Forefoot / Midfoot · Trauma · Core
Dropped Weight
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
"A heavy box fell on my foot and now I can't walk on it."
28-year-old male warehouse worker, seen in the ED.
History of present illness
Presents about 3 hours after a heavy box fell onto the top of his RIGHT forefoot at work. Immediate pain and swelling across the forefoot; he could not push off or bear weight and was helped to the ED.
- Direct blow to the dorsum of the foot from roughly waist height; no twisting or fall
- Pain 7/10, throbbing, worse with weight bearing and toe motion
- Swelling and bruising across the forefoot and 3rd toe
- No numbness or tingling, no open wounds, toes stay warm and pink
- No other injuries; no head strike
- Last meal 5 hours ago; tetanus status unsure
Questions a strong candidate asks at this step
- Mechanism: crush vs twist vs axial load, object weight, height, time since injury
- Pain: location, severity, character, what helps
- Able to bear weight immediately? Now?
- Numbness, tingling, coldness, pallor, pain out of proportion (6 Ps / early compartment syndrome)
- Any open wounds, bleeding or drainage?
- Other injuries (ankle, leg, back); head strike or LOC
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.