Week 1.2 Entry

I was presented with a gentleman who had sustained a bilateral calcaneal fracture. I was made aware of the nature of his injury the day before his visit so I was able to prepare for a condition which I had no previous knowledge of. My first thoughts were that this was a very debilitating injury due to his limited WB ability and the fact that it was bilateral….where would I start from a physiotherapy point of view?

This injury greatly affected his life in that he was self employed and unable to work, his social life was now non existent and this was compounded by the fact that he lived alone and was forced to fend for himself every day. Essentially he needed to improve to full functionality as soon as possible and he was very eager to make this happen. The treatment and HEP were designed to reduce pain, improve ROM of his ankles and begin the long process of his return to work. I made it very clear to him that he needed to regain full movement of his LLs not only to walk but to effectively work again due to its physical nature, he seemed to understand this point. I ensured that his pain levels were kept within safe levels during treatment despite his ability to put up with a great deal of pain before stopping, this restricted what type of intervention that could be performed. The treatment chosen however did increase his ROM and with the HEP given to him this should improve again when he returns next week.

The patient was very easy to communicate with and was very open with his communication. Next time I would make a point of clearing each and every joint since despite asking if he had any problems elsewhere now or in the past it only came out by chance that he had badly broken his finger some years ago and had not followed the physio program and now had a reduced function in this finger. This highlighted to me that I needed to make a special effort to ensure he understood the implications of not following a physio program with his current problem. I also neglected to pay attention to his function at his knees and hips which were important areas due to his decreased activity and de-conditioning. Even though not directly involved in the injury needed to be looked at as they would affect his walking when the time came. I have already planned to progress his HEP depending on his progress and also reassess all objective measures and possibly increase the grade of the mobilizations performed.

I was very comfortable throughout the process and felt that I had a clear grasp on the main issues and patient concerns. Next time I would gain a more complete and thorough history of the patient and remember that it’s better to have too much information rather than too little. Post treatment assessment is crucial, not only for me but for the next physio that may be treating. I felt that I have progressed today and continued to develop my assessment and treatment aptitude by understanding more so the importance of each aspect of the questioning. Not just asking questions for the sake of asking the question but realising where the information may lead my thinking and where it will guide my treatment.

One thing I would like to know is about the muscle strength scale that we have been shown on placement. It is similar to the Oxford scale but takes into account the range of motion of the joint not only the strength. Without going into too much detail it basically goes 0, 1, 1+……4, 4+, 5. I was not able to find any information on the internet but would like to know since I believe it would be much more useful than Oxford scale.