Diagnostic Assessment — Left Foot - Heel Abrasion
Example 1 of 1 · fictitious patient (Veteran A)
Diagnostic Assessment
Left Foot - HEEL ABRASION
Balance of Probabilities: Statement of Principles No. 38 of 2025 Reasonable Hypothesis: Statement of Principles No. 37 of 2025
ADF History
The veteran, Date of Birth: [withheld] occupation Aircraft Technician, enlistment date 18 Apr 1988, discharge date 22 October 1999.
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran the veteran was exposed to numerous occupational hazards. His role involved maintenance and repair of fixed-wing aircraft, particularly working with F-111 aircraft at the RAAF base in the state. The work required wearing military-issued footwear for prolonged periods while standing on hard surfaces, climbing on aircraft, and navigating maintenance platforms. This occupation involved extensive walking, standing, and physical activity that could subject footwear to friction against the feet, particularly in hot the state conditions. Aircraft technicians frequently work in confined spaces including fuel tanks, requiring awkward positioning that could cause additional friction and pressure on footwear contact points.
History
The veteran an Aircraft Technician in the Royal Australian Air Force, developed heel blisters on his feet in 2003. He presented on multiple occasions with concerns about constant blistering of his heels, noting issues with his military footwear being too big and his socks being too thin.
Timeline
- 28 Feb 1999: The veteran the veteran presented with complaints of small blisters on his heels. He specifically requested padding for the affected areas. Clinical examination revealed small blisters broken on the heels with no signs of infection. The skin was observed to be clean and intact. Treatment included cleaning the wounds and applying Cutinova dressing secured with Hypafix. The padding requested by the member was provided.
- 27 Dec 1998: The veteran the veteran presented with ongoing concerns about constant blistering of his heels. During this consultation, he specifically identified what he believed to be contributing factors to his condition, reporting that his boots too big & socks too thin. He was provided with dressings and advised on appropriate boot and sock fit. He was instructed to return if the problem persisted.
Symptoms
At the time of his presentations in 2003, the veteran the veteran experienced recurrent blisters on his heels that would break, causing discomfort and necessitating medical attention. He identified ill-fitting boots (too large) and inadequate sock thickness as contributing factors to his condition. The symptoms were significant enough to prompt multiple presentations to healthcare providers.
The heel abrasions manifested as small blisters that would rupture, leaving broken areas of skin that required dressing. Despite the broken skin, there were no signs of infection noted on examination, suggesting good wound hygiene was maintained. The recurrent nature of the condition suggested an ongoing irritation likely related to footwear issues.
Currently, there is no documentation of ongoing symptoms related to heel abrasions in the more recent medical records. The condition appears to have been related to specific footwear issues during his military service.
Imaging
No imaging studies were performed for this condition as they were not clinically indicated for heel abrasions/blisters.
- What is the formal diagnosis of the condition claimed above? The formal diagnosis is Heel Abrasion/Blisters, Left Foot (ICD-10 code: L30.9 - Unspecified dermatitis). This diagnosis falls under the DVA SOP for Cut, Stab, Abrasion and Laceration (Balance of Probabilities SOP No. 38 of 2025 and Reasonable Hypothesis SOP No. 37 of 2025).
Heel abrasions or friction blisters are a type of mechanical injury to the skin caused by repeated friction and shear forces. These injuries occur when friction and pressure between the skin and an external surface (typically footwear) cause separation within the epidermis or between the epidermis and dermis, with subsequent accumulation of fluid in the resulting space. This creates a blister that may rupture, leaving an abrasion.
In the veteran case, the condition was characterized by recurrent formation of small blisters on the heels that would break, requiring dressing and care. The condition was explicitly linked to ill-fitting footwear (boots too big) and inadequate sock thickness, which are classic contributing factors to friction blisters of the feet.
This type of injury is common in military personnel due to the requirements for prolonged wearing of standard-issue footwear, especially during periods of increased physical activity. The SOP specifically includes friction burns as a type of abrasion, and these heel injuries represent a form of friction abrasion.
