Rearfoot / Ankle · Reconstructive · Standard
Aching Arches
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 flat feet have been really painful."
39-year-old woman seen in the resident foot and ankle clinic.
History of present illness
She has had flat feet for as long as she can remember, but they became painful about 2 months ago with no clear trigger. She has never seen a foot and ankle specialist.
- Pain is deep in the hindfoot and sinus tarsi region, worse on uneven ground and at the end of the day, better with rest
- Pain is now limiting walking and daily activity
- No acute injury, no fever or chills, no swelling episodes, no numbness or tingling
- Has tried over-the-counter NSAIDs and her own shoes with minimal relief
- Stiff feet since adolescence with frequent ankle "turning"
Questions a strong candidate asks at this step
- Onset, duration, location and character of the pain; what makes it better or worse
- Was the flatfoot present since childhood, or did it develop recently?
- Any injury or mechanism preceding the pain (fall, twisting, repetitive impact)?
- History of recurrent ankle sprains or stiffness in the hindfoot since adolescence
- Prior treatment: NSAIDs, shoes, orthotics, braces, injections, PT
- Functional limits: distance walked, work and activity impact
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.