const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, PageBreak, UnderlineType
} = require('docx');
const fs = require('fs');

// ─── Colour palette ───────────────────────────────────────────────────────────
const NAVY   = "1F3864";   // heading backgrounds
const TEAL   = "17375E";   // sub-section bar
const LTBLUE = "D6E4F0";   // row shading
const WHITE  = "FFFFFF";

// ─── Helper: coloured heading bar (full-width single-cell table) ──────────────
function sectionBar(text, bgColor, textSize = 24) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: [
          new TableCell({
            shading: { fill: bgColor, type: ShadingType.SOLID },
            verticalAlign: VerticalAlign.CENTER,
            margins: { top: 80, bottom: 80, left: 160, right: 160 },
            children: [
              new Paragraph({
                children: [
                  new TextRun({
                    text,
                    bold: true,
                    color: WHITE,
                    size: textSize,
                    font: "Calibri",
                  }),
                ],
              }),
            ],
          }),
        ],
      }),
    ],
    borders: {
      top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE },
      left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE },
      insideH: { style: BorderStyle.NONE }, insideV: { style: BorderStyle.NONE },
    },
  });
}

// ─── Helper: two-column content table ────────────────────────────────────────
function twoColTable(rows) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: rows.map(([label, content], i) =>
      new TableRow({
        children: [
          new TableCell({
            width: { size: 28, type: WidthType.PERCENTAGE },
            shading: { fill: i % 2 === 0 ? LTBLUE : "EBF5FB", type: ShadingType.SOLID },
            verticalAlign: VerticalAlign.TOP,
            margins: { top: 80, bottom: 80, left: 140, right: 140 },
            children: [
              new Paragraph({
                children: [new TextRun({ text: label, bold: true, size: 18, font: "Calibri", color: TEAL })],
              }),
            ],
          }),
          new TableCell({
            width: { size: 72, type: WidthType.PERCENTAGE },
            shading: { fill: i % 2 === 0 ? "FDFEFE" : WHITE, type: ShadingType.SOLID },
            margins: { top: 80, bottom: 80, left: 140, right: 140 },
            verticalAlign: VerticalAlign.TOP,
            children: content.map(line =>
              new Paragraph({
                bullet: line.startsWith("•") ? undefined : undefined,
                children: [new TextRun({ text: line.replace(/^•\s*/, ""), size: 18, font: "Calibri" })],
                bullet: line.startsWith("•") ? { level: 0 } : undefined,
              })
            ),
          }),
        ],
      })
    ),
    borders: {
      top:     { style: BorderStyle.SINGLE, size: 4, color: "B0BEC5" },
      bottom:  { style: BorderStyle.SINGLE, size: 4, color: "B0BEC5" },
      left:    { style: BorderStyle.NONE },
      right:   { style: BorderStyle.NONE },
      insideH: { style: BorderStyle.SINGLE, size: 2, color: "CFD8DC" },
      insideV: { style: BorderStyle.SINGLE, size: 2, color: "CFD8DC" },
    },
  });
}

function spacer() {
  return new Paragraph({ text: "", spacing: { after: 80 } });
}

function pageBreak() {
  return new Paragraph({ children: [new PageBreak()] });
}

// ═══════════════════════════════════════════════════════════════════════════════
// CONDITION DATA
// ═══════════════════════════════════════════════════════════════════════════════

