Biomechanical exam forms

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Hey there,
Does anybody have mechanical examination form they feel is fairly sound in composition?

 

These kind of requests come up every so often here. Why do you need a form? If you have sound clinical knowledge and are competent in patient assessment, why should anyone need such an aide memoire?

 

I'd like to second Simon's comment. A lot of people fill in the forms without thinking what they mean for the diagnosis or orthotic prescription. You should correlate what tests you do to the patient's chief complaint.

Eric

 

Eric, I'd say a lot of people fill in a form hoping it will tell them what the diagnosis is and what orthotic prescription they should write. :drinks

Never going to happen. But let's listen as to why Rick "The foot guy" (as if there could possibly be another "foot guy" out there) is looking for such a form.....

 

Rick I started out looking for a form to put it all together for me, much as Eric and Simon are saying. I freely admit it now. I write all of my observations/measurements out on a blank sheet of paper. Exams should be dictated by the history and observations and not a standardized form, I'm sure its the same for podiatric complaints where foot orthoses are not the primary treatment? My 2 cents.

 

I so wanted a nice sexy looking form that i could fill out on an iPad and look great for patients. They exist, but they mean naff all.

Blank paper
Define the presenting complaint
Carry out tests and questioning that will lead you to a diagnosis
Decide on a treeatment pathway to best resolve the pathological tissues
Don't waste time taking measurements for measurements sake and doing tests because they form part of a biomechanical assessment(says a book somewhere)

My 2 Baht

 

Rick, there's definitely a few related threads, one was "What I do for a biom assessment" or similar. I don't use an assessment form 'cause i instantly get a headache but I can understand the need for one for those podiatrists, like myself, not as knowledgeable as they'd like to be, and for pedants. google latrobe podiatry assessment see what happens.

 

Thanks for the replies. I don't use a biomechanical for either. As part of an assignment for a wound care program I need to develop a comprehensive history form. I wanted to include something to show my train of thought for DFU's.

 

Just for the record, I use a biomechanical exam form to speed the entry of the measurements for every patient that I make custom foot orthoses for. I use this exam form as a record of my exam for my own reference and for any third party carriers who wish to see if I completed the exam or not for the patient.

I have found it very helpful over the years to perform these "screening biomechanical measurements" since they can help rule out pathologies that may otherwise go undiagnosed were one not to perform these measurements. Over the last 29 years of performing these measurements, I have detected many previously diagnosed tarsal coalitions, hip pathologies, torsional abnormalities, knee abnormalities and structural asymmetries between the two feet that would likely have gone undetected if I had not performed these measurements.

Do all of these measurements change my orthosis prescription? Of course not. But I am not treating an orthosis, I am treating a flesh and blood person. This flesh and blood person has expressed genuine concerns for their health by taking the time to visit my office and seek out my expert medical help. These screening biomechanical measurements allow me to know more about their foot and lower extremity, why they walk or run the way they do and helps me to better determine if there are any specific structural abnormalities or rotational abnormalites within their feet and lower extremities that may affect their gait function, their mechanically-based symptoms or their health in the future.

I don't measure in exact degrees on all measurements but estimate many measurements in 2-5 degree ranges in order to get a basic idea of the structure of the patient's one foot to their other foot and to also get an idea of how my patient's feet compare to the tens of thousands of other feet I have examined in the past. The complete biomechanical examination I do takes about 5 minutes, excluding gait examination.

My analogy for why I do this bioemechanical examination on every patient that receives orthoses (and on other patients where I suspect pathologies) is to compare my habits to that of a good primary care physician. This physician, when performing a complete physical examination of a patient, will go through many tests, including cranial nerve function, balance, strength testing, hernia tests, etc in order to rule out pathology that may exist but may otherwise be missed by a more cursory physical examination. Will this physician always see abnormals in each test? Of course not. But will they occasionally find something unusual that allows a previously undiagnosed pathology to become diagnosed. Why? Because this physician has expressed sufficient interest in the patient's well-being to perform these measurement/tests, even though these measurements/tests will more than likely be normal.

You must all ask yourselves which doctor would you rather be examined by or pay to be examined by: 1) The physician that looks you over very briefly and does a cursory exam for your first physical or 2) the physician that looks you over fully and does a more complete exam on your first physical? I have always wanted to be like physician #2 for my patients since I believe my patients greatly appreciate my attention to detail. In addition, I feel better that I am less likely to miss something important by performing these measurements in these individuals who have entrusted their medical well-being to my expert evaluation and care.

This may not be the popular opinion on Podiatry Arena currently, but I feel very comfortable with what I have done for well over the past quarter century for my patients in this regard and will likely continue to do so until I retire.:drinks

 

No argument with what you are saying Kevin, I think its how we individually read the initial question posed by Rick where he asked specifically about a "mechanical examination form". I read it as he was looking for a sort of road map given the information provided.

When I examine a spinal patient my exam is suited to the type and level of the complaint. Example; I probably wouldn't perform nerve root tests for a routine mechanical low back pain patient without clues in the history of nerve involvement. No sense performing an SLR on a patient without radiculopathy etc. and no need to tick that particular box IMO. I focus the exam to the complaint. Same with the foot and ankle, whenever their description of heel pain includes burning, parasthesia etc I also rule out lumbar disc involvement and do an SLR (among others) on those patients. I don't use a Coleman block test on every foot for example.

I have a standard regional form for every complaint but quite often just write it down in the margins or on a sheet of paper. Maybe I'm getting lazy? As long as you're thorough and document its a matter of preference I believe. It may well be better practice to standardize some aspects of the biomechanical exam.

 

Re: Rick's query on examination forms. (having just logged on after a good break) I'm kind of on board with you on this one Kevin. I see it as a series of organised observations, which can be very helpful if you are having to query anything at a later date.

I like to record all lower limb ranges of motion, implement a corrective exercise programme where indicated, and review progress in order to record improvements on the initial findings.

I see the orthotic as part of the solution, that is addressing the cause of the problem, but the resultant compensatory soft tissue responses need addressing, therefore having a logical list of joints and their improving range is good feed back to both the patient and the practitioner.

Colin

 

Colin,
Thanks I wholeheartedly agree with you.