Rearfoot / Ankle · Oncology · Arthritides & Derm · Standard
Heel 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 heel hurts."
39-year-old female seen in clinic.
History of present illness
Four weeks of pain at the bottom of the heel. While you examine her she mentions a discolored spot near her ankle that has been there about 1 year and seems to be getting bigger. It does not hurt and is not why she came, but she would like you to look at it.
Heel:
- Insidious onset, no trauma; worst with the first steps in the morning and after sitting, eases after a few minutes of walking
- Plantar-medial heel, 6/10, non-radiating; no numbness or tingling
Skin lesion:
- Present ~1 year, enlarging; color has become darker and uneven
- No itching, bleeding or ulceration
- No prior skin cancers; no personal history of atypical moles
Questions a strong candidate asks at this step
- Heel: onset, post-static dyskinesia, location, radiation, paresthesias, trauma, activity/shoe changes
- Lesion: how long, change in size, shape, color or elevation (Evolving)
- Bleeding, itching, ulceration, crusting
- Personal or family history of melanoma or skin cancer; sun exposure, tanning beds, sunburns
- Constitutional symptoms: weight loss, fatigue, night sweats, cough, bone pain
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.