Rearfoot / Ankle · Reconstructive · Advanced
Aching Arches
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
"Both my feet and ankles hurt, especially on the inside."
51-year-old African American female seen in the podiatry clinic.
History of present illness
Bilateral foot and ankle pain, mostly at the medial arch and medial ankle, left worse than right. Pain is intense.
- Onset, duration, course, aggravating/relieving factors and prior treatment were unknown/not obtained in the source
- For this case: gradual onset over ~2 years, worse with standing and walking, partial relief with rest; has tried OTC arch supports
- Recently also aching at the lateral hindfoot (sinus tarsi)
Questions a strong candidate asks at this step
- Onset, duration, progression (gradual vs acute 'pop')
- Location: medial (PT tendon) vs lateral (sinus tarsi / calcaneofibular impingement)
- Aggravating/relieving factors, difficulty with stairs or single-leg heel rise
- Treatments tried: orthoses, bracing, PT, injections
- Change in arch height or shoe wear
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.