Forefoot / Midfoot · Arthritides & Derm · Reconstructive · Standard
Crooked Toes
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 toes are all crossed over and I can't find shoes that fit."
Middle-aged female seen in the podiatry clinic for a painful right forefoot deformity.
History of present illness
Progressive deformity of the right forefoot over many years with pain under the ball of the foot and over the bunion. Walking feels "like walking on pebbles."
- Gradual onset, no trauma
- Pain 7/10, worse with walking and in shoes; relieved with rest
- Has tried wide shoes, accommodative padding and custom inserts without relief
- Painful calluses under the metatarsal heads; no open wounds, drainage or fever
- Morning stiffness of the hands and feet lasting over an hour
Questions a strong candidate asks at this step
- Onset, duration and progression of the deformity
- Location of pain: bunion, lesser MPJs, plantar met heads, toes
- Morning stiffness and other joints involved (hands, wrists, knees, cervical spine)
- Shoe-gear problems, calluses, ulcers, drainage
- Treatments tried: shoes, padding, orthotics, injections, DMARDs
- Constitutional symptoms (fever, fatigue, weight loss)
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.