1
2	"HPI:" HPI: 18 y.o. AAM with CC of b/l painful feet and postural complaints PMH: Unremarkable PSH : Unremarkable Meds: denies Allergies: Denies
3	"Previous conservative therapy included orthotics" Previous conservative therapy included orthotics, NSAIDS, and physical therapy without relief
4	"PE:" PE: Loss of longitudinal arch height, severe valgus with RCSP, pain to palpation of PTT and sinus Tarsi, no focal weakness with MMT, STJ limited to neutral, AJ dorsiflexion to neutral with leg straight and 5 degrees with knee bent
5	"Double limb heel rise test..." Double limb heel rise test shows lack of inversion at the STJ
6	"No Midtarsal joint break with..." No Midtarsal joint break with limb rise
7	"Attempted placement of STJ neutral..." Attempted placement of STJ neutral reveals a first ray elevatus that is reduciable (forefoot supinatus)
8
9
10	"Contralateral foot presenting with a..." Contralateral foot presenting with a C-N osseous coalition
11
12	C-N: Radiographic findings Fibrous or cartilaginous coalition,the bones are in close proximity, both have irregular surfaces, and the anteromedial calcaneus is abnormally widened or flattened. On lateral radiographs, elongation of the anterior dorsal calcaneus may simulate an anteater’s nose Hypoplasia of the talus may also be observed with calcaneonavicular coalition
13	"Tech-99 bone scan shows increased..." Tech-99 bone scan shows increased uptake at the level of STJ consistent with arthritic changes
14	"CT scan demonstrating Osseous coalition" CT scan demonstrating Osseous coalition
15
16	Assessment Adult type IB C-N coalition Treatment plan Gastroc recession Isolated Subtalar joint fusion
17
18
19
20
21
22
23
24
25