DVBCWFW1 ;ALB/CMM FEET WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
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. Describe symptoms at
;; rest and on standing and walking.
;;
;;
;; 2. Treatment - type, dose, frequency, response, side effects.
;;
;;
;; 3. 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.
;;
;;
;; 4. Describe whether crutches, brace, cane, corrective shoes,
;; etc., are needed.
;;
;;
;; 5. Describe details of any surgery or injury.
;;
;;
;; 6. Describe corrective shoes, shoe inserts, or braces used and
;; their efficacy.
;;
;;
;; 7. Describe effects of the condition(s) on the veteran's usual
;; occupation and daily activities.
;;
;;TOF
;;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. Using a goniometer, measure the PASSIVE and ACTIVE range of
;; motion, including movement against gravity and against strong
;; resistance.
;;
;;
;; 3. If the joint is painful on motion, state at what point in the
;; range of motion pain begins and ends.
;;
;;
;; 4. State to what extent (if any) and in which degrees (if possible)
;; the range of motion or function is ADDITIONALLY LIMITED by
;; pain, fatigue, weakness, or lack of endurance following
;; repetitive use or during flare-ups. If more than one of these
;; is present, state, if possible, which has the major functional
;; impact.
;;
;;
;; 5. Describe objective evidence of painful motion, edema,
;; instability, weakness, tenderness, etc.
;;
;;
;; 6. Describe gait and functional limitations on standing and walking.
;;
;;
;; 7. Describe any callosities, breakdown, or unusual shoe wear
;; pattern that would indicate abnormal weight bearing.
;;
;;
;; 8. Describe any skin and vascular changes.
;;
;;
;; 9. Posture on standing, squatting, supination, pronation, and
;; rising on toes and heels.
;;
;;
;; 10. Describe hammertoes, high arch, clawfoot, or other deformity -
;; actively or passively correctable?
;;
;;
;; 11. 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.
;;
;;
;; 12. For hallux valgus, describe angulation and dorsiflexion at
;; first metatarsal phalangeal joints.
;;
;;
;;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.
;; 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
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWFW1 4436 printed Sep 15, 2024@21:15:27 Page 2
DVBCWFW1 ;ALB/CMM FEET WKS TEXT - 1 ; 6 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;
+5 ;;B. Medical History (Subjective Complaints):
+6 ;;
+7 ;; Comment on:
+8 ;; 1. Pain, weakness, stiffness, swelling, heat, redness,
+9 ;; fatigability, lack of endurance, etc. Describe symptoms at
+10 ;; rest and on standing and walking.
+11 ;;
+12 ;;
+13 ;; 2. Treatment - type, dose, frequency, response, side effects.
+14 ;;
+15 ;;
+16 ;; 3. If there are periods of flare-up of joint disease:
+17 ;; a. State their severity, frequency, and duration.
+18 ;;
+19 ;;
+20 ;; b. Name the precipitating and alleviating factors.
+21 ;;
+22 ;;
+23 ;; c. Estimate to what extent, if any, they result in additional
+24 ;; limitation of motion or functional impairment during the
+25 ;; flare-up.
+26 ;;
+27 ;;
+28 ;; 4. Describe whether crutches, brace, cane, corrective shoes,
+29 ;; etc., are needed.
+30 ;;
+31 ;;
+32 ;; 5. Describe details of any surgery or injury.
+33 ;;
+34 ;;
+35 ;; 6. Describe corrective shoes, shoe inserts, or braces used and
+36 ;; their efficacy.
+37 ;;
+38 ;;
+39 ;; 7. Describe effects of the condition(s) on the veteran's usual
+40 ;; occupation and daily activities.
+41 ;;
+42 ;;TOF
+43 ;;C. Physical Examination (Objective Findings):
+44 ;;
+45 ;; Address each of the following as appropriate to the condition
+46 ;; being examined and fully describe current findings: A DETAILED
+47 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
+48 ;;
+49 ;; 1. Describe each foot separately. For nomenclature of toes use:
+50 ;; great toe, second, third, fourth, and fifth. The functional
+51 ;; loss should be related to the anatomical condition.
+52 ;;
+53 ;;
+54 ;; 2. Using a goniometer, measure the PASSIVE and ACTIVE range of
+55 ;; motion, including movement against gravity and against strong
+56 ;; resistance.
+57 ;;
+58 ;;
+59 ;; 3. If the joint is painful on motion, state at what point in the
+60 ;; range of motion pain begins and ends.
+61 ;;
+62 ;;
+63 ;; 4. State to what extent (if any) and in which degrees (if possible)
+64 ;; the range of motion or function is ADDITIONALLY LIMITED by
+65 ;; pain, fatigue, weakness, or lack of endurance following
+66 ;; repetitive use or during flare-ups. If more than one of these
+67 ;; is present, state, if possible, which has the major functional
+68 ;; impact.
+69 ;;
+70 ;;
+71 ;; 5. Describe objective evidence of painful motion, edema,
+72 ;; instability, weakness, tenderness, etc.
+73 ;;
+74 ;;
+75 ;; 6. Describe gait and functional limitations on standing and walking.
+76 ;;
+77 ;;
+78 ;; 7. Describe any callosities, breakdown, or unusual shoe wear
+79 ;; pattern that would indicate abnormal weight bearing.
+80 ;;
+81 ;;
+82 ;; 8. Describe any skin and vascular changes.
+83 ;;
+84 ;;
+85 ;; 9. Posture on standing, squatting, supination, pronation, and
+86 ;; rising on toes and heels.
+87 ;;
+88 ;;
+89 ;; 10. Describe hammertoes, high arch, clawfoot, or other deformity -
+90 ;; actively or passively correctable?
+91 ;;
+92 ;;
+93 ;; 11. For flatfoot
+94 ;; a. Describe weight bearing and non-weight bearing alignment
+95 ;; of the Achilles tendon.
+96 ;;
+97 ;;
+98 ;; b. Describe whether the Achilles tendon alignment can be
+99 ;; corrected by manipulation and whether there is pain on
+100 ;; manipulation.
+101 ;;
+102 ;;
+103 ;; c. Describe degrees of valgus and whether correctable by
+104 ;; manipulation.
+105 ;;
+106 ;;
+107 ;; d. Describe extent of forefoot and midfoot malalignment and
+108 ;; whether correctable by manipulation.
+109 ;;
+110 ;;
+111 ;; 12. For hallux valgus, describe angulation and dorsiflexion at
+112 ;; first metatarsal phalangeal joints.
+113 ;;
+114 ;;
+115 ;;D. Diagnostic and Clinical Tests:
+116 ;;
+117 ;; Comment on:
+118 ;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and
+119 ;; lateral views and non-weight bearing AP, lateral, and oblique
+120 ;; views.
+121 ;; 2. For other conditions, AP, lateral, and oblique of entire foot,
+122 ;; as applicable.
+123 ;; 3. Include results of all diagnostic and clinical tests conducted
+124 ;; in the examination report.
+125 ;;
+126 ;;
+127 ;;E. Diagnosis:
+128 ;;
+129 ;;
+130 ;;Signature: Date:
+131 ;;END
