Rearfoot / Ankle · Diabetic Limb & Charcot · Reconstructive · Advanced
Post-Op Return
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
"The screw is coming out of my foot."
52-year-old female presenting to the emergency department with exposed hardware of the right foot.
History of present illness
Presents with dislodgement of a surgical screw through the skin of the right foot.
- Prior right Charcot reconstruction (medial, middle and lateral column fusion) some months earlier
- Course complicated by a wound infection requiring surgical debridement
- Worsening pain at the surgical site over recent weeks
- Denies nausea, vomiting, fever or chills
- No other pedal complaints
Questions a strong candidate asks at this step
- Onset and timing of the screw becoming exposed; any trauma or a fall
- Time since the Charcot reconstruction; weight-bearing status and compliance since surgery
- Details of the prior infection: organism, debridement, antibiotic course, any residual drainage
- Pain character and change; drainage, redness, swelling, warmth
- Constitutional symptoms: fever, chills, nausea, vomiting, malaise
- NPO status and last tetanus (anticipating surgery)
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.