ESTUDIO ORTOPODOLÓGICO
Nº Hª:____________________ 3 FECHA: __________________ 11/4/2014
ANAMNESIS FECHA 1ª CONSULTA:___________________________ 11/4/14 APELLIDOS:________________________________________NOMBRE:________________________ CRISTINA ORTEGA RUIZ F.NAC:_____________________EDAD:___________PESO:_______________TALLA:_____________ 166cm 6/6/1989 26 68 MAESTRA PROFESIÓN:_____________________________ACT.DEPORTIVA:____________________________ NATACIÓN ALERGIAS?__________________________________________________________________________ DIABETES?___________________________________________________________________________ MEDICACIÓN HABITUAL?____________________________________________________________ MOTIVO 1ª CONSULTA:_______________________________________________________________ ALTERACIÓN UÑAS PIES ____________________________________________________________________________________ DOLOR?_____________________________________________________________________________ PROCEDENCIA: ______________________________________________________________________ 2-3 MESES OBSERVACIONES:____________________________________________________________________ ANTEC.FISIOLÓGICOS: -Parto____________________________________________________________________________ -Gateo___________________________________________________________________________ -Andador/Taca-Taca________________________________________________________________ X -Inicio Deambulación_______________________________________________________________ 2 AÑOS - Habitos Posturales ________________________________________________________________ GATEO ARRASTRANDO PIERNAS ROTADAS EXTERNAMENTE -Cambios Ponderales_______________________________________________________________ -Zurdo /Diestro X /Ambidiestro /__________________________________________________ -Otros___________________________________________________________________________ ANTEC.PATOLÓGICOS: -Patologías Previas_________________________________________________________________ ONICOLISIS _______________________________________________________________________________ -Enferm. Infantiles_________________________________________________________________ -Ant. Traumáticos _________________________________________________________________ -Hª anterior de: -Distensión/Esguines ___________________________________________________ -Tendinitis/Contracturas_________________________________________________ X POSTERIOR MUSLO -Bursitis______________________________________________________________ -Capsulitis_____________________________________________________________ -Luxación/Subluxación___________________________________________________ -Fisura/Fractura_________________________________________________________ -Enf.Reumáticas(gota, fibromialgia…)_______________________________________ -Ciática: ______________________________________________________________ -Otras_________________________________________________________________ ANTEC.FAMILIARES: -Dismetrías________________________________________________________________________ -Escoliosis_________________________________________________________________________ -Genu varo/valgo___________________________________________________________________ -Tibias varas_______________________________________________________________________ -Pies Planos_______________________________________________________________________ -Pies Cavos_______________________________________________________________________ -Pies Valgos______________________________________________________________________ -Pies Zambos_____________________________________________________________________ -Metatarsus Aductus/Varus__________________________________________________________ MUY LEVE -H.V_____________________________________________________________________________ -Dedos Garra______________________________________________________________________ X -Otros____________________________________________________________________________ ____________________________________________________________________________ 1