Rearfoot / Ankle · Sports Medicine · Reconstructive · Standard
Clicking Ankle
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 left ankle hurts deep inside and it clicks."
43-year-old woman seen in the outpatient podiatric clinic.
History of present illness
Several years of deep, throbbing left ankle pain with intermittent clicking, which began after an ankle sprain years ago that was never fully rehabilitated.
- Pain is deep within the joint, throbbing, worse with weight bearing, running or stairs and relieved by rest
- Clicking and occasional catching, no true locking or frank giving way
- Partial relief with NSAIDs, bracing and activity modification
- No fever, chills or redness; no numbness or tingling
- No recent trauma
Questions a strong candidate asks at this step
- Onset and mechanism: the original sprain, how it was treated, any recurrent sprains
- Character of pain: deep, throbbing, location (anterior, medial, lateral), night pain
- Mechanical symptoms: clicking, catching, locking, swelling, instability / giving way
- Aggravating and relieving factors; walking tolerance
- Prior treatment: immobilization, bracing, PT, NSAIDs, injections
- Constitutional symptoms and the 6 Ps
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.