const conditions = [

  // ── 1. PLANTAR FASCIOPATHY ──────────────────────────────────────────────────
  {
    title: "1. Plantar Fasciopathy",
    subtitle: "Degenerative enthesopathy of the plantar aponeurosis at its calcaneal origin",
    rows: [
      ["Assessment\n(History)", [
        "• Gradual onset inferior heel pain — worse first steps in morning (post-static dyskinesia)",
        "• Worsens with prolonged standing, walking, or running; may ease with activity then return",
        "• Aggravating factors: recent increase in activity, weight gain, hard surfaces, unsupportive footwear",
        "• PMH: enquire about systemic inflammatory arthritis (seronegative spondyloarthropathy)",
        "• Occupation / activity level / BMI",
      ]],
      ["Assessment\n(Physical Exam)", [
        "• Windlass test: dorsiflexion of hallux — reproduces medial calcaneal pain (positive = fasciopathy)",
        "• Palpation: point tenderness at medial calcaneal tubercle / proximal plantar fascia",
        "• Jack's Test: passive DF of 1st MTPJ — tests integrity of windlass mechanism",
        "• Assess ankle dorsiflexion ROM — equinus is a key risk factor (Silfverskiöld test)",
        "• Assess subtalar joint pronation / rearfoot alignment (inverted vs everted)",
        "• Observe foot posture: high-arched (pes cavus) or flat (pes planus) — both increase tension",
        "• Muscle testing: intrinsic foot muscles, TA, gastrocnemius-soleus complex",
      ]],
      ["Investigations", [
        "• Usually clinical diagnosis — no routine imaging required initially",
        "• X-ray (lateral foot): may show calcaneal spur — not diagnostic; spur is incidental in 50% of asymptomatic feet",
        "• Ultrasound: thickening of plantar fascia >4 mm, loss of fibrillar pattern, hypoechoic change — gold standard first-line imaging",
        "• MRI: if USS inconclusive — fascial oedema, partial/full tear, marrow oedema",
        "• Bone scan / SPECT-CT: if stress fracture of calcaneus suspected",
      ]],
      ["Gait Deviations", [
        "• Reduced ankle dorsiflexion at midstance → early heel rise (equinus gait pattern)",
        "• Shortened stride length to reduce forefoot loading",
        "• Antalgic gait — reduced stance time on affected limb",
        "• Increased supination / reduced pronation at initial contact to offload medial heel",
        "• In cavus feet: poor shock absorption → increased GRF at heel",
        "• In planus feet: prolonged midstance pronation → increased tensile load on fascia",
        "• Reduced push-off power (limited windlass mechanism activation)",
      ]],
      ["Management\nShort-Term\n(0–6 weeks)", [
        "• Activity modification — reduce high-impact activity",
        "• Ice therapy 15–20 min post-activity",
        "• NSAIDs (topical or oral) for pain relief",
        "• Low-Dye taping / calcaneal taping to offload fascia",
        "• Prefabricated heel cup or cushioned insole for immediate symptom relief",
        "• Calf stretching (gastrocnemius + soleus), plantar fascia stretch",
        "• Night splint if morning pain predominates",
      ]],
      ["Management\nMedium-Term\n(6 weeks–6 months)", [
        "• Custom functional foot orthosis (FFO): rearfoot post to control pronation; medial arch support; heel raise to reduce DF demand",
        "• Progressive loading programme: Alfredson-style eccentric calf raises on a step",
        "• Extracorporeal shockwave therapy (ESWT) — NICE-approved for refractory cases >3 months",
        "• Corticosteroid injection (US-guided): short-term pain relief; risk of fat pad atrophy and fascia rupture — use cautiously",
        "• Physiotherapy: intrinsic strengthening, proprioception, biomechanical retraining",
        "• Address footwear: stiff rocker sole, adequate heel counter, cushioning",
      ]],
      ["Management\nLong-Term\n(>6 months / refractory)", [
        "• Platelet-Rich Plasma (PRP) injection — emerging evidence for chronic cases",
        "• Dry needling / percutaneous needle fasciotomy",
        "• Surgical: endoscopic plantar fasciotomy (partial release, medial 1/3) — last resort after 12 months conservative treatment",
        "• Weight management advice",
        "• Continued orthotic use and footwear modification",
      ]],
      ["Orthosis\nPrescription", [
        "• Rearfoot post: 4–6° valgus (medially wedged) to control STJ pronation",
        "• Medial longitudinal arch support to reduce fascial tension",
        "• Heel raise 6–10 mm to reduce ankle DF demand and tension through fascia",
        "• Cushioned heel cup for shock absorption",
        "• Consider first ray cut-out if 1st ray is plantarflexed/rigid",
        "• Semi-rigid shell (polypropylene 3mm) + EVA topcover",
      ]],
      ["Differential\nDiagnoses", [
        "• Calcaneal stress fracture — squeeze test positive; X-ray / MRI confirms",
        "• Tarsal tunnel syndrome — paraesthesia, positive Tinel's at medial ankle",
        "• Baxter's nerve entrapment (1st branch lateral plantar nerve) — lateral heel pain, no morning pain pattern",
        "• Seronegative spondyloarthropathy (e.g., ankylosing spondylitis, psoriatic arthritis) — bilateral, systemic features",
        "• Heel fat pad syndrome — diffuse plantar heel pain, no Windlass provocation",
        "• Retrocalcaneal bursitis — posterior heel pain",
        "• Calcaneal bone cyst / tumour — X-ray needed",
      ]],
    ],
  },

