Podiatry Arena members do not see these ads

i have never been comfortable with most assessment forms / databases i've had to use in that, firstly, i am of the opinion that a significant proportion of pod's (practising in aus) overestimate their diagnostic ability (referring to neurovascular segment of an assessment) and secondly, i have never got a confident consensual opinion on the limits to which we can diagnose.......... for example i often have to enter "unable to determine" in response to prompts for peripheral neuropathy or pvd.......(note: i am only semi-aware of material covered by the present aus pod courses).....i am quite comfortable with neurovascular hx taking and testing, categorising for podiatry treatment status, and informing the primary carer gp of same....... looking forward to any responses............yours truly, mark c

Hey Mark

Quite agree that Diagnostic forms have limited value. A case study by D O McConville in the January issue of Podiatry now tells of a 77 yo male diabetic patient who presented with

"all pulses palpable... Monofilament sensation intact... The skin was fine (sic)"

and a damn great undermined PAINLESS heel ulcer 30 by 16 mm on the surface radiating 60mm distally . There are some rather distubing pictures of the podiatrist probing the extent of the tracking with a pain of forceps causing no pain.

Makes you wonder

Regards
Robert

From a musculo-skeletal viewpoint, the quantum-leap that the profession must get to is knowing when your typical biomechanical assessment is virtually irrelevant.

If you have a patient with a recalcitrant posterior impingement of the ankle-joint, and it is the main source of pain, then concern yourself about getting that right first, before you even begin to consider 'the medial STJ axis' or the 'plantar-flexed first ray'.

IMO, no allied health profession is great at diagnosing musculo-skeletal conditions, but podiatrists should aim to be better because the region of expertise is so condensed.


Ron

Me: "What is your diagnosis for this patient?"
Student: "They have got 4 degrees of this and 10 degrees of that and..."
Me: "NO...what is your diagnosis for this patient?"
Student: "The midfoot collapses during late stance and there is a ..."
Me: "Fail"

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

An interesting idea. Not sure I agree. I’ve always thought of it in terms of chicken pox.. The spots are the bit you see and the bits that itch but if all you treat is the spots they’ll just keep coming back because you’ve not addressed the underlying cause.

I get peeved when somebody writes “Neuroma” or “Sub talar collapse” in the Diagnosis box of an assessment form because IMO this is only half the story. If I was a surgeon I would be content to know that the neuroma was there because all I would need to do was remove it. As a biomechanist I want to know WHY it is there so I can stop it coming back!

If biomechanical assessment is irrelevant why are we doing it? Surely if we are just treating the symptom directly a flow chart of Condition – Prescription would be sufficient and we could get a technician to do it for us.

Opinions?

Robert

Biomechanical assessments are still relevant...the conclusions from it are just not a "diagnosis".

The biomechanical assessment serves 2 purposes:
1. Determine the most likely pathomechanical cause for the "diagnosis", assuming its mechanical in nature.
2. Derive a foot orthoses prescription, assuming they are indicated.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Agreed!

I am not saying it is irrelevant. I am saying that it is irrelevant in some clinical situations.


For instance, if a patient presents with an acute ankle ligament sprain secondary to descending a missed step. Even though the FPI may indicated a "pronated" foot, even though the SRT may be hard, even though the STJ axis is medially located, even though the midfoot is hypermobile...irrelevant now.

And how much are you going to obtain from an antalgic gait, which is a short-term (hopefully) artificial representation of the patient's usual gait.

The biomechanics in this situation say increase supination moments (forces) and invert the rearfoot (motion).

But this is the exact opposite of treating an acute ankle sprain isn't it.




All I am saying is that sometimes, we have to address the presenting problem, whose cause wasn't biomechanical, but incidental trauma.

Atlas

Could this be because you are thinking Root. Whereas tissue stress Biomechanics determines which tissue is traumatised and devises a treatment to suit it. Patient presenting with inversions sprain = trauma to lateral ligaments and peroneals = reduce supination moments.
Typical treatment plan = Rigid taping, heel lifts, possibly lateral post, ice, possibly RICE, mobilise, massage, contrast bathe, strengthening exercices.

Dave

I don't ever envisage ever thinking Root v. Sagittal-plane v. this v. that. You tend to pidgeon-hole yourself, your mindset and your patient and his/her problem.

Dear Atlas

Firstly sorry i misunderstood, i thought you meant Assessment was virtually irrelavant in all cases rather than some cases. My bad.

However i would still disagree that the pathomechanics is not relevant if they are not the cause of the injury. Using the tissue stress model that any movement which causes unsustainable tissue stress is pathological the traumatic strain has simply lowered the threshold for sustainable tissue stress. I still believe one must understand the surrounding biometrics to treat effectively even if they were not pathological before the injury. I also believe it is unsafe to attempt to manipulate/control foot function without understanding (or at least trying to understand) how that patient functions.

To use a metaphor, if i get my knees broken (dodgy financial arrangement with some unpleasant people ), i may well need a cast and later, a brace. This does not mean my function pre violent goon attack was pathological!

Regards
Robert