Forefoot / Midfoot · Reconstructive · Pediatrics · Advanced
Tight Shoes
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
"The ball of my foot hurts and I can't wear closed-toe shoes on my left foot."
19-year-old female seen in clinic.
History of present illness
Pain under the forefoot (metatarsalgia) of the left foot with difficulty fitting closed-toe shoes because of a prominence over the top of the first ray.
- Gradual onset over years, worsening over time with activity
- Pain under the lesser metatarsal heads and over the dorsal first metatarsal-cuneiform area in shoes
- Born with a left clubfoot treated in infancy and early childhood (casting and surgical release); the deformity has slowly changed since
- Failed accommodative shoes and OTC insoles
- No acute trauma, no open wounds, no fever
Questions a strong candidate asks at this step
- Onset, duration, progression, location of pain (plantar lesser MT heads vs. dorsal first ray)
- Birth history: congenital deformity, treatment (Ponseti casting, release, tendon transfers), age at treatment
- Shoe-wear problems and what has been tried (shoes, orthoses, injections)
- Neurologic symptoms, weakness, falls, and family history of neuromuscular disease
- Function: walking tolerance, sports, work or school limitations
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.