- For each diagnosis identified, please also provide the following dates: When did the veteran first experience symptoms attributable to this condition? Based on the available documentation, the veteran first experienced symptoms of heel abrasions/blisters sometime before May 8, 2003, which is the first documented medical presentation for this condition. However, the March 9, 2003 note suggests this was a recurrent issue, as he presented with concerns about "constant blistering of heels," indicating the condition had been ongoing for some time prior to these documented presentations.
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a health provider for this condition on May 8, 2003, at what appears to be the Health Services Flight (HSF) at the RAAF base. The specific healthcare provider's name is not clearly documented in the available records.
When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on May 8, 2003, by the attending medical staff at HSF the base. The diagnosis was made based on clinical examination which revealed small broken blisters on the heels without signs of infection.
When did the veteran first present to you (or your practice) for this condition? February 27, 2022
- How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results. The diagnosis of heel abrasions/blisters was confirmed through clinical examination on May 8, 2003. The key symptoms and signs documented include:
- Physical examination: Small broken blisters were observed on the heels. The skin was noted to be clean with no signs of infection.
- Patient history: The veteran identified causative factors including ill-fitting boots (too large) and inadequately thick socks, which are classic contributing factors to friction blisters.
- Recurrent nature: The March 9, 2003 note refers to "constant blistering of heels," indicating this was a persistent or recurring issue.
- Management: The treatment approach included wound cleaning, application of appropriate dressings (Cutinova) secured with Hypafix, and provision of padding as requested by the patient. Advice on appropriate boot/sock fit was also provided.
No investigations were necessary for this condition as it is diagnosed clinically based on characteristic appearance and history. The diagnosis was straightforward based on the visible blisters/abrasions and the history of friction from footwear, which is consistent with the definition of abrasion (specifically friction burns) as described in the Statement of Principles concerning Cut, Stab, Abrasion and Laceration.
- What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Factor 6(1) - having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration
- MET
- This factor is clearly met as documented in the medical records from May 8, 2003, and March 9, 2003. The veteran experienced direct physical trauma to his heels in the form of friction and shear forces from ill-fitting boots and inadequately thick socks. The SOP specifically includes friction burns as a type of abrasion, and heel blisters represent a form of friction injury. The note specifically mentions that his "boots [were] too big & socks too thin," which would create conditions for increased friction
between the foot and boot, particularly at the heel, leading to the formation of blisters which subsequently broke to create abrasions.
Factor 6(2) - inability to obtain appropriate clinical management for cut, stab, abrasion or laceration before clinical worsening
- NOT MET
- There is no evidence to suggest that the veteran was unable to obtain appropriate clinical management for his heel abrasions. On the contrary, the records indicate that he received appropriate medical attention with wound cleaning, dressing application, and advice on footwear. He was also instructed to return if problems persisted, indicating that ongoing care was available.
Note: This condition occurred in 2003, which is after July 1, 2002, but there is no indication it occurred during warlike deployment. Therefore, it comes under MRCA legislation, and the SOP factors do apply.
The occupational context is particularly relevant in this case. As an Aircraft Technician in the RAAF, the veteran was required to wear military-issued footwear for prolonged periods while performing physically demanding tasks. His role would have involved extensive standing, walking, and navigating maintenance platforms and aircraft structures. These occupational requirements, combined with the specific issues he identified with his footwear (boots too big, socks too thin), directly contributed to the development of the heel abrasions through friction mechanisms.
The % contribution of the causes is 100% and significant.
Sequelae
There is no evidence that these heel abrasions were sequelae of another condition. They were primary injuries caused by direct physical trauma in the form of friction between the feet and footwear.
Unintended Consequence
This condition is not an Unintended Consequence of Medical Management as it was not caused by any medical treatment provided by the ADF.
Inability to Attain Appropriate Medical Management
There is no evidence of inability to attain appropriate medical management. The medical records document that the veteran received prompt and appropriate treatment for his heel abrasions, including wound cleaning, dressing application, padding, and advice on appropriate footwear.
The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgment of Merkel J) enlarges on the meaning to be given to "inability" as the lack of the ability to get the treatment in both an objective and subjective sense. In this case, the veteran did not experience any objective or subjective barriers to receiving appropriate care, as
evidenced by his presentations to medical services and the documentation of appropriate treatment provided.
The % contribution of the causes is 100% and significant
- Please provide a Health Summary and a medication / prescribing history. -see attached report
