Forefoot / Midfoot · Oncology · Standard
Painful Fourth Toe
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 fourth toe has been hurting."
35-year-old female seen in clinic.
History of present illness
Pain around the right 4th toe that began 4 weeks ago.
- No injury she can recall (possibly stubbed it, unsure)
- Pain is constant, including at rest and at night; no relief with analgesics
- Mild swelling of the toe; no redness, drainage or open wound
- No fevers, chills, weight loss or night sweats
- Has noticed small, firm lumps on her hands
Questions a strong candidate asks at this step
- Onset and any trauma (even minor)
- Constant vs. activity-related; night pain; response to NSAIDs (osteoid osteoma relieved by NSAIDs)
- Swelling, redness, drainage, wounds (infection)
- Constitutional symptoms: fever, weight loss, night sweats (malignancy/infection)
- Masses elsewhere — hands, skin lesions
- Personal 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.