Objective:

General: Pt ambulates into clinic wearing

General: Pt ambulates into clinic wearing

b/l.
on the left foot and on the right foot.

Patient is alert, awake, and conscious at this time.

-----------------------------------------------------------------------------------------------------------Dermatological Exam:
Skin appears normal in color, texture, and turgor throughout the right and left lower
extremity.
Skin appears dry and scaly.
-----------------------------------------------------------------------------------------------------------Toenails are noted to be normal in color, shape, length and thickness on the right
and left foot digits 1-10.
Toenails are noted to be thick long and dystrophic with brownish yellowish chalky
discoloration digits 1 2 3 4 5 right foot and 1 2 3 4 5 left foot.
-----------------------------------------------------------------------------------------------------------There is incurvation of the medial lateral side of the toes right foot and left foot.
There is redness along the nail margins on the medial and lateral sides of the toe
right foot and left foot.
-----------------------------------------------------------------------------------------------------------There are no hyperkeratotic lesions on the dorsal or plantar aspect of the right foot
and left foot.
There are hyperkeratotic lesions that are punctate diffuse in nature located at the
dorsal digits DIPJ PIPJ 1 2 3 4 5 right foot and 1 2 3 4 5 Left foot.
There are hyperkeratotic lesions evident on the plantar aspect of metatarsal heads 1
2 3 4 5 right foot and 1 2 3 4 5 left foot
-----------------------------------------------------------------------------------------------------------No open wounds are evident to the right foot or left foot.
A superficial deep wound is evident to the dorsal plantar medial lateral right foot
and left foot.
-----------------------------------------------------------------------------------------------------------There is no malodor, erythema, or signs of infection at this time.

Vascular Exam:
Dorsalis pedis and posterior tibial pulses are palpable on the right and left foot and
are graded as +2/4.
Dorsalis pedis and posterior tibial pulses are weakly palpable on the right and left
foot and are graded as +1/4.
Dorsalis pedis and posterior tibial pulses are absent on the right and left foot and
are graded as +0/4.
-----------------------------------------------------------------------------------------------------------The skin temperature is warm/cool on the right and left foot.
The temperature gradient is warm to warm on the right and left foot.
-----------------------------------------------------------------------------------------------------------Digital capillary fill time is < 3 seconds on the right and left foot digits 1-10.
Digital capillary fill time is > 3 seconds on the right and left foot digits 1-10.
There is no edema on the right or left foot.
-----------------------------------------------------------------------------------------------------------There is edema on the right and left foot graded as + 1 2 3 4 /4 and is non-pitting in
nature.
-----------------------------------------------------------------------------------------------------------There are no varicosities noted on the lower extremity bilaterally.
There are varicosities noted on the.
------------------------------------------------------------------------------------------------------------

Neurological Exam:
Deep tendon reflexes are intact and symmetrical on the right foot and left foot.
-----------------------------------------------------------------------------------------------------------Sensation to sharp/dull is intact on the right foot and left foot.
-----------------------------------------------------------------------------------------------------------Proprioception is intact to the right foot and left foot.
-----------------------------------------------------------------------------------------------------------Vibratory sensation is intact on the right foot and left foot.
-----------------------------------------------------------------------------------------------------------Protective sensation to 5.07 monofilament is intact to the right foot and left foot.
-----------------------------------------------------------------------------------------------------------There is no Babinski response to the right foot or left foot.
-----------------------------------------------------------------------------------------------------------Ankle clonus is absent on the right foot and left foot.
-----------------------------------------------------------------------------------------------------------A positive Tinel sign was elicited when the area of the leg was percussed with the
pain radiating

Musculoskeletal Exam:
Muscle strength appears to be normal for plantarflexion, dorsiflexion, inversion and
eversion of the right and left foot and ankle and is graded as +5/5.
There appears to be limited severe weakness to the
left foot and is graded as.

muscles of the right foot and

There is tightness to the dorsal extensors and plantar flexors of digits 1 2 3 4 5 of

the right and left foot.
-----------------------------------------------------------------------------------------------------------There is tightness evident to the posterior calf muscles of the right leg and left leg.
Calves are soft and non-tender on palpation of the right and left leg.
-----------------------------------------------------------------------------------------------------------Passive and Active range of motion of the 1st MPJ, ankle, and subtalor joints appear
to be within normal ranges on the right foot and left foot.
There is limitation of motion evident to the
joint of the right foot and left foot.
-----------------------------------------------------------------------------------------------------------No crepitus is felt with joint motion on the right foot and left foot.
-----------------------------------------------------------------------------------------------------------There are no gross static deformities of the right foot or left foot.
The right and left foot both exhibit a pes cavus deformity.
The right and left foot both exhibit a pes planus foot deformity.
-----------------------------------------------------------------------------------------------------------There is no pain on palpation of the lower extremity of the right and left foot and
leg.
There is pain on palpation of the .

ASSESSMENT/PLAN:
1.
- Patient was seen and evaluated at the clinic.
-Patient will return to clinic in.