Forefoot / Midfoot · Reconstructive · Standard
Wandering Toes
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 toes hurt and they feel like they're moving over."
25-year-old female seen in clinic.
History of present illness
Painful bumps at both big toe joints that have progressively worsened over the past 2 years. She feels her big toes are "moving over" toward the second toes.
- Location: medial 1st MPJ, bilateral; also aching under the ball of the foot (2nd metatarsal heads)
- Pain 7/10 with walking, aching/rubbing, worse in closed-toe and narrow shoes; relieved by rest and going barefoot
- No trauma; no numbness or tingling
- Treatment so far: occasional acetaminophen with partial relief; has not tried wider shoes, pads or orthoses
- No morning stiffness, other joint swelling, fevers or rashes
Questions a strong candidate asks at this step
- Onset, duration and progression (how fast is it changing?)
- Location: medial eminence vs. dorsal 1st MPJ vs. sub-2nd metatarsal head
- Character, severity, aggravating factors (shoe gear, activity) and relieving factors
- Previous treatment: shoe modification, padding, orthoses, injections, NSAIDs
- Trauma history; numbness or tingling (dorsomedial cutaneous nerve)
- Other joints, morning stiffness (screen for inflammatory arthritis)
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.