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This part of the Hyperbook is about making diagnoses and decisions. Whereas the main Hyperbook starts from the conditions that affect the foot – hallux valgus, ankle instability, flatfoot – this section starts with the patients. Its aim is to help you interpret the things they complain of about their feet and work out, by talking to them, examining them investigating their problems further and, above all, to put all that together and work out the most likely causes of their problem. Obviously, that is closely interwoven with the “condition-based” sections of the Hyperbook. In fact, this part will re-use a lot of the condition-based chapters’ material, but it will present that material in a different way.

Each section in this part of the Hyperbook begins with a typical complaint. We then look at the most important questions to ask, the most important things to look for on examination, and the main investigations that help decision-making. Students in clinical disciplines are taught a list of questions to ask – where is the pain, what makes it better, what makes it worse – which sometimes become routine. We will use these questions, but we'll show how to focus them to get the information that helps decision making.
We will point out the most likely conditions to consider. You do need to keep in mind that:
  • common conditions sometimes present in odd ways
  • occasionally, familiar (or puzzling) complaints are caused by a rare condition that you might not immediately think of
  • complex problems that cannot be fully accounted for by pathology or biomechanics can happen in the foot as anywhere else, and it is important as a clinical professional to consider the patient holistically and with respect
  • often, there is no specific explanation for the patient’s complaint, and all one can do is make sure one does not miss something common or serious. Sometimes the explanation emerges with time but often it never does
We have to confess some biases. We are old-fashioned enough to believe that talking to a person and examining them carefully will allow an accurate diagnosis a lot of the time. We feel that investigations only help if they answer clear questions. And we need to keep in mind what the patient actually wants out of the consultation, which may not always be a clever diagnosis leading to a technically exciting operation.
We also believe that diagnostic practice should be informed by the best available evidence, just as treatment should. There is less quality evidence on diagnosis, but we’ll aim to use what is there.
We are aware that many clinicians use the Hyperbook to prepare for examinations, so we’ll highlight the most important questions, examination findings and investigations for that environment.
The Hyperbook is free. Like most freeware, that includes accepting a few errors and bugs! You are welcome to use material from it for presentations or journal clubs,
provided you acknowledge us as the source.