Patient Assessment
Assessment as a sequence
Start with the chief complaint and the patient's goals, then build a structured history: onset, duration, progression, prior devices, surgeries, medications, systemic disease, occupation, and activity. Inspect both feet and both shoes. Document skin integrity, nails, calluses, ulcers, temperature, hair growth, edema, pulses, and sensation. Screen vascular and neurologic status; note red flags such as absent pulses, cold or dusky skin, non-healing wound, spreading redness, fever, sudden swelling, or night pain and refer appropriately. Examine range of motion, strength, deformity, leg length, weight-bearing status, and gait barefoot and shod when safe. Compare sides and record measurable findings.
Traps
Questions often reward completing the whole exam before choosing a device. Common errors are examining only the painful foot, ignoring the shoe as a source of pressure, treating a callus without checking sensation and circulation, and documenting conclusions without the findings that support them.
Worked example
A patient with diabetes reports a hot spot under the first metatarsal. The skin is intact but sensation is reduced and the shoe contains a wrinkled insole. Do not simply add padding: remove the shoe, inspect and compare both feet, document neurovascular findings, and refer if there is any break in the skin or signs of ischemia.
Rule of thumb: inspect both feet and both shoes every visit; if you have not looked at the shoe, the assessment is incomplete.