patient Assessment

An antalgic gait pattern is characterized by:

  1. Excessive knee flexion during swing
  2. A shortened stance phase on the sore side Correct answer.
  3. Circumduction of the affected limb
  4. A wide-based, shuffling stride with short steps

Explanation

A patient with a painful limb reduces the time spent loading it, so stance time on the affected side shortens and the swing phase on the sound side speeds up. This produces the characteristic limp.

Question 21Patient Assessment

A patient with diabetes reports burning and numbness in the feet but feels the 10-g monofilament at every site. Which additional test is most useful for detecting early large-fiber sensory loss?

  1. Capillary refill time
  2. Ankle-brachial index determination
  3. 128-Hz tuning fork vibration testing Correct answer.
  4. Transcutaneous oximetry measurement

Explanation

Vibration sense travels in large myelinated fibers and is often lost before light-touch thresholds rise enough to fail monofilament testing. The tuning fork therefore reveals neuropathy earlier in many patients.

Question 22Patient Assessment

Rubor that develops in a foot within one to two minutes of standing and fades when the limb is elevated most suggests:

  1. Severe arterial insufficiency Correct answer.
  2. Normal venous pooling
  3. Cellulitis of the foot
  4. Acute deep vein thrombosis

Explanation

In severe arterial disease the arterioles are maximally dilated at rest, so dependency fills the skin and produces rubor while elevation blanches it. This sign reflects critically reduced perfusion pressure.

Question 23Patient Assessment

With the subtalar joint held in neutral and the patient non-weight-bearing, the first metatarsal head sits higher than the fifth. This deformity is:

  1. Rearfoot varus
  2. Forefoot varus Correct answer.
  3. Forefoot valgus
  4. Tibial varum

Explanation

Forefoot varus is defined in the non-weight-bearing, subtalar-neutral position by a plantarflexed first ray relative to the fifth. When the foot is loaded, the forefoot must evert to reach the ground, which drives rearfoot pronation.

Question 24Patient Assessment

Which finding requires medical referral before any orthotic or footwear intervention proceeds?

  1. Thickened callus beneath the second metatarsal head
  2. Mild hallux valgus without pain
  3. A new painless black area on a diabetic heel Correct answer.
  4. Bilateral flexible pes planus

Explanation

A new black, painless area in an insensate foot may represent necrosis or a deep tissue injury and requires urgent medical evaluation before any device is applied. Loading unperfused or infected tissue with an orthosis or shoe can accelerate tissue loss.

Question 25Patient Assessment

A plantar ulcer at the first metatarsal head, surrounded by thick callus, with readily palpable pedal pulses, most likely represents:

  1. Venous ulcer
  2. Neuropathic ulcer Correct answer.
  3. Ischemic ulcer
  4. Friction blister

Explanation

Neuropathic ulcers occur at high-pressure plantar sites, are ringed by callus and are painless because sensation is lost, while pulses remain palpable since arterial supply is intact. Ischemic ulcers tend to occur distally or at the margins, are painful and lack surrounding hyperkeratosis.

Question 26Patient Assessment

Vibratory sensation in the foot is most commonly assessed using which instrument?

  1. A handheld Doppler
  2. A goniometer
  3. A 128-Hz tuning fork Correct answer.
  4. A reflex hammer

Explanation

Vibratory sense is carried by large myelinated nerve fibers and is often lost early in peripheral neuropathy. A 128-Hz tuning fork is applied to a bony prominence such as the great toe or medial malleolus, and the patient reports when the vibration is no longer felt.

Question 27Patient Assessment

The posterior tibial artery pulse is best palpated at which location?

  1. Anterior to the lateral malleolus
  2. In the popliteal fossa behind the knee
  3. Posterior to the medial malleolus Correct answer.
  4. On the dorsum of the foot, lateral to the extensor hallucis longus tendon

Explanation

The posterior tibial artery curves behind the medial malleolus, where its pulse can be felt against the bone. This pulse is a key indicator of plantar foot perfusion.

