Forefoot / Midfoot · Diabetic Limb & Charcot · Reconstructive · Standard
Changing Shape
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 and it keeps changing shape."
49-year-old female presenting to clinic with left foot pain and increasing deformity.
History of present illness
Increasing deformity of the left foot with worsening, shooting midfoot pain for 6 months.
- Denies any trauma
- Remote left 5th metatarsal fracture about 15 years ago
- Pain is shooting/burning in quality and now present with walking and at rest
- Arch has progressively flattened and a bump has appeared on the inner top of the midfoot
- Shoes are becoming hard to fit
Questions a strong candidate asks at this step
- Onset, duration and progression; any inciting trauma, even minor (missed sprain, misstep)
- Character of pain (shooting/burning suggests neuropathy), location, aggravating and relieving factors, night or rest pain
- Swelling, warmth or redness; fever, chills, constitutional symptoms
- Open wounds, drainage, prior ulcers
- Numbness or tingling, balance problems
- Treatments tried: shoes, NSAIDs, immobilization, injections
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.