Forefoot / Midfoot · Diabetic Limb & Charcot · Reconstructive · Standard
Stubborn Blister
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 got a blister on the bottom of my foot at the beach and it turned into a sore that won't close."
41-year-old female with diabetes seen in the wound clinic.
History of present illness
Known history of chronic ulcers under the left 2nd metatarsal head. While at the beach she developed a blister on the plantar left forefoot that progressed to an open wound. It is not painful. She denies signs of infection.
- Currently receiving IV meropenem once daily through a PICC line
- Dressing the wound daily with Dakin's solution, 4x4 gauze, Kerlix and an ACE wrap
- Denies nausea, vomiting, fever, chills, shortness of breath
- No other wounds
Questions a strong candidate asks at this step
- Onset and mechanism: barefoot walking, blister, footwear
- Duration of ulcer, prior ulcers and their treatment
- Pain (absent pain = neuropathy)
- Signs of infection: drainage, odor, redness, swelling, fever, chills, nausea, vomiting
- Current treatment: antibiotics (route, duration, why), dressings, offloading device, adherence
- Prior cultures, imaging, or osteomyelitis
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.