steps of assessment needed to practice bu the prosthetist and orthotist for patient with charcoot foot

1. MUHAMMAD FAIDHI BIN AZMAN KED120007
NUR RASYIDAH BINTI HASAN BASRI KED120013
NURUL NADHIROH BT MOHAMAD NASER KED120014
NURUL NADIA ASHIKIN BINTI ZAKARIA KED120015
KUEP 3134: CLINICAL PRACTICE
Presentation on Case Scenario
(Impairment & Assessment)

2. SCENARIO 3
Seorang wanita berumur
68 tahun yang mengalami
‘Charcot foot’ yang
memerlukan ‘customised
insole’ pada kaki kiri
beliau. Beliau juga punyai
masalah ‘peripheral
sesorymotor neuropathy’
serta masalah ‘cataract’
pada kedua belah mata.

3. List down the
potential
impairment
the patient
might have?
In health,
IMPAIRMENT is any
loss or abnormality of
physiological,
psychological, or
anatomical structure
or function, whether
permanent or
temporary.

4. Charcot foot (L)
LOCOMOTION RESISTANCE
 Fractures and dislocations of bones and joints that
occur with minimal or no known trauma.​
LOSS OF SENSORY
 Loss sensory of the foot. Because of the loss of pain
perception and the loss of the sense of position of the
foot, joints receive repeated injuries.
 Calluses and ulcers may form when bony protrusions
rub inside the shoes.

5. Peripheral sensory neuropathy
LOSS OF SENSATION
 Sensory nerves that receive sensation from the
skin such as temperature, pain, vibration or touch
had interrupted.
 Cause numbness, tremor, and gait abnormality on
the lower limb.
LOSS OF COORDINATION
 Lose coordination and ability to sense position of
her limb.
 Impedes ability to feel or “sense” her feet, making
it difficult to keep a steady gait. She may lose her
balance and become more prone to falls.

6. Cataract in both eye
 A cataract is a clouding of the lens inside the eye
which leads to a decrease in vision
VISION PROBLEM
 Vision is reduced with ageing and visual impairments
affect balance.
BALANCE PROBLEM
 Uncorrected visual deficits and balance problems are
reported to be risk factors for falls and fall related
fractures.

7. Steps involved
in the
assessment of
a patient as
required for a
P&O?
ASSESSMENT is the
process of obtaining
information or data
regarding to the
patients and their
problems and
related to the
treatment

8. S.O.A.P Assessment
 Subjective Observation
- Symptoms the patient verbally expresses or as
stated by a significant other.
 Objective Observation
- Symptoms that can actually be measured
 Assessment
- Assessment is the diagnosis
 Plan
- P&O intervention and treatment

9. Q & A Relevant to the question
PC (Presenting
complaint)
Morning!, How can I help
you? What brought you
here?
To know the patient intention.
HOPC (History
of Presenting
Complaint)
When – date ? How long
ago?
What happen -? DM ulcer?
To know the detail of the
complication and impairment
that may exist.
FxH (Functional
History)
ADLs – personal, domestic
Mobility – ambulation
To know their daily activity.
PMH (Past
Medical
Surgical
History)
Do you have any other
disease?
Medical: DM, cataract,
peripheral sensory
neuropathy.
Do you done any surgery on
your eyes?
Do you have any numbness
and where is it? How often is
it?
To relate the impairment,
disease and orthotic
prescription.

10. Q & A Relevant to the question
SH (Social History) Where do you live and
with whom?
How often you involve in
community?
How will you fund the
insole?
To know the effectiveness of
the insole to the patient.
To know their funding.
SR (Systemic
Review)
Other systems;
Vision: can see well?
Feet: got numbness?
Easy to prescribe the orthotic
design based on their problem.
PsyH
(Psychological
History)
How do you feel now?
“ feel sad, burden to
family member”
To know the patient feeling and
what they want to achieve
based on their needs.
Expectation What do you expect with
the insole?
“prevent the ulcer”
To acknowledge the patient
understanding on the orthotic
prescription.

11. Assessment
 Eye test
 Balance
 Gait
 Power
Objective Observation
 Diagnosis : CMT with cataract on both eye and
having a peripheral sensorymotor neuropathy

12. Plan
(ORTHOTIC GOAL)
 Total contact insole
 To prevent the further progress of the
charcot foot; stabilize foot minimize the
deformity.
 To give protection to the foot as the nerve is
damage.
 To give comfort to patient when walking.