Question 28Patient Assessment

A capillary refill time of 4 seconds in the great toe most likely indicates:

  1. Impaired arterial perfusion Correct answer.
  2. An expected finding in older adults
  3. Normal arterial perfusion
  4. Venous insufficiency

Explanation

Capillary refill is normally about 2 seconds or less. A delay of 4 seconds suggests reduced arterial inflow and warrants further vascular evaluation before orthotic or footwear intervention.

Question 29Patient Assessment

When measuring anatomic leg length with a tape measure, which landmarks are used?

  1. Umbilicus to the medial malleolus
  2. PSIS to the lateral malleolus
  3. ASIS to the medial malleolus Correct answer.
  4. ASIS to the greater trochanter

Explanation

Anatomic leg length is measured from the anterior superior iliac spine to the medial malleolus on the same side. Comparing the two sides helps identify a structural limb-length difference.

Question 30Patient Assessment

The navicular drop test is used primarily to assess:

  1. The angle of toe-out during walking
  2. Gastrocnemius muscle strength
  3. Ankle dorsiflexion range with knee extended
  4. Medial longitudinal arch flexibility Correct answer.

Explanation

The test compares navicular height in subtalar neutral non-weight-bearing with height in relaxed stance. A larger drop indicates greater collapse of the medial longitudinal arch under load.

Question 31Patient Assessment

On manual muscle testing, a grade of 3/5 indicates that the muscle:

  1. Contracts with no joint motion and no visible movement
  2. Moves through full range against gravity but not resistance Correct answer.
  3. Moves the joint through full range against maximal resistance
  4. Moves the joint only when gravity is eliminated

Explanation

Grade 3 denotes active movement through the available range against gravity alone, with no added resistance. Grades 4 and 5 require increasing resistance, while grades 0 to 2 reflect little or no antigravity movement.

Question 32Patient Assessment

A patient with long-standing diabetes presents with a unilateral red, hot, markedly swollen foot and a temperature difference of several degrees from the other side, without an open wound. The most appropriate action is to:

  1. Recommend compression stockings and elevation
  2. Fit a custom orthosis and schedule a routine follow-up in one month
  3. Debride the callus and dispense extra-depth shoes
  4. Refer urgently and immobilize the foot Correct answer.

Explanation

This presentation suggests acute Charcot neuroarthropathy, which can progress rapidly if the foot is allowed to bear weight. Urgent medical referral and immobilization are needed to limit deformity.

Question 33Patient Assessment

A sterile probe inserted into a plantar ulcer contacts a hard, gritty structure. This finding most strongly suggests:

  1. A superficial fungal infection
  2. Osteomyelitis involving bone Correct answer.
  3. A venous stasis ulcer
  4. An adequate granulation bed

Explanation

A positive probe-to-bone finding in a diabetic foot ulcer is highly suggestive of underlying osteomyelitis. The patient should be referred for medical imaging and treatment before further orthotic loading.

Question 34Patient Assessment

Which set of findings is most characteristic of a venous stasis ulcer?

  1. A deep wound with exposed tendon and palpable pulses
  2. Punched-out borders with a pale base and surrounding shiny hairless skin
  3. Irregular borders, moist bed, edema and brownish skin staining Correct answer.
  4. Dry black eschar at the heel with normal pulses

Explanation

Venous ulcers typically occur near the medial malleolus with irregular margins, a moist bed, dependent edema, and hemosiderin staining of the surrounding skin. These features reflect chronic venous hypertension rather than arterial insufficiency.

Question 35Patient Assessment

During gait observation, the patient lifts the affected limb unusually high and the foot slaps down at initial contact. This pattern most suggests:

  1. A plantarflexion contracture
  2. Spasticity of the gastrocnemius
  3. Ankle dorsiflexor weakness Correct answer.
  4. Hip abductor weakness

Explanation

Excessive hip and knee flexion with a slapping foot is the steppage pattern used to clear a foot that cannot dorsiflex. It indicates weakness of the ankle dorsiflexors and loss of controlled heel strike.

