Case Study 1: Follow-up

Lloyd: As part of the management plan, the patient was been asked to return to the QUT Podiatry Clinic in a weeks time. The purpose of the follow-up visit was to review the x-rays , conduct a more detailed computerised gait analysis and review the short-term response to the treatment of the callous. On his return, Mr Bearay reports no difficulties since the last visit, the padding has now been removed and it is decided to go ahead with the gait analysis and review of the x-rays.

Lloyd: Thankyou for coming in for the second visit today Mr Bearay - Ronald has completed the gait analysis with the computer there and what is shows is that you have got some very high pressures under different parts of your foot particularly the bones that should be in the arch area of the foot - they shouldn't be touching the ground but they are actually experiencing some of the highest pressures of anywhere in your foot.

Lloyd: So its not surprising that you have had a bit trouble over the last little while, the next thing we might do is take a closer look at what is happening inside your foot by reviewing those x-rays with you.

Lloyd: Mr Bearay this is a normal foot and we can see that we have the heel down here and the arch bones up the top and then the metatarsals going down to the ball of the foot so we should have a nice arch profile there, and on your foot the arch bones are lower than the heel or the ball of the foot and thats why we have those very high pressures in the other room - and that is why as you have said already that is a direct result of the charcot deformity. We also see on your x-ray these little white lines running down your foot there and down through here those are changes in your arteries - thats calcium being deposited in your arteries - that is a common finding in people who have had diabetes for a while - this can affect the circulation tests that we did the other day.

Lloyd: Mr Bearay, Ronald has looked after you for the last couple of weeks now for the initial visit, all those tests on your circulation, the sensation and there was some areas of the foot where the sensation was okay and other areas where the sensation was absent, and then today we've done the computer analysis and weve looked at your x-rays and we have talked about making a new orthotic for you to insert into your shoe and we have talked about getting some medical shoes to replace the current ones that you've got which have worked really well but they are just a bit tired now and Ronald and I will draft a report and that will all go back to your doctor so that he knows what is happening.

Lloyd: Do you have any questions for us about the tests or anything that we've done.

Mr Bearay: No not really.

Lloyd: hats great we'll make an appointment for about two weeks time to fit the inserts into your shoes.