Orthotic Patient Assessment
What assessment must capture
Assessment is the data-gathering phase that justifies every later decision, so questions in this domain test whether you can separate subjective from objective findings and impairment from functional limitation. Expect to name the components: history (chief complaint, onset, prior orthotic use, comorbidities, medications, skin integrity history, occupational and recreational demands), systems review, and physical examination. Key examination concepts include range of motion (active vs. passive, and why the difference matters), manual muscle testing graded 0–5, muscle tone (spasticity vs. rigidity), sensation (protective sensation screening with monofilament), vascular status (pulses, capillary refill, skin temperature), alignment and posture in all three planes, gait observation, and anthropometric measurement for device fabrication.
Traps to watch
- Confusing a finding with an impairment or a goal. "Decreased dorsiflexion to −5°" is a finding; "patient will clear the toe during swing" is a functional goal.
- Ignoring contraindications (e.g., absent protective sensation, non-healing ulcer, severe fixed deformity) that change the device class before you ever design it.
- Overlooking psychosocial and environmental factors (home layout, caregiver support, transportation, work footwear) that predict adherence.
- Assuming a normal exam in one position (seated) rules out a problem that appears only in weight-bearing.
Rule of thumb
Document findings in a way that a second clinician could reproduce them: joint, side, position, and value. If you cannot state the measurement, you cannot defend the plan.
Worked example
A patient with diabetes reports a "hot spot" under the first metatarsal. The trap answer jumps to a custom insole. The correct assessment step is to screen protective sensation and inspect skin; if protective sensation is absent, the plan must address offloading and skin surveillance, not just cushioning.