  // ── 2. HALLUX LIMITUS / RIGIDUS ─────────────────────────────────────────────
  {
    title: "2. Hallux Limitus / Rigidus",
    subtitle: "Progressive osteoarthritis of the 1st metatarsophalangeal joint (MTPJ) causing restricted dorsiflexion",
    rows: [
      ["Assessment\n(History)", [
        "• Gradual onset dorsal 1st MTPJ pain — worsened by push-off, walking upstairs, running",
        "• Hallux Limitus: restricted but present DF (functional limitation during gait)",
        "• Hallux Rigidus: end-stage — minimal/no DF, pain even at rest",
        "• May report inability to stand on tiptoe",
        "• History of trauma (e.g., turf toe), gout, RA, previous surgery",
        "• Footwear history — tight toe box, high heels accelerating deformity",
      ]],
      ["Assessment\n(Physical Exam)", [
        "• Observation: dorsal osteophyte (dorsal prominence), widened joint",
        "• ROM: assess 1st MTPJ DF (NB: ≥65° required for normal gait); reduced in both limitus and rigidus",
        "• Grade ROM: Hallux Limitus = some DF present; Hallux Rigidus = <10° or nil DF",
        "• Grind test: axial load + rotation reproduces pain (chondral damage)",
        "• Compression test: axial compression of 1st MTPJ provokes pain",
        "• Palpate: dorsal osteophytes, medial/lateral joint swelling, crepitus on motion",
        "• Assess 1st ray mobility (plantarflexed/hypermobile 1st ray as predisposing factor)",
        "• Sagittal plane foot posture — pes planus/pronated foot loads 1st MTPJ excessively",
      ]],
      ["Investigations", [
        "• Weight-bearing X-ray (AP + lateral): narrowed joint space, subchondral sclerosis, subchondral cysts, dorsal osteophytes — Coughlin & Shurnas grading (I–IV)",
        "• Grade I: mild; Grade II–III: moderate with osteophytes; Grade IV: end-stage with complete joint destruction",
        "• MRI: cartilage assessment, avascular necrosis",
        "• Serum uric acid / ESR / CRP if inflammatory arthritis suspected",
      ]],
      ["Gait Deviations", [
        "• Reduced / absent 1st MTPJ DF → failure of windlass mechanism at push-off",
        "• Abductory twist at toe-off: foot abducts to avoid 1st MTPJ DF (circumduction)",
        "• Early heel rise to reduce DF demand at the 1st MTPJ",
        "• Transfer of load to lateral forefoot / lesser metatarsals → sub-2nd/3rd metatarsalgia",
        "• Increased hip external rotation on affected side",
        "• Antalgic gait — shortened stance phase",
        "• Propulsive phase deficiency — reduced ankle plantarflexion power at toe-off",
      ]],
      ["Management\nShort-Term\n(0–6 weeks)", [
        "• Stiff-soled footwear / rocker sole shoe to eliminate 1st MTPJ motion",
        "• NSAIDs — oral or topical",
        "• Ice / relative rest",
        "• Morton's extension orthosis: rigid flat extension under 1st MTPJ to immobilise joint",
        "• Carbon fibre insole to stiffen forefoot",
      ]],
      ["Management\nMedium-Term\n(6 weeks–6 months)", [
        "• Custom FFO with kinetic wedge / Morton's extension (1st ray cut-out or extension plate) to offload 1st MTPJ",
        "• Intra-articular corticosteroid injection for inflammatory flares (short-term relief)",
        "• Hyaluronic acid injection — limited evidence",
        "• Physiotherapy: joint mobilisation (if limitus, not rigidus), intrinsic strengthening",
        "• Footwear advice: extra-depth shoe, wide toe box, stiff rocker sole",
      ]],
      ["Management\nLong-Term\n(>6 months / surgical)", [
        "• Cheilectomy: excision of dorsal osteophytes (Grade I–III) — preserves joint motion",
        "• Moberg osteotomy: proximal phalanx dorsal closing wedge — increases functional DF",
        "• 1st MTPJ Arthrodesis: gold standard for Grade III–IV / Rigidus — fused in 15° DF + 15° valgus",
        "• Total joint replacement / hemi-implant — limited evidence, lower satisfaction than arthrodesis",
        "• Continued orthotic use post-surgery",
      ]],
      ["Orthosis\nPrescription", [
        "• Morton's extension: rigid plate extending to beyond 1st MTPJ — limits DF during gait",
        "• Kinetic wedge: 1st ray cut-out — allows 1st ray plantarflexion, improving windlass mechanism (for functional limitus)",
        "• Rearfoot post: valgus post to correct pronation (reduces 1st MTPJ loading in planus foot)",
        "• Carbon fibre plate under forefoot for stiffness",
        "• Full-length semi-rigid orthosis with deep heel cup",
      ]],
      ["Differential\nDiagnoses", [
        "• Gout / pseudogout — acute onset, erythema, hyperuricaemia, crystals on aspiration",
        "• Hallux valgus — medial deviation deformity, different joint alignment",
        "• Sesamoiditis — pain plantar 1st MTPJ, sesamoid tenderness",
        "• 1st MTPJ septic arthritis — systemic signs, elevated WBC/CRP",
        "• Freiberg's infraction — avascular necrosis 2nd metatarsal head",
        "• Rheumatoid arthritis — symmetrical, systemic, RF/anti-CCP positive",
        "• Turf toe — acute hyperextension injury of 1st MTPJ, plantar capsule tear",
      ]],
    ],
  },

