MU PT 8390 CM II - PBL Case – Roy Burnett
Part 3, Roy Burnett: OPPT, 6 weeks post TTA
PT Referral for “Prosthetic gait training, exercise”
Mr. Burnett arrives at the clinic using bilateral axillary crutches. His wife is carrying his prosthetic limb. He
reports that over the weekend while he was on his tractor, brush hogging around his new pond, “a rock got picked
up by the mower and hit me just below my left knee on the outside. It didn’t bleed but it’s been swollen ever
since.”
“The Home Health PT said I should use my walker out in the yard, but I showed her that I could do just fine with
my crutches instead. If it’s flat, I don’t need my crutches at all. I wear my leg most of the time, but some days
(like today) I have trouble getting it on. When my wife and I go shopping, by the time I get back to the car, my
left calf will often feel achy and cramped. Sometimes cramps in my calf wake me up at night. My left knee has
always given me problems, especially going down the stairs to get to my woodworking shop. By the way, would
you like a wren house? The phantom pains on the R side never did amount to much, but my L foot has been sore
lately.”
“My kids don’t think I should still be driving to therapy, but I do fine once I get on the interstate. I can’t see that
well when it’s dark so they made me stop driving at night.”
“Do you think I need new shoes? I run the left one down on the outside pretty fast. I know it would help
everything if I lost some weight.”
Pt. independent with all transfers using crutches. Rolls to lie prone on mat with some difficulty.
Vital signs: BP: 150/85 sitting 130/70 in standing; HR: 90 Reg; RR: 16
Left LE sensation to 5.07 SWM on plantar foot intact at 1/5 sites tested. Vibration to 128Hz absent at great toe.
L knee circumference 1cm > R knee, ecchymosis lateral aspect of LLE extending from knee to mid lower leg. L
knee and calf is warm to touch. L knee is tender to palpation on lateral aspect proximal to fibular head. L calf
also tender to palpation
AROM: Bilateral hip flex 10 – 100d. Other motions of hips WFL.
L knee flexion 10 - 115d. R knee flexion 8 - 100d. L ankle DF 0d.
MMT LE: WNL except L knee Extension: painful – deferred, and L ankle DF: 3+/5
B UE ROM and strength WFL.
R residual limb: reddened area anteriorly below knee; incision clean and dry. Attempted to don prosthesis, but
unable to completely seat residual limb in socket.
Gait performed without prosthesis using bilateral axillary crutches for 175’. Bears weight on medial aspect of
forefoot, increased hip ER through mid-stance.
Vital Signs immediately after gait: BP:168/78, HR:118 Reg; RR:24; RPE 14/20; Dyspnea 4/10; diaphoretic.
Post gait: Gross examination and palpation of foot and ankle demonstrates overall tenderness, forefoot
hypermobility, warmth to touch, and reddened. Area of TMT joint 5 is darkened reddish color. Navicular drop in
WB is 12mm below NWB
PCM setting: OPPT
Complete the table for Well’s Clinical
Decision Rule for DVT (Exam
Toolkit). Turn in the completed table
with your PCM and summarize your
conclusion in the PCM.
Describe in the PCM your differential
diagnoses of the conditions that may
be occurring, and justify your
decisions.
Pathology: what condition may be
developing in the foot?
EB Search:
“Mueller MJ AND gait”
Professor Mueller at Washington
University is widely published in the
field of diabetic neuropathy and gait.
Resources
Exam-Tool Kit  CV  DVT …
Well’s Clinical Decision Rule
Visual Impairments / Driving
 Course website
 Lewis 109 file cabinet – bottom
drawer (across from the microwave)