Question 36Patient Assessment

A high, rigid medial longitudinal arch that does not lower during weight-bearing and a rearfoot that remains inverted most suggests:

  1. Flexible flatfoot
  2. Rigid forefoot valgus
  3. Plantar fasciitis
  4. A cavus foot Correct answer.

Explanation

A cavus foot has a high arch that persists under load, often with a rigid inverted rearfoot. Because cavus feet are frequently neurogenic, sensation and muscle balance should also be assessed.

Question 37Patient Assessment

The Silfverskiöld test is used to differentiate:

  1. Sensory neuropathy from motor neuropathy
  2. Gastrocnemius equinus from combined equinus Correct answer.
  3. True leg length discrepancy from a functional one
  4. Anterior from posterior tibial tendon dysfunction

Explanation

The test compares ankle dorsiflexion with the knee extended and flexed. Improvement with knee flexion points to isolated gastrocnemius tightness, while limited dorsiflexion in both positions suggests combined gastrocnemius-soleus tightness.

Question 38Patient Assessment

Cadence is defined as:

  1. The distance covered in one full gait cycle
  2. The angle formed by the foot and the line of progression
  3. The number of steps taken per minute Correct answer.
  4. The time spent in single-limb support during one cycle

Explanation

Cadence is a temporal gait parameter expressing how many steps are taken per minute. It is distinct from stride length, which measures distance across a full gait cycle.

Question 39Patient Assessment

When checking the fit of a shoe's toe box, the most appropriate criterion is that there is:

  1. No space between the longest toe and the end of the shoe
  2. Light contact between the toes and the top of the toe box
  3. A thumb's width between the longest toe and the shoe end Correct answer.
  4. At least three finger widths of space in front of the toes

Explanation

About one thumb's width of clearance beyond the longest toe allows room for toe extension during gait and prevents pressure at the nail and apex. The toe box should also be tall enough that the toes do not rub the upper.

Question 40Patient Assessment

A patient reports calf pain that consistently begins after walking two blocks and resolves within a few minutes of standing still. This history most suggests:

  1. Chronic venous insufficiency
  2. Lumbar spinal stenosis
  3. Plantar fasciitis
  4. Intermittent claudication Correct answer.

Explanation

Reproducible exercise-induced calf pain relieved promptly by rest is the classic pattern of intermittent claudication from peripheral arterial disease. Vascular assessment, including pulse examination and ankle-brachial index, should precede orthotic planning.

Question 41Formulation of the Treatment Plan

Which is the primary goal of a pedorthic plan for a patient with diabetic sensory neuropathy and a healed plantar ulcer?

  1. Correct the underlying forefoot varus deformity
  2. Redistribute pressure away from the ulcer site Correct answer.
  3. Restore normal proprioceptive feedback through the insert
  4. Immobilize the ankle during standing and walking

Explanation

In a neuropathic foot with a history of ulceration, the central aim is to lower peak plantar pressure at the site of prior injury while keeping the foot protected and stable. Devices such as total contact inserts, accommodative depth shoes, and rocker soles are selected to redistribute load rather than to reshape the foot.

Question 42Formulation of the Treatment Plan

A total contact insert is designed primarily to do which of the following?

  1. Increase the shoe's forefoot stiffness at the metatarsal break
  2. Spread loading across the whole plantar surface Correct answer.
  3. Restrict rearfoot motion through the whole stance phase
  4. Concentrate loading beneath the heel pad and metatarsal heads

Explanation

A total contact insert is molded to the shape of the foot so body weight is shared over the largest possible area. This lowers peak pressure at any single point and is the underlying principle of pressure-relief design.

Question 43Formulation of the Treatment Plan

A patient with hallux rigidus has pain at the first metatarsophalangeal joint when walking. Which shoe modification best limits motion at that joint?

  1. Rigid rocker sole with the apex behind the metatarsal heads Correct answer.
  2. Metatarsal pad placed distal to the first metatarsal head
  3. Cushioned heel with a soft, low heel counter
  4. Steel shank ending just behind the metatarsal break with a flexible forefoot

Explanation

A rigid rocker sole places a fulcrum behind the metatarsal break so the shoe rolls the foot through late stance instead of the toe joint bending. This reduces dorsiflexion demand at the first metatarsophalangeal joint.