  // ── 3. MORTON'S NEUROMA ─────────────────────────────────────────────────────
  {
    title: "3. Morton's Neuroma",
    subtitle: "Perineural fibrosis of the common interdigital nerve — most common in 3rd web space (85%)",
    rows: [
      ["Assessment\n(History)", [
        "• Burning, shooting, or electric-shock pain in the forefoot radiating into adjacent toes",
        "• Paraesthesia / numbness in affected web space and toes",
        "• Relieved by removing shoes and massaging the foot",
        "• Worsened by narrow, pointed or high-heeled footwear (forefoot compression)",
        "• Most common: 3rd web space (between 3rd–4th toes); 2nd web space next",
        "• Middle-aged women more commonly affected",
        "• Can coexist with metatarsalgia, bursitis",
      ]],
      ["Assessment\n(Physical Exam)", [
        "• Mulder's click test: mediolateral forefoot compression + dorsal pressure on plantar web space — palpable/audible click + reproduction of pain (sensitivity ~60%, specificity ~90%)",
        "• Web space squeeze: compress between thumb and finger in affected web space — reproduces pain/paraesthesia",
        "• Lateral compression test: squeeze across all metatarsal heads",
        "• Metatarsal head palpation — exclude 2nd/3rd metatarsalgia",
        "• Neurological testing: sensation with monofilament in web space — may show reduced sensation",
        "• Assess intermetatarsal space width — splay foot / hypermobile forefoot predisposes",
        "• Rule out MTP joint synovitis (Lachman test at MTPJ)",
      ]],
      ["Investigations", [
        "• Ultrasound: hypoechoic mass in plantar web space, >5–6 mm = clinically significant; compressible with probe",
        "• MRI: low signal on T1; confirms size and location; best for surgical planning",
        "• X-ray (AP weight-bearing): rules out metatarsal stress fracture, arthritis",
        "• Diagnostic US-guided local anaesthetic injection: symptom resolution confirms diagnosis",
      ]],
      ["Gait Deviations", [
        "• Forefoot avoidance pattern — patient avoids full forefoot loading / toe-off through affected web space",
        "• Increased supination: rolls onto lateral forefoot to reduce 3rd web space compression",
        "• Reduced push-off through forefoot — shortened propulsive phase",
        "• Antalgic gait with shortened stance time",
        "• Toe splay during stance to open web spaces and reduce nerve compression",
        "• Reduced walking speed",
      ]],
      ["Management\nShort-Term\n(0–6 weeks)", [
        "• Footwear advice: wide toe box, low heel, adequate depth — immediate priority",
        "• Metatarsal pad/dome: placed proximal to metatarsal heads to splay them and decompress web space",
        "• NSAIDs for pain management",
        "• Activity modification",
        "• Padding: felt padding to offload affected metatarsal heads",
      ]],
      ["Management\nMedium-Term\n(6 weeks–6 months)", [
        "• Custom FFO with integrated metatarsal dome/bar to separate metatarsal heads",
        "• US-guided corticosteroid injection: 70–80% short-term relief; repeat up to 3 injections",
        "• US-guided sclerosing alcohol injections: 4% alcohol series — evidence for long-term reduction in neuroma size",
        "• Physiotherapy: intrinsic strengthening, gait retraining",
        "• Reassess footwear compliance",
      ]],
      ["Management\nLong-Term\n(>6 months / surgical)", [
        "• Surgical excision (neurectomy) via dorsal or plantar approach — 80–85% success rate",
        "• Plantar approach: better access but scar on weight-bearing surface",
        "• Dorsal approach: preferred — no plantar scar, slightly higher recurrence",
        "• Complications: stump neuroma, haematoma, infection, incomplete excision",
        "• Radiofrequency ablation: emerging minimally invasive option",
      ]],
      ["Orthosis\nPrescription", [
        "• Metatarsal dome/bar: placed just proximal to 2nd–4th metatarsal heads on orthosis — key component",
        "• Full-length semi-rigid orthosis with forefoot accommodation",
        "• Lateral forefoot extension to reduce supinatory loading",
        "• Metatarsal pad placed to splay 3rd and 4th metatarsal heads",
        "• Softer EVA forefoot topcover for shock absorption",
        "• No rearfoot posting needed unless secondary biomechanical driver present",
      ]],
      ["Differential\nDiagnoses", [
        "• Metatarsalgia — diffuse forefoot pain under MTP heads, no Mulder's click",
        "• MTP joint synovitis / capsulitis — dorsal swelling, Lachman test positive",
        "• Intermetatarsal bursitis — may coexist; bursal sac visible on USS",
        "• Metatarsal stress fracture — X-ray/MRI; localised bone tenderness",
        "• Peripheral neuropathy (diabetes) — bilateral, stocking distribution",
        "• Tarsal tunnel syndrome — more proximal, medial ankle",
        "• Freiberg's infraction — 2nd metatarsal head AVN, adolescent/young adult",
      ]],
    ],
  },

