why interview at top program if not one of your top choices?

Ya, I've been curious how many people match outside of their top 2 or 3 on their rank list. If you interview at 10+ places, there is a higher chance of matching, but does anyone really match at their 9th, 10th, 11th choice? Maybe the number of interviews you're invited to and/or go on is just a better surrogate for how competitive you are.

For someone who didn't match last year, I have a little perspective.

You don't interview at 10+ place in hopes of matching at your 10th or higher spot. The goal is to interview at as many places as possible to hopefully find that "best fit" program where they will rank you high and you will rank them high. The more places you interview at the better you learn what that "best fit" means to you, and the more likely you will find a program that matches those criteria.

I did not apply and interview at enough places last year to do this. I only felt I was a good fit at few programs last year although I would have been happy at any of the programs I interviewed at. Of those 3-4, a couple are extremely competitive programs, while those other couple didn't think I was a god fit for them.

What gave you the indication that you wouldn't be ranked highly?

Post-match communication.

How did you make sure you let those programs know you would be a good fit now?

Anything specific? Or just lack thereof?

Not post-interview, but post-match communication.

This year I have openly communicated with my ortho mentors on which programs I've interviewed at that I really like. They have offered to make personal communications with those programs on my behalf to help my chances of matching at those programs. Hopefully it all works out in the end!