GALLOP Pt File - Surname, NamePodiatristMegan MaddocksDate of Appt Date Format: DD dot MM dot YYYY Start Time HH : MM End Time HH : MM LocationParkmore RoomsWoodmead RoomsHouse CallIntercare Day Hospital RivoniaWhich Appointment?First AppointmentFollow Up AppointmentFirst Physical Appointment after Initial Telehealth ConsultationHISTORYCurrent ConcernPain Scoreno pain12345678910use VAS | 0 = No pain | 5 = Moderate Pain | 10 = Worst PainPrevious TreatmentNonePrevious PainNoneFamily Medical HistoryNone applicableMedications &/ AllergiesNoneSensory ConcernsNoneFootwearSport Road Running Trail Running Soccer Tennis Golf Basket Ball Cricket Swimming Hockey Dancing - mostly ballet Dancing NA - Preschooler Other Sport DetailsNACurrent AgeSexMaleFemaleShoes (EU)Height (cm)Weight (kg)BMIPOSTNATAL HISTORYGestation (weeks)Birth weight (grams)APGAR 1min1-34-67-910Don't remember but all was okayAppearance | Pulse | Grimace | Activity | Reflexes 7,8,9 = Normal (10 unusual) The lower the score, the more help the baby needs to adjust outside the mother's womb. Most of the time a low Apgar score is caused by: - Difficult birth - C-section - Fluid in the baby's airway A baby with a low Apgar score may need: - Oxygen and clearing out the airway to help with breathing - Physical stimulation to get the heart beating at a healthy rate Most of the time, a low score at 1 minute is near-normal by 5 minutes. A lower Apgar score does not mean a child will have serious or long-term health problems.APGAR 5min1-34-67-910Don't remember but all was okayBreechNoYesType of BirthVaginalCaesareanVaginal BirthSpontaneousInducedCaesareanEmergencyPlannedInstrumentationNoneForcepsVentouseReasonComplicationsNoYesDetailsOther health professionals involved at birth or in first 14 days?NoYesDetailsSKILL ACQUISITIONAge of skill acquisition recorded in monthsSittingCrawlingCrawl TypeNormalBum ShuffleOtherWalkingRunningJumping*****ON PALPATIONTendernessNoneR onlyL onlyBoth sides equallyR > LL > RL & R differentnoneStructures involved Achilles Tendon above insertion Achilles Tendon at insertion Post Tib Tendon at insertion Post Tib Tendon along course of tendon Post Tib Tendon muscle belly Ankle Gutter Medial Ankle Gutter Lateral Plantar Fascia proximal portion (heel) Plantar Fascia mid portion (arch) Plantar Fascia distal portion (MTPJ area) More detailsBIOMECHANICSHip Int ROM RIGHTHip Int ROM LEFTHip Ext ROM RIGHTHip Ext ROM LEFTMod Thomas RIGHTMod Thomas LEFTHip Abduction RIGHTHip Abduction LEFTPopliteal angle RIGHTPopliteal angle LEFTFoot Thigh angl RIGHTFoot Thigh angle LEFTAnkle WBL/NWB straight RIGHTThe weightbearing lunge (WBL) should be performed if the child is able to put their heel to the group due to age specific normative values and higher reliability than the non weight bearing test (NWB)Ankle WBL/NWB straight LEFTThe weightbearing lunge (WBL) should be performed if the child is able to put their heel to the group due to age specific normative values and higher reliability than the non weight bearing test (NWB)Ankle WBL/NWB bent RIGHTAnkle WBL/NWB bent LEFTFPI - Talar Head RIGHTLat ≠ medLat & slight medLat = medMed & slight LatMed ≠ LatFPI - Talar Head LEFTLat ≠ medLat & slight medLat = medMed & slight LatMed ≠ LatFPI - Mal. Curves RIGHTBelow straight/convexBelow < aboveBelow = aboveBelow > aboveBelow +++> aboveFPI - Mal. Curves LEFTBelow straight/convexBelow < aboveBelow = aboveBelow > aboveBelow +++> aboveFPI - Calcaneus RIGHT> 5° Inverted/Varus0-5° Inverted/VarusVertical0-5° Everted/Valgus> 5° Everted/ValgusFPI - Calcaneus LEFT> 5° Inverted/Varus0-5° Inverted/VarusVertical0-5° Everted/Valgus> 5° Everted/ValgusFPI - Talo-Nav-J RIGHTMarkedly concaveSightly concaveFlatSightly convex/bulgeMarkedly