Forefoot / Midfoot · Reconstructive · Arthritides & Derm · Advanced
Big Toe Pain
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 big toe joint is stiff and hurts when I walk."
52-year-old male seen in clinic.
History of present illness
Two years of gradually worsening pain at the top of the left big toe joint, worse when pushing off and in dress shoes; the toe has become stiff and there is a bump on top.
- Aching, 6/10, worse with activity, better with rest and a stiff-soled shoe
- No trauma recalled
- Tried NSAIDs, a stiff insole and one steroid injection with short relief
Questions a strong candidate asks at this step
- Location — dorsal joint pain (impingement) vs pain through the whole range (global arthritis)
- Onset, duration, prior trauma
- Shoe and activity limitations
- Conservative care tried
- Pain at the IPJ or lesser MPJs (compensation)
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.