Pre-Assessment Case Study

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Author’s note: I am a Certified Pedorthist operating out of a multidisciplinary clinic. Please bear in mind that I have not yet formally assessed this client. She is being sent to me on a trial basis by her physiotherapist to determine if my services and skill set meet the needs of another clinic. I have met with this client and her physiotherapist for a brief introduction during which time I did pick up some bits of information. As it is a test for me I would like to see if there are any suggestions as to things I should absolutely look for, assessment techniques I should absolutely perform, etc. In theory my assessment covers all that is necessary and I end up with a solution that works for this client and the other clinicians she is seeing. What I don’t want to do is forget something that I should have done or a question I forgot to consider. Any advice is welcome and I will post an update post assessment/treatment.

CASE STUDY- Pre Assessment Intro

Chief Complaint: White female, mid-late 40s, enlisted military member. History of plantar/medial heel pain that started on the R foot and is now bilateral. The client is now also experiencing some intermittent, mild tingling/numbness at the site of pain as well as some mild, bilateral, plantar metatarsal head pain. Knees and low back also affected.

History of Present Illness: Symptoms have been on going for several years and have worsened over time despite treatment efforts which have included custom foot orthoses (aliplast+EVA fill), ultrasound, some radiology traditionally used to break down kidney stones (?), cortisone shots x 2 L side only. Previous, potentially inaccurate, diagnoses for the complaint include plantar fasciitis, heel pad atrophy and Tib Post Dys.
Past Medical History: Bilateral knee surgery for meniscal tears.

Physical Exam:

MSK- Bilat: Neutral RF, mild metatarsus adductus, prominent base of 5th metatarsal, hallux dorsi restricted in WB. STJ axis appears as though it would be mildly medially deviated.

Dermatological- Medial heel callusing.

Footwear- Neutral Brooks running shoe with torsional stability through midfoot portion of midsole. Significant lateral wear on the sole particularly from mid to forefoot. Client intends to replace soon.

Goals: The client’s physiotherapist would like to get the biomechanics sorted (with custom orthoses) before applying any other treatment. The client would like to be physically active again as she has once been including work related requirements such as rucksack marches.

 

? Baxters
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=37527
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=46934