Rearfoot / Ankle · Trauma · Standard
Heel Caught
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 last night and now it hurts and is swollen."
33-year-old female seen in the emergency department.
History of present illness
Pain and swelling of the right ankle that began the evening before presentation, when her high-heeled shoe caught in a street drainage grate and her foot twisted under her.
- Mechanism: plantarflexion with inversion of the foot
- Immediate anterolateral ankle and hindfoot pain, then swelling and bruising
- Able to hobble but painful to bear weight
- Pain is worse over the lateral midfoot/sinus tarsi region than over the lateral malleolus
- No open wound, no numbness or tingling, foot stayed warm and pink
- Ice, elevation and OTC ibuprofen at home with partial relief
- Tetanus up to date; last oral intake several hours ago (NPO status matters if operative)
Questions a strong candidate asks at this step
- Mechanism: twisting, inversion/plantarflexion, axial load, height of fall
- Onset, timing, location, severity (0-10), weight-bearing ability
- Pop or snap; immediate swelling or deformity
- Prior ankle sprains or instability
- Numbness, tingling, color change, open wound (6 Ps)
- Treatments tried; tetanus; NPO status
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.