  // ── 4. ACHILLES TENDINOPATHY ────────────────────────────────────────────────
  {
    title: "4. Achilles' Tendinopathy",
    subtitle: "Degenerative tendinopathy (collagen disorganisation, mucoid degeneration) — insertional (25%) vs non-insertional (75%)",
    rows: [
      ["Assessment\n(History)", [
        "• Posterior heel / Achilles pain, stiffness, swelling",
        "• Non-insertional: pain 2–6 cm proximal to insertion ('critical zone' of hypovascularity)",
        "• Insertional: pain at bone-tendon junction; worsened by direct shoe pressure",
        "• Morning stiffness ('start-up pain'), eases with activity, worsens after",
        "• VISA-A questionnaire to quantify severity (max 100 = asymptomatic)",
        "• Aggravating factors: running, hills, sudden load increase, poor footwear",
        "• Risk factors: age, male sex, fluoroquinolone use, hyperlipidaemia, pronated foot, equinus",
      ]],
      ["Assessment\n(Physical Exam)", [
        "• Palpation: focal tenderness 2–6 cm above insertion (non-insertional); posterior calcaneal tenderness (insertional)",
        "• Arc sign: tender nodule moves with tendon on ankle DF/PF — indicates intratendinous pathology",
        "• Royal London Hospital test: pain on tendon palpation at 90° DF but NOT at PF — positive for midportion tendinopathy",
        "• Single-leg calf raise test: ability to perform 25 raises — quantifies function",
        "• Thompson/Simmonds test: rule out Achilles rupture — squeezing calf → no plantarflexion = positive (rupture)",
        "• Silfverskiöld test: assess equinus (gastrocnemius vs soleus tightness)",
        "• Haglund deformity: palpable bony prominence posterosuperior calcaneus (insertional)",
        "• Assess rearfoot alignment, subtalar ROM, gait observation",
      ]],
      ["Investigations", [
        "• USS: tendon thickening (>6 mm), hypoechoic areas, loss of fibrillar pattern, neovascularisation on Doppler",
        "• X-ray (lateral): insertional calcification, Haglund prominence, intratendinous calcification",
        "• MRI: extent of degeneration, partial tears, marrow oedema in insertional disease",
        "• VISA-A score: validated functional outcome measure (used at assessment and review)",
      ]],
      ["Gait Deviations", [
        "• Reduced ankle dorsiflexion during midstance → early heel rise",
        "• Shortened stride length to reduce Achilles load",
        "• Reduced plantarflexion power at push-off (deficient propulsion)",
        "• In insertional tendinopathy: heel strike avoided → midfoot/forefoot strike to reduce calcaneal compression",
        "• Antalgic gait — reduced stance time on affected limb",
        "• Increased knee flexion to compensate for restricted DF",
        "• Possible contralateral trunk lean to unload affected limb",
      ]],
      ["Management\nShort-Term\n(0–6 weeks)", [
        "• Relative rest — reduce high-impact loading; maintain low-impact activity (cycling, swimming)",
        "• Ice post-activity",
        "• Heel raise 6–10 mm: reduces Achilles tension (non-insertional and insertional)",
        "• NSAIDs for pain management (short course)",
        "• Low-Dye or Achilles tendon off-loading taping",
        "• Avoid stretching in insertional tendinopathy (compresses insertional zone — contraindicated)",
      ]],
      ["Management\nMedium-Term\n(6 weeks–6 months)", [
        "• Eccentric loading programme (Alfredson protocol): heel drops on step edge — 3 × 15 reps, 2× daily, through pain, 12 weeks (evidence grade A for non-insertional)",
        "• For insertional: heavy slow resistance (HSR) training preferred over eccentric drops (reduces insertional compression)",
        "• Custom FFO: heel raise, rearfoot post to control pronation; reduce Achilles load",
        "• ESWT: for refractory non-insertional tendinopathy (NICE approved after 3 months)",
        "• US-guided high-volume injection (HVI): saline + steroid to strip neovascularisation",
        "• Physiotherapy: calf strengthening, proprioception, load management",
        "• Avoid corticosteroid peritendinous injection — high rupture risk",
      ]],
      ["Management\nLong-Term\n(>6 months / surgical)", [
        "• PRP injection: evidence mixed — may benefit refractory cases",
        "• Surgical: debridement of degenerative tissue (non-insertional) or reattachment/excision of bone prominence (insertional)",
        "• FHL tendon transfer if >50% tendon debridement required (insertional)",
        "• Zadek osteotomy (dorsal closing wedge of calcaneus) — reduces insertional compression",
        "• Haglund resection + retrocalcaneal bursectomy (insertional)",
        "• Continued rehabilitation 6–12 months post-op",
      ]],
      ["Orthosis\nPrescription", [
        "• Heel raise 6–10 mm (both sides to avoid limb length discrepancy): reduces Achilles tensile load",
        "• Rearfoot valgus post (4–6°): controls STJ pronation — reduces torsional stress on tendon",
        "• Heel cup: cushioning and shock absorption",
        "• Silicone heel sleeve: offloads retrocalcaneal bursa (insertional)",
        "• Avoid arch support that may increase Achilles load through dorsiflexion",
        "• For insertional: deep heel cup relief / heel lift to decompress insertion",
      ]],
      ["Differential\nDiagnoses", [
        "• Achilles tendon rupture — Thompson test positive; palpable gap; sudden 'pop'",
        "• Retrocalcaneal bursitis — deep bursal tenderness anterior to tendon insertion; USS shows bursal distension",
        "• Haglund syndrome (pump bump) — bony prominence + bursitis; insertional pain",
        "• Sural nerve entrapment — lateral heel/leg shooting pain; sensory symptoms",
        "• Calcaneal stress fracture — squeeze test; X-ray/MRI",
        "• Seronegative spondyloarthropathy (enthesitis) — bilateral, systemic features",
        "• Posterior ankle impingement — ballet dancers; posterior pain on plantarflexion",
        "• Peroneal tendinopathy — lateral pain, eversion weakness",
      ]],
    ],
  },

