Forefoot / Midfoot · Reconstructive · Infection & Wound · Standard
Chronic Ache
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 left foot has hurt right under the front of my second toe for a long time."
25-year-old female seen in the outpatient podiatry clinic with chronic left forefoot pain.
History of present illness
Chronic left forefoot pain centered at the 2nd metatarsophalangeal joint (MPJ). A foreign body near the joint was found incidentally on imaging.
- Pain is localized to the 2nd MPJ, worse with weight-bearing and push-off, better with rest
- Months to years in duration; no definite recent trauma; she does not recall a specific puncture, though a penetrating injury in the distant past is possible
- Mild intermittent swelling of the joint; no fever, drainage, redness or sinus tract
- Has tried shoe changes and NSAIDs with only partial relief
- No numbness or tingling
Questions a strong candidate asks at this step
- Onset, duration, progression and exact location of the pain
- Mechanism: any prior trauma, puncture, glass or needle injury, barefoot injury, prior injection
- Aggravating factors: weight-bearing, push-off, tight or high-heeled shoes; relieving factors
- Swelling, warmth, redness, drainage, sinus tract, fever or chills (infection)
- Mechanical symptoms: clicking, locking, catching (loose bodies)
- Toe deformity: is the 2nd toe drifting, crossing over the hallux or floating off the ground (predislocation)
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.