Rearfoot / Ankle · Trauma · Standard
Ladder Fall
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 fell off a ladder."
60-year-old African American male, professional house painter, seen in the ED.
History of present illness
Presents to the ED 2 hours after slipping off his ladder while painting a house. On standing he had immediate pain in the LEFT heel and could not bear weight. His partner drove him in.
- Landed on both heels from roughly one story; no twisting
- No head strike or loss of consciousness; no back, pelvic or knee pain
- Pain 8/10, constant, non-radiating, worse with any weight bearing
- No numbness or tingling; no open wounds
- Last meal 4 hours ago; tetanus status unknown
Questions a strong candidate asks at this step
- Exact time of injury and mechanism: height of fall, landed on heels, twisting?
- Head strike / LOC? Back, pelvic, hip or knee pain? (axial load → spine fx)
- Pain: location, severity, radiation, what helps
- Able to bear weight immediately? Now?
- Numbness, tingling, coldness — the 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia)
- Any open wounds? Swelling and bruising spreading?
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.