Forefoot / Midfoot · Diabetic Limb & Charcot · Infection & Wound · Advanced
Draining Wound
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 a wound on the bottom of my foot that's draining."
62-year-old female seen in the ED.
History of present illness
Draining wound on the bottom of the right foot under the 5th metatarsal head, present for about 1 week (she noticed drainage on her sock). It became painful 2 days ago.
- No known trauma; she cannot feel her feet well
- Drainage is yellow and foul-smelling; increasing redness and swelling around the forefoot
- No fevers, chills, nausea or vomiting
- Blood sugars running higher than usual this week
- No prior wounds at this site
Questions a strong candidate asks at this step
- How long the wound has been present and how it started (shoe, trauma, callus)
- Drainage: color, amount, odor; spreading redness, swelling, pain
- Constitutional symptoms — fever, chills, nausea, vomiting; glycemic control (hyperglycemia is often the first sign of infection)
- Prior ulcers, amputations, offloading, wound care
- Claudication or rest pain
- 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.