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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Anthony and conduct a focused examination. Outline the most likely diagnosis and your proposed management to the observing examiner.

Scenario

Anthony Campbell is a 46-year-old Aboriginal man who is complaining of pain in his right foot. He sprained his ankle when he was leaving a council meeting a few months ago. For the last few weeks he has experienced pain first thing in the morning, and after standing or walking for a period of time.

The following information is on Anthony’s summary sheet at your suburban general practice:

  • Past medical history

  • Hypertension

  • Medication

  • Ramipril 5 mg od

  • Allergies

  • Nil known

  • Immunisations

  • Nil recorded

  • Family history

  • Nil known

  • Social history

  • Married

  • Works as a finance officer for the local town council

  • Non-smoker

  • Infrequent alcohol consumption.

INSTRUCTIONS FOR THE PATIENT, ANTHONY CAMPBELL

You are a 46-year-old Aboriginal man. You work as a finance officer for the local council. You have come to see the GP today because of a pain in your right heel. You experience sharp intense pain when you put your heel down first thing in the morning or after sitting.

The pain eases after you have been up for a while, but it gets worse after walking any distance. It is worse when you walk around barefoot.

The pain is getting worse, not better. You first noticed it a few weeks ago.

A few months ago, you sprained your ankle when coming out of a council meeting late at night. Your ankle discomfort had seemed to have completely resolved, but you wonder if the two problems are connected (they turn out not to be).

The following information is on your medical record:

  • Past medical history

  • Hypertension

  • Medication

  • Ramipril 5 mg once a day

  • Allergies

  • Nil known

  • Immunisations

  • Nil recorded

  • Family history

  • Nil known

  • Social history

  • Married

  • Works as a finance officer for the local town council

  • Non-smoker

  • Infrequent alcohol consumption.

SUGGESTED APPROACH TO THE CASE

Introduction

Establish rapport.

History

Use open questions to explore Anthony’s ideas, concerns and expectations.

Specific questions1

Location of the pain—plantar fascia insertion right foot

Duration of the pain

Timing

What’s been tried so far?

Injury to ankle—sprain after council meeting, location of current pain suggests no connection

Exclude other musculoskeletal/systemic symptoms1

Request permission to examine.

Examination

Height 1.85 m

Weight 99 kg

BMI 29 kg/m2

Expose both feet ...

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