convex/bulgeFPI - Talo-Nav-J LEFTMarkedly concaveSightly concaveFlatSightly convex/bulgeMarkedly convex/bulgeFPI - MLA Height RIGHTV high & acute posterior angleMod high & slight posterior angleNorm & concentric curveLowered & central flatteningV Low & central ground contactFPI - MLA Height LEFTV high & acute posterior angleMod high & slight posterior angleNorm & concentric curveLowered & central flatteningV Low & central ground contactFPI - FF Angle RIGHTNo lat toes, med toes clearly visMed > lat toes visibleMed = lat toes visibleLat > med toes visibleNo med toes, lat toes clearly visFPI - FF Angle LEFTNo lat toes, med toes clearly visMed > lat toes visibleMed = lat toes visibleLat > med toes visibleNo med toes, lat toes clearly visFoot Posture Index RIGHTFoot Posture Index LEFTInter-condylar distance (cm)Inter-malleoli distance (cm)Beighton Score (9)Limb Length Discrepancy*Left = Right (none)Left > RightLeft < RightLLD DetailsOther observations of rotation / limb lengthNEUROLOGYDorsiflex Strng RIGHT012345Dorsiflex Strng LEFT012345Plantarflex Strn RIGHT012345Plantarflex Strng LEFT012345Inversion Strng RIGHT012345Inversion Strng LEFT012345Eversion Strng RIGHT012345Eversion Strng LEFT012345Patella Reflex RIGHT01234Patella Reflex LEFT01234Achilles Reflex RIGHT01234Achilles Reflex LEFT01234Plantar Reflex RIGHTDownUpPlantar Reflex LEFTDownUpAnkle Catch RIGHTNoYesAnkle Catch LEFTNoYesAnkle Clonus RIGHTNoYesAnkle Clonus LEFTNoYesGower's SignNegativePositiveIndicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength.Observation of muscle tone or neurological signs:Presence of metatarsus adductus graded by severity and flexibility, uneven creases behind the knees or buttocks. GAIT** Indicate items without paediatric age-specific normative values or low reliability therefore clinicians should use and interpret with cautionHead & NeckNormal AlignmentTilt RightTilt LeftComputer postureShouldersEven positionRight lowerLeft lowerBoth ElevatedTrunk / TorsoLordosisKyphosisTilt to RightTilt to LeftTwist to RightTwist to LeftArm SwingSymmetricalR > LL > RGaurd positionFlapping / flailingHipsSymmetricalRotated to rightRotated to leftFlexedR hip dropL hip dropR hip raiseL hip raiseKnees Normal for age Genu Valgum Genu Varum Patella: B int rotation Patella: R int rotation Patella: L int rotation Flexed Hyperextended Heel Contact B Everted R > L Everted L > R Everted B Perpendicular then pronates supinatroy moment stays in that position Midstance MF Pronated - both MF Pronated - R > L MF Pronated - L > R MF Pronated - R only MF Pronated - L only MF Neutral - both MF Neutral - R > L MF Neutral - L > R MF Neutral - R only MF Neutral - L only MF Supinated - both MF Supinated - R > L MF Supinated - L > R MF Supinated - R only MF Supinated - L only ND&D - both ND&D - R > L ND&D - L > R ND&D - L only ND&D - R only Heel Lift No abnormalities Early heel lift - both Early heel lift - R > L Early heel lift - L > R Early heel lift - R only Early heel lift - L only Abductory Twist - both Abductory Twist - R > L Abductory Twist - L > R Abductory Twist - R only Abductory Twist - L only Toe Off No abnormalities (high gear) Low gear No TO Angle Of Gait Normal / Appropriate for age Abducted - both Abducted - R only Abducted - L only Adducted - both Adducted - R only Adducted - L only Base Of GaitNormalNarrowWideScissorOther Gait Observations Trendelenberg Limp Circumduction Other Gait CommentsFUNCTIONAL TESTSObservation of ability to perform the following appropriate to ageSingle Leg Balance RIGHTYes / GoodNo / PoorNASingle Leg Balance LEFTYes / GoodNo / PoorNAHopping RIGHTYesNoNAHopping LEFTYesNoNAJumpingYesNoNASquatting NA Yes Knees -> valgus - both Knees -> valgus - R > L