Rearfoot / Ankle · Trauma · Standard
Fence Jump
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 heel is killing me. I jumped off a fence."
59-year-old male, seen as the on-call podiatry resident in the ED.
History of present illness
Presents to the ED a few hours after jumping from a fence about 6 feet high and landing on his right heel. Immediate severe heel pain; unable to bear weight.
- Landed on the heels, mostly the right; no twisting or inversion
- No head strike or loss of consciousness; no back, hip, pelvic or knee pain
- Pain 9/10, constant, non-radiating, worse with any weight bearing
- No numbness, tingling, coldness or color change; no open wounds
- Last meal 6 hours ago; tetanus status up to date
- No fever, chills, chest pain or shortness of breath
Questions a strong candidate asks at this step
- Time of injury and mechanism: height, landing position (heels?), twisting?
- Head strike / LOC? Back, pelvic, hip, knee pain? (axial load: lumbar spine and contralateral calcaneus)
- Pain: location, severity, radiation, what helps
- Able to bear weight immediately? Now?
- Numbness, tingling, coldness: the 6 Ps
- Open wounds? Spreading swelling or bruising?
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.