Rearfoot / Ankle · Reconstructive · Advanced
Failed Insoles
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 left foot hurts, and the bunion and the arch are getting worse."
54-year-old female seen in the podiatry clinic with a painful left foot that has not improved with conservative treatment.
History of present illness
Progressive left foot pain centered on the medial arch and the bunion, with some lateral hindfoot aching.
- Gradual onset over several years; arch has been flattening and the heel turning outward
- Pain with standing and walking, better with rest; now limits walking and shoe wear
- Failed conservative care: custom foot orthoses, supportive shoes, a bracing trial, NSAIDs, physical therapy and an injection
- No acute injury or "pop"; no open wounds, fever or constitutional symptoms
Questions a strong candidate asks at this step
- Onset, duration, progression; acute "pop" or injury vs gradual collapse
- Location: medial arch / posterior tibial tendon, bunion, lateral sinus tarsi (impingement)
- Aggravating and relieving factors; walking tolerance; stairs; trouble with single heel rise
- Conservative care tried and for how long: orthoses, shoes, brace (UCBL, AFO, Arizona), NSAIDs, PT, injections
- Change in arch height, shoe size or shoe wear; prior ankle sprains
- Numbness/tingling, swelling, wounds; fever, chills (rule out infection)
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.