Foot evaluation

OVERALL_INSTRUCTIONS

Indicate R/ L where applicable or insert findings assuming b/l. Write as a bulleted list, no paragraphs

Chief Complaint

[Insert chief complaint or reason for foot evaluation referral]

Template

Date: [Insert Date] RE: [Insert Patient Name], DOB: [Insert Date of Birth (YYYY-MM-DD)], DIABETIC STATUS: [Yes / No] EXAMINATION FINDINGS: SKIN: [Insert findings with regards to Skin integrity (intact, callous/corn, cracks/fissures, blisters, ulcers, infection), Redness, heat, swelling, or signs of cellulitis] NAILS: [Insert findings with regards to nail condition (normal, thickened, long, deformed, missing), Ingrown or infected nails] STRUCTURE / ANATOMY: [Insert findings with regards to Overall foot structure, Presence of deformities (bunions, hammer/claw toes, overlapping digits), Range of motion at ankle and toe joints, Arch presentation (e.g., fallen arch), Previous amputation or structural changes, Redness over pressure areas or painful joints] SENSATION: [Insert findings with regards to Sensation testing with 10 g monofilament (mark + or –), Subjective sensory symptoms (numbness, tingling, burning, crawling sensation), Pain or inflammation in areas with reduced sensation] VASCULAR: [Insert findings with regards to Pulses, Capillary refill, Skin temperature and color, Presence of edema, Hair loss, varicosities, dependent rubor, Pain with walking relieved by rest] FOOT CARE: [Insert findings with regards to General foot hygiene and skin/nail care, Ability to perform self-care or need for assistance] FOOTWEAR: [Insert findings with regards to Appropriateness of footwear for foot shape, Signs of pressure, wear, or skin breakdown caused by footwear] RECOMMENDATIONS: [Insert recommendations for management, further investigations, or referrals] Next appointment: [Insert follow-up plan or date] Sincerely, [Insert Clinician Name and Credentials]