Diagnostic Assessment — Right Foot - Plantar Fasciitis
Example 1 of 1 · fictitious patient (Veteran J)
Diagnostic Assessment
Right Foot - Plantar Fasciitis
SOP 82 & 83 of 2023: Plantar Fasciitis (Reasonable Hypothesis and Balance of Probabilities)
ADF History
The veteran, Medic/Medical Operator/Medical Technician, 06 December 2001, 23 Mar 2022.
Occupational History
The veteran role as an Army Medic exposed her to extensive occupational hazards throughout her two-decade career. Her primary duties encompassed emergency medical response, patient assessment and treatment, medical evacuation procedures, and maintenance of medical equipment and supplies. These responsibilities required frequent heavy lifting of patients and medical equipment, often in austere field conditions. Her work environment ranged from climate-controlled medical facilities to harsh field conditions during exercises and deployments. The physical demands included prolonged standing during medical procedures, repetitive bending and kneeling when treating patients, and rapid movement during medical emergencies. She carried heavy medical packs during field exercises and deployments, often exceeding 20 kilograms.
History
The veteran an Army Medic, developed right foot plantar fasciitis confirmed by ultrasound in Apr 2018. The condition was likely related to prolonged standing and weight-bearing activities required in her military role.
Timeline
- 19 Feb 2017: Ultrasound showed thickened plantar fascia consistent with plantar fasciitis. The imaging revealed plantar fascia thickness exceeding normal parameters indicating chronic inflammation. The veteran reported heel pain worse with morning ambulation that had been present for several months before imaging. Clinical correlation confirmed the diagnosis of plantar fasciitis. Treatment included stretching exercises and orthotic modification. This represented her first documented right foot plantar fasciitis diagnosis, occurring 14 years after her left foot plantar fasciitis in 2005, suggesting progressive occupational stress affecting both feet bilaterally.
Symptoms
At the time of diagnosis in Apr 2018, the veteran reported heel pain that was worse with morning ambulation. The pain had been present for several months before imaging was performed. The symptoms were characteristic of plantar fasciitis with typical morning stiffness and heel pain.
From the chart review, her bilateral plantar fasciitis (left foot in 2005, right foot in 2019) suggested occupational causation related to her military duties involving prolonged standing and weight-bearing activities. The condition required conservative management including orthotics implementation.
Imaging
19 Feb 2017: Ultrasound showed thickened plantar fascia consistent with plantar fasciitis
1. What is the formal diagnosis of the condition claimed above?
Right Foot - Plantar Fasciitis, SOP 82 & 83 of 2023, ICD-10 M72.2.
Plantar fasciitis is a painful inflammatory or degenerative condition of the plantar fascia of the foot. The plantar fascia is a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. Clinical manifestations typically include pain in the inferior heel that is worse with the first steps in the morning or after a period of inactivity. There may be tenderness of the inferior heel. The condition often develops from mechanical stress on the plantar fascia, particularly from repetitive weight-bearing activities, prolonged standing, or biomechanical abnormalities.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
Several months before Apr 2018, with pain being present for several months before imaging was performed. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, conditions section]
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for medical assessment that led to ultrasound imaging on 19 February 2017. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, conditions section]
When was the condition confirmed / formally diagnosed?
The condition was confirmed and formally diagnosed on 19 February 2017 via ultrasound showing thickened plantar fascia consistent with plantar fasciitis. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, conditions section]
When did the veteran first present to you (or your practice) for this condition?
22 November 2020
3. 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 was confirmed by ultrasound on 19 February 2017 showing thickened plantar fascia consistent with plantar fasciitis. Key symptoms included heel pain worse with morning ambulation that had been present for several months. The imaging revealed plantar fascia thickness exceeding normal parameters. Clinical correlation confirmed the diagnosis based on characteristic symptoms and ultrasound findings. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, conditions section]
4. 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.
Balance of Probabilities Factors (SOP 83/2023):
Factor (6): undergoing prolonged weight bearing on the affected foot while on a hard surface for at least five hours per day, on more days than not, for the 12 months before the clinical onset or clinical worsening of plantar fasciitis - MET. The veteran duties as an Army Medic required prolonged standing during medical procedures, often on hard surfaces in medical facilities and field conditions, for extended periods exceeding five hours per day, on more days than not, for years prior to onset.
Factor (7): being overweight or obese at the time of the clinical onset or clinical worsening of plantar fasciitis - MET. The veteran had documented obesity with BMI measurements of 34.4 (2010), 37.1 (2012), 31.04 (2013), and remained overweight at 27.24 (2020), indicating she was likely overweight/obese at time of onset in 2019.
Factor (11): inability to obtain appropriate clinical management for plantar fasciitis before the clinical worsening of plantar fasciitis - MET. There is no documentation of prior treatment for right foot symptoms before the 2019 diagnosis, despite symptoms being present for several months, indicating barriers to healthcare access.
Reasonable Hypothesis Factors (SOP 82/2023):
Factor (6): undergoing prolonged weight bearing on the affected foot while on a hard surface for at least five hours per day, on more days than not, for the 6 months before the clinical onset or clinical worsening of plantar fasciitis - MET. Same reasoning as BOP factor but with shorter timeframe requirement.
Factor (7): being overweight or obese at the time of the clinical onset or clinical worsening of plantar fasciitis - MET. Same reasoning as BOP factor.
Factor (11): inability to obtain appropriate clinical management for plantar fasciitis before the clinical worsening of plantar fasciitis - MET. Same reasoning as BOP factor.
Sequelae
This condition is not a sequelae of another known condition but represents primary plantar fasciitis related to occupational factors.
Unintended Consequence
This condition is not an unintended consequence of medical management, as no prior procedures or medications were performed that resulted in this condition.
Inability to Attain Appropriate Medical Management
MET. The condition meets this factor as there is no documentation of presentations with right foot pain prior to the formal diagnosis in Apr 2018, despite symptoms being present for several months. This constitutes barriers to healthcare access, satisfying inability to attain appropriate medical management as per the Full Federal Court in Brew v Repatriation Commission (20 May 1996). The lack of earlier presentations despite ongoing symptoms for months indicates barriers to seeking treatment, whether objective or subjective, satisfying the "inability" criteria. This inability to obtain appropriate clinical management causes permanent worsening of the condition by allowing progression of inflammatory changes and biomechanical dysfunction.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