  // ── 5. POSTERIOR TIBIAL TENDON DYSFUNCTION / AAFD ──────────────────────────
  {
    title: "5. Posterior Tibial Tendon Dysfunction / Adult Acquired Flatfoot",
    subtitle: "Progressive failure of the PTT leading to pes planovalgus deformity — staged I–IV (Johnson & Strom / Myerson)",
    rows: [
      ["Assessment\n(History)", [
        "• Medial ankle/foot pain — early stages; lateral ankle pain late (subfibular impingement)",
        "• Progressive collapse of medial longitudinal arch",
        "• Difficulty walking on uneven ground; fatigue with standing",
        "• Unable to perform single-leg heel rise (key functional complaint)",
        "• Risk factors: female, >40 years, obesity, diabetes, hypertension, seronegative arthritis, steroid use, fluoroquinolones",
        "• Stage I: pain without deformity; Stage II: flexible flatfoot deformity; Stage III: rigid flatfoot; Stage IV: ankle involvement",
      ]],
      ["Assessment\n(Physical Exam)", [
        "• Standing observation: collapse of medial arch, hindfoot valgus, forefoot abduction",
        "• Too-many-toes sign: viewed from posterior — excessive lateral forefoot visible beyond heel",
        "• Single-heel rise test: inability to perform (Stage II+) — definitive functional test",
        "• PTT palpation: tenderness along tendon course (medial malleolus → navicular)",
        "• Resisted inversion + plantarflexion: weakness = PTT insufficiency",
        "• Assess deformity flexibility: Is hindfoot correctable to neutral? (Stage II = flexible; Stage III = rigid)",
        "• Silfverskiöld test: gastrocnemius contracture is common finding",
        "• Check for spring ligament tenderness (distal to medial malleolus over TN joint)",
        "• Late stages: lateral ankle pain, peroneal tenderness, subfibular impingement",
      ]],
      ["Investigations", [
        "• Weight-bearing X-ray (AP + lateral foot + AP ankle):",
        "  – Negative Meary's angle (lateral talar-1st MT angle): pes planus",
        "  – Increased TN uncoverage (forefoot abduction)",
        "  – Calcaneal pitch < 20°",
        "• MRI: PTT degeneration, partial/complete tear; spring ligament status",
        "• USS: PTT thickening, intratendinous hypoechogenicity, partial tear",
        "• CT: rigid deformity (Stage III) — assess subtalar/transverse tarsal joint arthritis; tarsal coalition",
      ]],
      ["Gait Deviations", [
        "• Loss of heel inversion at toe-off — failure of PTT to lock transverse tarsal joint → unlocked propulsion",
        "• Inability to perform heel rise — absent propulsive phase",
        "• Excessive/prolonged subtalar pronation throughout stance",
        "• Abducted forefoot position during gait — forefoot abduction in swing",
        "• Too-many-toes visible in gait observation (posterolateral view)",
        "• Reduced push-off power — planovalgus unlocked midtarsal joint absorbs propulsion",
        "• Altered hip/knee mechanics: increased hip IR and knee valgus",
