Forefoot / Midfoot · Reconstructive · Arthritides & Derm · Standard
Push-Off 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."
45-year-old female seen in the outpatient clinic.
History of present illness
Progressive stiffness and pain at the left great toe joint for about 3 years, with activity-related pain that is worse with push-off, walking uphill and in tighter shoes.
- Aching, 5-6/10 with activity, 1-2/10 at rest
- Dorsal bump that rubs on shoes
- Failed conservative care: NSAIDs, a stiff-soled shoe with rocker bottom, a carbon-fiber insert and a corticosteroid injection with only temporary relief
- No trauma, no night pain, no fever, no history of gout attacks
Questions a strong candidate asks at this step
- Location: dorsal impingement pain vs. pain through the whole range of motion (global joint damage)
- Onset, duration, progression, prior trauma or sports (turf toe)
- Which activities and shoes provoke it; effect on work
- Conservative care tried and for how long: shoes, orthoses, NSAIDs, injections, activity change
- Pain at the hallux IPJ, sesamoids, or lesser MPJs / lateral foot (compensatory gait)
- Night pain, swelling, redness (gout/inflammatory arthritis); numbness along the dorsomedial hallux
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.