Question 44Formulation of the Treatment Plan

A patient has a 1.5 cm anatomic leg length discrepancy, with the right leg shorter. Where should an internal heel lift be placed?

  1. In neither shoe; apply an external lift to the left shoe
  2. In the right shoe, under the heel Correct answer.
  3. In the left shoe, under the heel
  4. In both shoes equally

Explanation

Height is added to the shorter side so the pelvis levels during stance. A modest internal heel lift can be placed inside the shoe before an external sole buildup is considered.

Question 45Formulation of the Treatment Plan

Where should a metatarsal pad be placed for a patient with metatarsalgia?

  1. Directly beneath the metatarsal heads
  2. Just proximal to the metatarsal heads Correct answer.
  3. Along the lateral border of the foot
  4. Over the toes, distal to the metatarsophalangeal joints

Explanation

A metatarsal pad sits just proximal to the metatarsal heads so it lifts and spreads the transverse arch, transferring load off the heads. Placing it directly under the heads would concentrate pressure on the painful area.

Question 46Formulation of the Treatment Plan

A 4-year-old child has asymptomatic, flexible flatfeet and is developing normally. What is the most appropriate recommendation?

  1. Appropriate footwear and observation Correct answer.
  2. Rigid UCBL orthoses worn full time
  3. Custom molded orthoses with a 6 mm medial post
  4. Firm prefabricated insoles with a medial arch pad

Explanation

Flexible flatfoot in a young child is a normal variant when it is asymptomatic and development is normal; routine orthoses have not been shown to change arch development or gait. Well-fitting footwear and periodic observation are sufficient.

Question 47Formulation of the Treatment Plan

A patient with diabetes has a Charcot midfoot with a rigid rocker-bottom deformity and intact skin. Which plan is most appropriate?

  1. Custom molded orthoses to correct the midfoot deformity
  2. Firm prefabricated insoles with a medial post
  3. Extra-depth shoes with custom total contact inserts Correct answer.
  4. Rigid carbon inserts to immobilize the midfoot

Explanation

A rigid Charcot deformity cannot be corrected, and forcing the foot toward a normal shape risks skin breakdown over bony prominences. The plan should accommodate the existing shape with a total contact insert in an extra-depth shoe that shares load over a broad area.

Question 48Formulation of the Treatment Plan

Which documentation best supports the medical necessity of a custom-molded insert?

  1. The patient's verbal request for a more comfortable insole
  2. A copy of the manufacturer's brochure for the insert material
  3. The clinic's standard fitting protocol signed by the pedorthist
  4. Objective findings linking the condition to the device Correct answer.

Explanation

Medical necessity is supported by clinical findings - diagnosis, deformity, sensory status, and functional limitation - tied to the specific features of the device ordered. Product literature, routine protocols, and preference alone do not establish need.

Question 49Formulation of the Treatment Plan

What is the main purpose of an extra-depth shoe in a pedorthic plan?

  1. To reduce the shoe's weight by thinning the sole
  2. To limit ankle motion during the swing phase
  3. To let the upper stretch permanently over the forefoot
  4. To make room for a thick or custom insert Correct answer.

Explanation

Extra depth refers to added internal volume, which lets a custom insert or bulky dressing sit beneath the foot without compressing the toes or dorsum. The added space is the defining feature, not sole thickness.

Question 50Formulation of the Treatment Plan

A patient with stage II posterior tibial tendon dysfunction has a flexible, pronating foot. Which orthotic design is most appropriate?

  1. Neutral shell with no posting and a soft full-length cover
  2. Deep heel cup with medial posting and arch support Correct answer.
  3. Lateral heel wedge with a lateral flare
  4. Metatarsal pad with a first-ray recess

Explanation

A flexible pronating foot with a painful posterior tibial tendon needs medial support: a deep heel cup and medial post hold the rearfoot in a better position while the longitudinal arch shares load.