Knees -> valgus - L > R Knees -> valgus - R only Knees -> valgus - L only No SkippingYesNoNARunningYesNoNAAbility to go up and down stairsYesNoNAQuality of body movementGoodPoorDoes the child perform tasks symmetrically or with smooth movement? Is their movement clumsy, jerky or asymmetrical?Observation of functional tasksIs the child able to perform activities appropriate to their age such as: throwing a ball, catching a ball, kicking a ball, animal walks, sport specific activitiesOTHER OBSERVATIONS*MANAGEMENT PLANPlan going forward Masterful Inactivity (no intervention) New shoes Custom Foot Orthoses (CAD/CAM) Sock Liner Modification Physiotherapy - Acute pain & start strengthening Biokinetics - Strength & Conditioning Dietician GP Referral to other practitioner DetailsNext AppointmentMediciFace to FaceFittingIn< 1 week1-2 weeks3-4 weeks6-8 weeks>8 weeksORTHOTIC PRESCRIPTIONMaterialLocal BiSport (50/55)-(40/45)Local BiPlus (40/45)-(30/35)Local BiComfort (40/45)-(20/25)Local Multicolour (40/45)Local Stoney (White) (50/55)Local Stoney (Black) (50/55)Local Stability (40/45)Local Relax (30/35)Local Relax Plus (20/25)Double Black (40/45)Granite (70/75)Pink Speckle (40/45)Local Stratos 5 (40/45)Local Reverse (40/45)Polyprop / Whitman / UCBLArch HeightSubstantial / very highModerateLowMedial HF W Substantial / very high (8-12) - Both Substantial / very high (8-12) - Right Substantial / very high (8-12) - Left Moderate (6-7) - Both Moderate (6-7) - Right Moderate (6-7) - Left Low (<6) - Both Low (<6) - Right Low (<6) - Left Heel BorderVery high (>30mm)High (25-30mm)Moderate (18-24mm)Low (11-17mm)Very Low (10mm)NoneHeel RaiseForefoot Met Bar PMP 1st Ray Cut Out 5th Ray Cut Out Cluffy Wedge Kinetic Wedge Toe Offloads CoverEVAFirenze / VinylVL3PoronSpencoMonoPig SkinSuede / LeatherVery thin (fun)HD (No Cover)OtherGoing ahead with them now?YesNoUntitledBirth and developmental history questions are an important component of paediatric history taking to identify potential concerns or raise red flags for disease processes. For example, infants who are born preterm or secondary to intrauterine growth restriction often present with gait or gross motor concerns . Low birth weight has been associated with cognitive delay, cerebral palsy and can be associated with a greater risk of chronic medical conditions in later life . Parent recall of birth and developmental history has been reported as adequate [17–19] therefore it is relevant that these questions be an important component of the GALLOP. Categorical and quantitative outcome measures are also essential in diagnosis and for evaluation of treatment in paediatric populations. For example, the use of the FPI-6 as an established reliable and valid measure of foot posture allows the clinicians to measure any change over time with growth or disease progression . The measures involved in gait assessment proved to be challenging, with visual assessment and quantitative recorded observations being the preferred method. This was also the area with limited reliability data. Accordingly, the recommendation is that clinicians should view visual gait analysis with caution. For example, the child presenting with pain in multiple joints may require the use of the Paediatric Gait Arms and Legs (pGALS) tool  or the child presenting with toe walking, should trigger the use of the Toe Walking Tool . Similarly, the use of standardised gross motor assessment tools, such as the Bruininks-Oseretsky Test of Motor Proficiency-2 , may be required for indepth analysis of the child who is unable to demonstrate age appropriate gross motor skills. Assessments without acceptable or any reliability values are indicated by an asterisk within the GALLOP.