Forefoot / Midfoot · Reconstructive · Arthritides & Derm · Standard
Crowded Forefoot
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 is crooked, my second toe is bent and painful, and the top and outside of my foot hurt."
60-year-old female seen in the podiatry clinic.
History of present illness
Longstanding left bunion deformity that has progressed to a severe hallux valgus. She now has a painful, contracted second toe and pain over the dorsal midfoot and the lateral border of the foot.
- Gradual onset over years, progressively worse; no single injury
- Pain with shoe gear and walking; worse at the end of the day
- Bunion pain at the medial eminence and stiffness of the big toe joint
- Second toe rubs on the shoe dorsally and is painful
- Dorsal midfoot (2nd TMTJ) pain and lateral pain at the base of the 5th metatarsal with weight bearing
- Has tried wider shoes; padding and OTC orthotics gave little lasting relief
- No open wounds, no fever, no recent trauma
Questions a strong candidate asks at this step
- Onset, duration, progression, and any inciting event
- Location and character of pain (medial bunion, joint pain, dorsal toe, dorsal midfoot, lateral base of 5th)
- What makes it worse or better; shoe gear limitations
- Treatments tried: shoe modification, padding, orthoses, NSAIDs, injections
- Function: walking tolerance, work, ability to exercise
- Prior foot surgery or trauma; family history of bunions
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.