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1DVBCWFW3 ;ALB/RLC FEET WKS TEXT - 1 ; 16 JAN 2007
2 ;;2.7;AMIE;**120**;Apr 10, 1995;Build 4
3 ;
4TXT ;
5 ;;A. Review of Medical Records:
6 ;;
7 ;;B. Medical History (Subjective Complaints):
8 ;;
9 ;; Comment on:
10 ;;
11 ;; 1. Pain, weakness, stiffness, swelling, heat, redness,
12 ;; fatigability, lack of endurance, etc.
13 ;; 2. Describe symptoms at rest and on standing and walking.
14 ;; 3. Treatment - type, dose, frequency, response, side effects.
15 ;; 4. If there are periods of flare-up of joint disease:
16 ;;
17 ;; a. State their severity, frequency, and duration.
18 ;; b. Name the precipitating and alleviating factors.
19 ;; c. Estimate to what extent, if any, they result in additional
20 ;; limitation of motion or functional impairment during the
21 ;; flare-up. (Per veteran)
22 ;;
23 ;;
24 ;; 5. Describe whether crutches, brace, cane, corrective shoes,
25 ;; shoe inserts, etc., are needed and their efficacy.
26 ;; 6. History of any hospitalization or surgery (Date, location, if known,
27 ;; reason or type of surgery).
28 ;; 7. Describe effects of the condition(s) on the veteran's usual
29 ;; occupation and daily activities.
30 ;; 8. Describe any injury to the feet.
31 ;; 9. Functional limitations on standing (i.e., unable to stand, able
32 ;; to stand 15-30 minutes) and walking (i.e., nonambulatory, able to
33 ;; walk 1/4 mile).
34 ;; 10. History of neoplasm:
35 ;;
36 ;; a. Date of diagnosis, diagnosis.
37 ;; b. Benign or malignant.
38 ;; c. Types and dates of treatment.
39 ;; d. Date of last treatment.
40 ;;
41 ;;C. Physical Examination (Objective Findings):
42 ;;
43 ;; Address each of the following as appropriate to the condition
44 ;; being examined and fully describe current findings: A DETAILED
45 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
46 ;;
47 ;; 1. Describe each foot separately. For nomenclature of toes use:
48 ;; great toe, second, third, fourth, and fifth. The functional
49 ;; loss should be related to the anatomical condition.
50 ;; 2. Describe objective evidence of painful motion, edema,
51 ;; instability, weakness, tenderness, etc.
52 ;; 3. Describe gait.
53 ;; 4. Describe any callosities, breakdown, or unusual shoe wear
54 ;; pattern that would indicate abnormal weight bearing.
55 ;; 5. Describe any skin and vascular changes.
56 ;; 6. Describe hammertoes, high arch, clawfoot, or other deformity -
57 ;; actively or passively correctable?
58 ;; 7. For flatfoot
59 ;;
60 ;; a. Describe weight bearing and non-weight bearing alignment
61 ;; of the Achilles tendon.
62 ;; b. Describe whether the Achilles tendon alignment can be
63 ;; corrected by manipulation and whether there is pain on
64 ;; manipulation.
65 ;; c. Describe degrees of valgus and whether correctable by
66 ;; manipulation.
67 ;; d. Describe extent of forefoot and midfoot malalignment and
68 ;; whether correctable by manipulation.
69 ;;
70 ;; 8. For hallux valgus, describe angulation and dorsiflexion at
71 ;; first metatarsal phalangeal joints.
72 ;; 9. Is there any active motion in the metatarsophalangeal joint of
73 ;; the great toe?
74 ;;
75 ;;D. Diagnostic and Clinical Tests:
76 ;;
77 ;; Comment on:
78 ;;
79 ;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and
80 ;; lateral views and non-weight bearing AP, lateral, and oblique
81 ;; views, if none are of record or if of record and condition has or
82 ;; may have progressed.
83 ;; 2. For other conditions, AP, lateral, and oblique of entire foot,
84 ;; as applicable.
85 ;; 3. Include results of all diagnostic and clinical tests conducted
86 ;; in the examination report.
87 ;;
88 ;;E. Diagnosis:
89 ;;
90 ;;
91 ;;Signature: Date:
92 ;;END
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