Forefoot / Midfoot · Infection & Wound · Diabetic Limb & Charcot · Standard
Red Foot
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 foot is red and swollen, and it keeps getting worse."
64-year-old male presenting to the emergency department.
History of present illness
Redness and swelling of the LEFT instep (midfoot) that began 4 days before the first ED visit.
- First ED visit: diagnosed with erysipelas/cellulitis plus tinea pedis; discharged on an anti-staphylococcal penicillin
- Two days later returned with erythema spreading toward the lower leg; changed to amoxicillin-clavulanate
- Five days after that returned again with ulcers at multiple areas of the foot and was admitted
- Admitted on linezolid with no improvement after 48 hours
- No known trauma or puncture; fevers and malaise over the past week
- Last meal 6 hours ago; tetanus status unknown
Questions a strong candidate asks at this step
- Onset, mechanism (trauma, puncture, shoe rub, tinea fissuring), progression
- Spread up the leg, drainage, odor, ulcers, blistering, dusky skin
- Fever, chills, rigors, nausea, malaise (systemic toxicity)
- Antibiotics already taken: which, how long, adherence
- Pain out of proportion or crepitus (necrotizing infection)
- Last meal (NPO status) and tetanus 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.