Forefoot / Midfoot · Reconstructive · Standard
High Heels
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 hurts and my bump rubs in shoes."
35-year-old female seen in the office.
History of present illness
Pain in the RIGHT great toe joint and over her "bunion bump," especially in tight shoes and high heels. She describes a dull, deep, aching pain and points to the plantar and medial aspect of the right 1st metatarsal head.
- Gradual onset over about 3 years, progressively worse
- Pain 6/10 with shoes; relieved by removing shoes and rest
- Tried wider shoes, bunion pads and ibuprofen with only partial relief
- No trauma; no swelling attacks or redness suggestive of gout
- No numbness or tingling
Questions a strong candidate asks at this step
- Nature, location, onset, duration, character (NLDOCAT) — dorsal bump pain vs joint pain
- Aggravating factors (shoes, activity) and relieving factors
- Previous treatments: shoe modification, padding, orthotics, injections, NSAIDs
- Family history of bunions; history of trauma or gout
- Goals and expectations (shoe wear, activity, cosmesis)
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.