PATIENT EVALUATION

A.    Subjective:

•    Patient complaint

•    Location

•    Onset and duration of symptoms

•    Description of symptoms (i.e. numbness, pain [constant, dull, sharp! hypersensitivity. stiffness); use pain scale

•    Pattern of when symptoms occur (AM. PM. after activity, etc.)

•    Self-help or other formal treatment

•    Other medical problems

•    Concurrent medications and allergies

B.     Objective (also compare with uninvolved foot):

1.  Inspection

•    Redness, swelling, warmth

•    Scars

•    Gait pattern

•    Arches

2. Palpation:

•    Plantar surface of the foot, locate point tenderness

•    Differentiate nodules, which indicate Dupuytren's contracture

•    Differentiate soft tissue tenderness between 3rd and 4th metatarsal heads (Morton's neuroma)

3. Mobility:

•   Active and passive ROM (plantar and dorsi
flexion, inversion and eversion)

4. Muscle Testing:

•   Dorsi and plantar flexors, invertors and evertors

5. Provocation Tests:

•   Palpation of deep, non-nodular tenderness
anywhere along the plantar fascia, from origin to
insertion

6. Other Joints:

•   Test toes, ankle, knee and hip for secondary
involvement

7. Review x-ray films and physician's report

C.    Assessment:

1.     Problem list

2.  Goals

3.  Treatment:

•    Iontophoresis (medications, dosages, electrode size)

•    Other modalities (e.g. ice or heat, stretching. friction massage, arch supports for longitudinal arch, home program, activity or sport re-education to prevent re-injury, etc.)

•    Oral or injectable medications (administered by physician, e.g. NSAIDs. corticosteroids)

D.     Plan:

1.     Frequency and duration of treatment

2.  Date(s) for assessment of progress