Forefoot / Midfoot · Diabetic Limb & Charcot · Infection & Wound · Advanced
Hot 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
"I have sores on both of my feet."
53-year-old male with diabetes seen in the emergency department observation unit for bilateral foot ulcers.
History of present illness
Bilateral plantar foot ulcers; the left foot is worse and has become draining and foul-smelling over the last several days.
- Ulcers noticed days to weeks ago; he cannot feel his feet and cannot say how they began
- Left forefoot is increasingly swollen, red and malodorous, with purulent drainage
- Feels unwell, feverish and weak; poor oral intake; home glucose readings have run high
- Prior partial amputations on both feet (see PSH); no recent trauma he recalls
- Tetanus status unknown
- Last meal and last drink: to be confirmed for possible emergency surgery (NPO)
Questions a strong candidate asks at this step
- Onset, duration, how the ulcers started (shoe, callus, trauma) and which came first
- Drainage, odor, spreading redness, swelling, pain (often absent in neuropathy)
- Constitutional symptoms: fever, chills, rigors, nausea, vomiting, confusion, hyperglycemia
- Prior ulcers, prior osteomyelitis, antibiotics, offloading and wound care
- Claudication, rest pain, prior vascular studies or revascularization
- 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.