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

•    Achilles tendon alignment

•    Gait pattern

•    Arches

2.  Palpation:

•    Posterior aspect of the ankle: locate point tenderness

•    Differentiate nodules, which indicate a pump bump

•    Differentiate soft tissue tenderness between muscle and tendon

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:

To rule out Achilles rupture:

•  With the patient prone and the foot off the table.
squeeze the calf to see if there is any resultant
plantar flexion. If there is no motion or it is
diminished - the Achilles tendon is ruptured.

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, heel lift, arch supports for longitudinal arch, home program, activity or spoil 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.

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