Rearfoot / Ankle · Pediatrics · Standard
Runner's Limp
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
"Her feet turn in and she limps after she runs."
9-year-old African American girl brought by her mother to the pediatric orthopedic clinic.
History of present illness
Mother noticed in-toeing, left worse than right, starting about 6 months ago and getting worse. The child is active and has been training for a 5K race.
- Pain with prolonged activity, followed by a limp
- Pain is vague — "leg and knee" — not clearly localized to the foot
- No trauma, no fever, no night pain, no weight loss
- Rest improves symptoms; no treatment so far
Questions a strong candidate asks at this step
- Onset, duration and progression of the in-toeing; unilateral or bilateral
- Where exactly is the pain? (hip pathology often refers to the thigh/knee)
- Limp: painful (antalgic) or painless (Trendelenburg)?
- Trauma, fever, night pain, weight loss (infection, tumor)
- Birth history, developmental milestones, sitting position (W-sitting)
- Activity level and what makes it better or worse
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.