        "• Lateral thrust at subtalar joint — late-stage subfibular impingement pattern",
      ]],
      ["Management\nShort-Term\n(0–6 weeks)", [
        "• Rest, activity modification, ice, NSAIDs",
        "• Immobilisation boot / below-knee cast (acute Stage I–II) to offload PTT",
        "• Medial heel and arch support (OTC) for immediate symptom relief",
        "• Physiotherapy referral: calf stretching, gentle strengthening",
      ]],
      ["Management\nMedium-Term\n(6 weeks–6 months)", [
        "• Custom functional foot orthosis (Stage I–II flexible): UCBL-style deep heel cup, medial heel post, aggressive medial arch support",
        "• Arizona brace / gauntlet AFO: for significant deformity or failed insole therapy",
        "• Progressive PTT strengthening: resisted inversion, single-leg calf raises",
        "• Gastrocnemius/soleus stretching (equinus correction)",
        "• Corticosteroid injection: peritendinous — extreme caution (tendon rupture risk); may inject spring ligament region",
        "• Weight management",
      ]],
      ["Management\nLong-Term\n(Surgical — Stage II–IV)", [
        "• Stage II (flexible): FDL or FHL tendon transfer + medial slide calcaneal osteotomy ± lateral column lengthening (Evans osteotomy) ± gastrocnemius recession ± spring ligament repair",
        "• Stage III (rigid): double/triple arthrodesis (subtalar + talonavicular ± calcaneocuboid)",
        "• Stage IV: total ankle replacement or tibiotalar + hindfoot arthrodesis",
        "• Post-operative: non-weight-bearing 6–8 weeks, graduated rehabilitation",
      ]],
      ["Orthosis\nPrescription", [
        "• UCBL (University of California Biomechanics Lab) orthosis: most aggressive; deep heel cup cups calcaneus to prevent valgus",
        "• Rearfoot post: medial (valgus) 4–6° to control STJ eversion",
        "• Aggressive medial arch fill to support spring/plantar ligament complex",
        "• Rigid polypropylene shell (4 mm) for Stage II deformity",
        "• Medial flange extension along navicular border",
        "• Heel raise if equinus present",
        "• AFO / gauntlet brace for Stage III rigid or failed FFO",
        "• Key aim: maintain flexible deformity in corrected position and slow progression",
      ]],
      ["Differential\nDiagnoses", [
        "• Spring ligament rupture — acute flatfoot deformity without PTT pathology; MRI differentiates",
        "• Tarsal coalition — rigid flatfoot in younger patient; CT/MRI confirms bony/fibrous bar",
        "• Inflammatory arthritis (RA, psoriatic) — bilateral, systemic, erosive changes on X-ray",
        "• Deltoid ligament insufficiency — medial ankle laxity, history of ankle sprains",
        "• Lisfranc injury — midfoot pain and arch collapse; weight-bearing X-ray gap at Lisfranc joint",
        "• Accessory navicular syndrome — medial navicular pain; X-ray shows os naviculare",
        "• Medial ankle ganglion / tarsal tunnel syndrome — USS/MRI; neurological symptoms",
      ]],
    ],
  },
];

