Rearfoot / Ankle · Reconstructive · Advanced
Failed Orthotics
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 right foot hurts, all the way down into the arch, and nothing has helped."
64-year-old female seen in the podiatry clinic and ready to discuss surgery.
History of present illness
Right foot pain radiating to the arch, 10/10 at its worst. It has not improved with custom or OTC orthotics, a Medrol dosepak, or a change of shoe gear. She has had enough of non-surgical care and wants to proceed with surgery.
- Pain centered over the medial ankle and medial arch (course of the posterior tibial tendon)
- Failed: orthoses, oral steroid taper, shoe-gear modification
- Gradual onset over many months, worse with standing and walking; no single traumatic event; no fever or constitutional symptoms
- Prior diagnosis of plantar fasciitis on the same side
Questions a strong candidate asks at this step
- Onset, duration and progression (gradual vs. acute 'pop' or twisting injury)
- Exact location: medial ankle / PT tendon course vs. plantar heel (fasciitis) vs. lateral sinus tarsi or subfibular impingement
- Aggravating/relieving factors: stairs, prolonged standing, ability to rise up on the toes
- Change in arch height, foot shape or shoe fit; 'too many toes' noticed by others
- Treatments tried: orthoses/brace, shoe change, NSAIDs, steroid, injections, PT, immobilization
- Pain score and functional limitation; goals and expectations of surgery
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.