Podiatry Consult Letter Template November 26, 2025

Demographics

RE: [patient name] DOB: [date] Dear Dr. [referring physician name], Thank you for referring [patient name] to our office for evaluation.

Chief Complaint

Medical Note Template -- [Chief Complaint]

History of present illness

Provide a brief summary of the patient's condition, including onset, duration, and any relevant details.

Past medical history

[Include any past medical history or chronic illnesses.]

Past surgical history

[Include any surgical history.]

Current medications

[List current medications including medication name, dose, frequency, route, and duration.]

Allergies

[List any known allergies or state if none.]

Social history

- Occupation: [Insert occupation] - Recreational activities: [Insert recreational activities] - Smoking: [Insert smoking status] - Alcohol use: [Insert alcohol use] - Recreational drug use: [Insert recreational drug use] - Footwear: [Describe footwear]

Podiatric medical exam

- Height: [Insert height] - Weight: [Insert weight] - Shoe size: [Insert shoe size]

Vascular

- Right: - Popliteal: [Insert value] - DP: [Insert value] - PT: [Insert value] - Capillary refill time: [Insert value] - Digital hair: [Present/absent] - Left: - Popliteal: [Insert value] - DP: [Insert value] - PT: [Insert value] - Capillary refill time: [Insert value] - Digital hair: [Present/absent]

Neurological

- Vibratory sensation: [Intact/impaired] - 10g monofilament: [Insert value] - Tinel's sign: [Positive/negative] - Mulder's click: [Positive/negative]

Musculoskeletal/biomechanical

- Pain-free on external and internal rotation of the hips. - Pain-free on range of motion of bilateral knees. - Ankle joint dorsiflexion to perpendicular with the knee extended and [insert value] degrees with the knee flexed. - Subtalar joints are pain-free with [insert value] inversion and [insert value] eversion. - Midtarsal joints are pain-free bilaterally. - [Insert value] forefoot valgus bilaterally. - Hallux limitus with reduced dorsiflexion to less than [insert value] degrees with the forefoot loaded and [insert value] degrees with the forefoot unloaded. - Mild contractures of the lesser toes noted. - Standing maximally pronated. - RCSP: [Insert value] degrees everted bilaterally. - NCSP: [Insert value] bilaterally. - Double toe rise: [Description of findings]. - Single toe rise: [Description of findings]. - Gait analysis: [Description of findings].

Dermatological

- Calluses: [Description] - Nails: [Description] - Skin: [Description]

Footwear

[Description of footwear]

Orthotics/insoles

[Description of orthotics ]

X-rays

[Description]

Assessment and plan

Impression: [Insert diagnosis] Treatment plan/discussion: We reviewed the surgical and non-surgical options. The potential risks and complications of surgery, including but not limited to post-operative infection, delayed or non-healing, complex regional pain syndrome, swelling, and deep vein thrombosis, were discussed. No guarantees can be provided. The patient consented to surgery, which will be scheduled upon availability. Sincerely Ian Yu DPM FACFAS DABPS MSc Fellow of the American College of Foot and Ankle Surgeons Diplomate of the American Board of Podiatric Surgery Masters of Science in Medical Education Board Certified in Foot Surgery Certificate in AI in Healthcare Harvard Medical School

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