PO-13 · Special Populations in Prosthetics and Orthotics

Special Populations in Prosthetics and Orthotics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The cast force is 100% adherence to the offloading protocol — Correct: A non-removable cast enforces offloading by removing the option of taking the device off. It does not guarantee 100% adherence: a patient can still bear weight in the cast, which is why closure rates are about 89% rather than universal. (2) In the audio: only about 16% of diabetic foot ulcer patients receive total contact casting nationally. — Correct: The 16% figure belongs to patients in the US Wound Registry, not to diabetic foot ulcer patients nationally. Those are different populations with different utilization, and the registry denominator is the one the figure was drawn from. (3) In the audio: Option A covers one pair of extra depth shoes plus three pairs of molded inserts. ... Option B is for more severe deformities. — Correct: CMS does not letter these baskets. Identify them by shoe type: the depth-shoe basket is one pair of extra-depth shoes plus three pairs of inserts, and the custom-molded basket is one pair of custom-molded shoes, inserts included, plus two additional pairs. The letters appear in no statute or CMS document, and the review books that use them do not agree with each other on which is which. (4) In the audio: Option A provides extra depth shoes plus three inserts. Option B provides custom shoes plus two inserts. — Correct: Same correction as the earlier passage: the baskets are not lettered by CMS. Name them by shoe type. (5) In the audio: and 64 designates a double below-knee amputee who is running. — Correct: T/F64 is the single below-knee running class. The doubles come first in the 60s series: T/F61 double above-knee, T/F62 double below-knee, T/F63 single above-knee, T/F64 single below-knee. The 40s are the standing classes, T/F42 single above-knee and T/F44 single below-knee. (6) In the audio: A normal ankle brachial index falls precisely between 1.00 and 1.30. That's your healthy baseline. Okay, 1.00 to 1.30. — Correct: Normal is 1.00 to 1.40. The 2024 ACC/AHA lower extremity PAD guideline reports the resting ABI as abnormal (0.90 or below), borderline (0.91 to 0.99), normal (1.00 to 1.40) or noncompressible (above 1.40), the same four bands as the 2016 guideline and the 2011 focused update. A value of 1.35 is normal and does not by itself call for a toe-brachial index; the TBI trigger is above 1.40. The 1.30 top-of-normal is the 2005 convention, replaced in 2011. The episode carries the contradiction internally, stopping normal at 1.30 and then putting the non-compressible trap above 1.40, which leaves 1.31 to 1.40 unnamed. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-13.