Rearfoot / Ankle · Trauma · Medicine & Peri-op · Standard
Curb Misstep
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
"I twisted my ankle stepping off the curb and I can't stand on it."
35-year-old female seen in the ED after a fall.
History of present illness
Stepped off a curb about 1 hour ago and twisted her left ankle (foot rolled out and the leg turned in). Unable to bear weight and came straight to the ED.
- Pain 10/10 at the ankle, constant
- Rapid swelling; the ankle 'looks crooked'
- No head strike, LOC, or other injuries
- No numbness or tingling; no open wounds
- Last meal 3 hours ago; tetanus up to date
- Her boyfriend repeatedly asks which pain medication she will be prescribed at discharge
Questions a strong candidate asks at this step
- Mechanism — foot position and direction of force (Lauge-Hansen)
- Time of injury; able to bear weight?
- Other injuries, head strike, LOC
- 6 Ps; open wounds
- NPO status and tetanus
- Note concerning behaviour (drug-seeking companion) — screen safety and substance use
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.