Rearfoot / Ankle · Trauma · Standard
Twisting Fall
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 hurt my leg and I can't stand on it."
Adult patient seen in the ED after a lower-leg injury with obvious deformity near the ankle.
History of present illness
Presents to the ED shortly after a high-energy twisting and axial-loading injury to the right lower leg. Immediate severe pain and swelling above the ankle, deformity, and inability to bear weight.
- Mechanism: fall/twist with axial load (exact height or force not specified)
- Pain 9/10, constant, worse with movement
- No open wound reported; no numbness or tingling
- No head, spine or other limb injury
- Last meal several hours ago; tetanus status unknown
Questions a strong candidate asks at this step
- Exact mechanism, energy of injury, time of injury
- Pain, ability to bear weight, deformity
- Open wound or bone exposure?
- Numbness, tingling, coldness - the 6 Ps; compartment symptoms
- Other injuries: head, spine, pelvis, other limbs
- Constitutional symptoms; 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.