Rearfoot / Ankle · Sports Medicine · Medicine & Peri-op · Standard
Referred Calf
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 doctor thinks I tore my Achilles tendon."
45-year-old female referred to your resident clinic by her primary care physician.
History of present illness
Referred about 2 weeks after an episode of posterior RIGHT leg/heel symptoms that her PCP worked up as a possible Achilles rupture.
- Symptom began about 2 weeks ago during ordinary activity; she recalls a pulling sensation in the back of the lower leg rather than a clear "pop" or a direct blow
- Mild to moderate swelling and some bruising; she is not in severe pain and has been walking with a limp
- Was told to stay off the leg; PCP ordered an MRI before referral
- No prior Achilles pain, no fluoroquinolone or steroid injection history, no calf pain with swelling or warmth, no fever
- Has not yet had a detailed podiatric examination of the calf and tendon
Questions a strong candidate asks at this step
- Onset and mechanism: sudden push-off, stumble, direct blow, "pop" or feeling of being kicked in the back of the leg
- Pain level: the absence of significant pain does NOT exclude a rupture
- Ability to walk, climb stairs, rise onto the toes; swelling and bruising
- Prior Achilles tendinopathy or heel pain; fluoroquinolones, corticosteroid injections or oral steroids
- Calf pain, warmth, swelling (DVT must be on the differential); constitutional symptoms
- What has been done so far: immobilization, imaging, who examined the leg, NPO status if surgery has been discussed
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.