Forefoot / Midfoot · Pediatrics · Reconstructive · Standard
Plantar Ache
Podiatric surgery residency interview case. Work through it the way you would at an interview: take the history, ask for the exam and imaging, then commit to a diagnosis and plan.
Chief complaint
"My foot hurts on the bottom when I walk."
13-year-old girl seen in clinic with plantar foot pain.
History of present illness
Five years ago she began to have foot pain during sporting activities. The pain has gradually worsened and now bothers her during normal daily activities.
- Pain is localized under the ball of the foot, worse with push-off, running, jumping and going up on her toes
- Toes have looked short since birth; no one else has examined them in detail
- Worse barefoot or in thin-soled shoes, better with rest and cushioned shoes
- No single injury; no fever, night pain or other joint pain
- OTC ibuprofen gives partial relief; has not had formal treatment or orthoses
- No swelling, redness or open wound
Questions a strong candidate asks at this step
- Onset, duration and progression (5 years, sport-related, now with ADLs)
- Exact location - under the 1st MTPJ vs. lesser metatarsal heads, heel, arch
- Aggravating factors: push-off, jumping, barefoot, hard surfaces; sport type and volume
- Mechanism or trauma; prior injury
- Treatments tried: rest, shoes, orthoses, NSAIDs, injections
- Swelling, warmth, night pain, fever, weight loss (exclude infection/tumor)
Present the rest of the case
Past history, exam, imaging, assessment, plan and discussion questions, with model answers, are in the interactive trainer. The diagnosis is kept there on purpose so you can practice committing to one.