Rearfoot / Ankle · Reconstructive · Neurology & Nerve · Advanced
Old Sprains
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 hurts on the outside, especially on uneven ground."
40-year-old male seen in clinic with long-standing right heel pain.
History of present illness
Long-standing right heel and hindfoot pain with swelling. He points to the sinus tarsi as the point of maximal pain, worst when walking on uneven surfaces. He gave a history of recurrent ankle sprains when he was younger.
- Gradual, progressive course over years; pain is activity related and eased by rest
- Feels the ankle "gives way" on uneven ground
- Tried supportive shoes, ankle bracing and NSAIDs with only partial relief
- No recent trauma, fever, or open wounds
- No history of foot drop or tripping
Questions a strong candidate asks at this step
- Onset, duration, progression; location (sinus tarsi vs. lateral gutter vs. peroneals)
- Aggravating factors: uneven ground, stairs, prolonged walking
- Mechanism and number of prior sprains; giving-way episodes; prior immobilization or rehabilitation
- Treatments tried: shoes, orthoses, braces, NSAIDs, injections, physical therapy
- Weakness, foot drop, tripping, balance problems (neurologic cause of cavus)
- Family history of high arches, neuropathy or neurologic disease
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.