Generate a SOAP note from this dictation:

 presented with concern of left forefoot pain. She has had a long-standing history of pain to the forefront. She does use orthotics. She notes that she was last seen about six months ago. Pain has occurred. She notes only in the last several weeks or so. She continues with orthotics consistently. Pain is associated with activities. there is four-foot varus left with plantar flex left with metatarsal and also plantar flex first metatarsal ankle drives restricted to the door selection left. There's hyperkeratosis to the plantar first and fifth metatarsal head of the left foot. Skin is intact, however, non-inhalation or infection assessment metatarsal left with four-foot deformity and hyperkeratosis. The lesions were debrided to reduce pain. Her orthotics were refurbished as there is metatarsal padding, which is significant. This should help reduce forefoot pressure. at this point she is content to continue with this treatment and does not feel more aggressive treatment as warranted or re-evaluate in six months should she ever occur. Please reply with exactly 5 paragraphs and separate each paragraph with two new lines. The very first paragraph must start with the word "important".
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