DVBCWFW3 ;ALB/RLC FEET WKS TEXT - 1 ; 16 JAN 2007 ;;2.7;AMIE;**120**;Apr 10, 1995;Build 4 ; TXT ; ;;A. Review of Medical Records: ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; ;; 1. Pain, weakness, stiffness, swelling, heat, redness, ;; fatigability, lack of endurance, etc. ;; 2. Describe symptoms at rest and on standing and walking. ;; 3. Treatment - type, dose, frequency, response, side effects. ;; 4. If there are periods of flare-up of joint disease: ;; ;; a. State their severity, frequency, and duration. ;; b. Name the precipitating and alleviating factors. ;; c. Estimate to what extent, if any, they result in additional ;; limitation of motion or functional impairment during the ;; flare-up. (Per veteran) ;; ;; ;; 5. Describe whether crutches, brace, cane, corrective shoes, ;; shoe inserts, etc., are needed and their efficacy. ;; 6. History of any hospitalization or surgery (Date, location, if known, ;; reason or type of surgery). ;; 7. Describe effects of the condition(s) on the veteran's usual ;; occupation and daily activities. ;; 8. Describe any injury to the feet. ;; 9. Functional limitations on standing (i.e., unable to stand, able ;; to stand 15-30 minutes) and walking (i.e., nonambulatory, able to ;; walk 1/4 mile). ;; 10. History of neoplasm: ;; ;; a. Date of diagnosis, diagnosis. ;; b. Benign or malignant. ;; c. Types and dates of treatment. ;; d. Date of last treatment. ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following as appropriate to the condition ;; being examined and fully describe current findings: A DETAILED ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED. ;; ;; 1. Describe each foot separately. For nomenclature of toes use: ;; great toe, second, third, fourth, and fifth. The functional ;; loss should be related to the anatomical condition. ;; 2. Describe objective evidence of painful motion, edema, ;; instability, weakness, tenderness, etc. ;; 3. Describe gait. ;; 4. Describe any callosities, breakdown, or unusual shoe wear ;; pattern that would indicate abnormal weight bearing. ;; 5. Describe any skin and vascular changes. ;; 6. Describe hammertoes, high arch, clawfoot, or other deformity - ;; actively or passively correctable? ;; 7. For flatfoot ;; ;; a. Describe weight bearing and non-weight bearing alignment ;; of the Achilles tendon. ;; b. Describe whether the Achilles tendon alignment can be ;; corrected by manipulation and whether there is pain on ;; manipulation. ;; c. Describe degrees of valgus and whether correctable by ;; manipulation. ;; d. Describe extent of forefoot and midfoot malalignment and ;; whether correctable by manipulation. ;; ;; 8. For hallux valgus, describe angulation and dorsiflexion at ;; first metatarsal phalangeal joints. ;; 9. Is there any active motion in the metatarsophalangeal joint of ;; the great toe? ;; ;;D. Diagnostic and Clinical Tests: ;; ;; Comment on: ;; ;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and ;; lateral views and non-weight bearing AP, lateral, and oblique ;; views, if none are of record or if of record and condition has or ;; may have progressed. ;; 2. For other conditions, AP, lateral, and oblique of entire foot, ;; as applicable. ;; 3. Include results of all diagnostic and clinical tests conducted ;; in the examination report. ;; ;;E. Diagnosis: ;; ;; ;;Signature: Date: ;;END