Rearfoot / Ankle · Oncology · Reconstructive · Standard
Stubborn Heel
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 heel has been hurting for about a year."
42-year-old male seen in the office with left heel pain.
History of present illness
Dull, aching pain of the left heel, worst on the plantar lateral aspect, present for about a year.
- Progressively worse over the past 6 months
- Icing has not helped
- No trauma
- Pain is worse after prolonged standing or walking and is not clearly worse with the first steps in the morning
- No fever, chills, night pain, weight loss or other constitutional symptoms
- No numbness, tingling or burning in the foot
- Has not yet tried heel cups, orthoses, NSAIDs or physical therapy
Questions a strong candidate asks at this step
- Onset, duration and progression; location (plantar medial vs. plantar lateral vs. posterior)
- Character of the pain; first-step pain, pain at rest and night pain (red flag for tumor)
- Trauma or change in activity or footwear
- Treatments tried: ice, NSAIDs, stretching, orthoses, injections
- Numbness, tingling, burning (Baxter nerve, tarsal tunnel, S1 radiculopathy)
- Constitutional symptoms: fever, weight loss, history of cancer
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.