Rearfoot / Ankle · Trauma · Advanced
Car Crash
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 heels hurt and my feet are swollen."
38-year-old man seen in the ED with bilateral heel pain the day after a motor vehicle accident.
History of present illness
Was in a car accident yesterday and woke up this morning with swollen feet and ankles and bilateral heel pain.
- Mechanism: motor vehicle collision with axial load through both heels
- Pain is bilateral, 8/10, worse with weight bearing, unable to bear weight
- No open wounds; no numbness or tingling
- No head strike, neck, back, chest or abdominal pain reported after trauma screening
- Last meal several hours ago; tetanus status unknown
Questions a strong candidate asks at this step
- Mechanism: speed, restraint, footwell intrusion, airbag, ejection, other injured occupants (axial load)
- Head strike / LOC; neck, back (L1), pelvic, hip, knee pain; chest or abdominal pain
- Pain: location, severity, character, radiation, aggravating factors
- Weight bearing since the accident?
- Numbness, tingling, coldness – the 6 Ps
- Open wounds, blisters, spreading bruising or tense swelling
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.