Rearfoot / Ankle · Reconstructive · Standard
Failed Insoles
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 feet have been flat forever, and now they hurt."
29-year-old non-diabetic female seen in clinic.
History of present illness
Lifelong flat feet that became painful about 2 years ago and have progressively worsened.
- Pain with activity, located in the midfoot/arch region, both feet
- Has tried over-the-counter and prescription orthoses without much relief
- Has completed a course of physical therapy without lasting benefit
- Does not take ibuprofen or other NSAIDs
- Pain now interferes with daily activities and her gym routine
- She wants to have surgery
- No trauma, no swelling or redness, no numbness or tingling, no fever or constitutional symptoms
Questions a strong candidate asks at this step
- Onset, duration, progression; was the foot always flat (congenital/flexible) or did it collapse recently
- Location of pain (medial arch, sinus tarsi, lateral impingement, midfoot) and what aggravates or relieves it
- Mechanism or trauma; recent change in activity, weight or footwear
- Treatments already tried: shoes, OTC and custom orthoses, PT/stretching, NSAIDs, injections, immobilization
- Function: effect on work, exercise and daily activities
- Patient goals and expectations of surgery
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.