// ═══════════════════════════════════════════════════════════════════════════════
// BUILD DOCUMENT
// ═══════════════════════════════════════════════════════════════════════════════

const docChildren = [];

// Cover section
docChildren.push(spacer());
docChildren.push(sectionBar("PODIATRY REVISION SHEETS", "0B3D91", 36));
docChildren.push(spacer());
docChildren.push(sectionBar("5AH027/UW1: Musculoskeletal Pathology", "1565A6", 26));
docChildren.push(spacer());
docChildren.push(new Paragraph({
  children: [
    new TextRun({ text: "Assessment, Diagnosis, Gait Analysis, Management & Differential Diagnoses", size: 22, color: "555555", font: "Calibri", italics: true }),
  ],
  alignment: AlignmentType.CENTER,
}));
docChildren.push(spacer());
docChildren.push(new Paragraph({
  children: [
    new TextRun({ text: "Conditions covered: ", bold: true, size: 20, font: "Calibri" }),
    new TextRun({ text: "Plantar Fasciopathy  |  Hallux Limitus/Rigidus  |  Morton's Neuroma  |  Achilles' Tendinopathy  |  PTTD/AAFD", size: 20, font: "Calibri" }),
  ],
  alignment: AlignmentType.CENTER,
}));
docChildren.push(spacer());
docChildren.push(new Paragraph({
  children: [new TextRun({ text: "Exam Date: Thursday 7th May 2026  |  Module: 5AH027 Musculoskeletal Pathology", size: 18, italics: true, color: "888888", font: "Calibri" })],
  alignment: AlignmentType.CENTER,
}));

for (let ci = 0; ci < conditions.length; ci++) {
  const cond = conditions[ci];
  docChildren.push(pageBreak());
  docChildren.push(sectionBar(cond.title, NAVY, 28));
  docChildren.push(spacer());
  docChildren.push(new Paragraph({
    children: [new TextRun({ text: cond.subtitle, size: 18, italics: true, color: "444444", font: "Calibri" })],
  }));
  docChildren.push(spacer());

  for (const [label, content] of cond.rows) {
    // Sub-section label bar
    docChildren.push(sectionBar(label.replace(/\n/g, " — "), TEAL, 20));
    docChildren.push(twoColTable([[label.replace(/\n/g, " "), content]]));
    docChildren.push(spacer());
  }
}

const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: 18 },
      },
    },
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 720, bottom: 720, left: 900, right: 900 },
      },
    },
    children: docChildren,
  }],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/podiatry-revision/Podiatry_Revision_Sheets.docx", buffer);
  console.log("Done: Podiatry_Revision_Sheets.docx");
}).catch(err => {
  console.error(err);
  process.exit(1);
});