Plantar Foot Study

Plantar Foot Study-Single Case & Single/Multiple Visit
Form Completion; Summary Detailed For More Information Printable Notes Power Point Presentation Theoretical Perspective Previous Plantar Foot Study 7/02 Literature Review
1.) First Name		2.) Last Name
3.) E-Mail		4.) Web Page
5.) Phone		6.) Profession	Massage Therapist Chiropractor Medical Doctor Osteopath Physical Therapist Other (Specify)
7.) Other Profession
8.) Date of Treatment (Mo,Day,Yr)		9.) Clients Initials (1st & Last)
10.) Pre-Screening	Lumbar Pathology Yes No	Current Lumbar Pain Yes No	Early AM Heal Pain Yes No
Achilles Tendinitis Yes No	Recently Active Middle Aged Women Yes No	Frequent Weight Bearing Activities Yes No	Wears Shoes w/ Elevated Heal Yes No
Plantar Foot Tenderness Yes No	Achilles Tendon Tenderness Yes No	11.) Pre-Treatment Rating (0-10)	LEFT RIGHT
12.) Treatment Technique	Pressure is directed against the Calcaneal Tuberosity just anterior (Medial & Lateral Process), calcaneal plantar surface, bases of the 2nd thru 5th metatarsal (Right Foot), with foot Dorsiflexion, and between the Proximal Heads of the Metatarsal bones, with toe extension. Treatment continues until Achilles Tendon tenderness subsides.
13.) Post-Treatment Rating (0-10)	RIGHT 2-3 Days Between Visit #1 & #2	14.) Visit # 2	DATE PRE POST 2-3 Days Between Visit #2 & #3
15.) Visit # 3	DATE PRE POST 2-3 Days Between Visit #3 & #4	16.) Visit # 4	DATE PRE POST 2-3 Days Between Visit #4 & #5
17.) Visit # 5	DATE PRE POST Exactly 7 Days Between Visit #5 & #6	18.) Visit # 6	DATE LEFT RIGHT