Forefoot / Midfoot · Infection & Wound · Diabetic Limb & Charcot · Advanced
Not Healing
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
"The sore on my big toe just keeps getting worse."
Middle-aged male seen in the podiatry clinic for a non-healing right great toe / 1st MPJ ulcer.
History of present illness
Has had an ulcer over the right 1st MPJ for the past 5 months after multiple surgical treatments for a prior bone infection of the first ray.
- He has been applying daily Betadine and a dry sterile dressing at home, but the wound has gotten larger
- Pain is 10/10; he takes Norco 5/325 mg daily
- Denies fever, chills, nausea, vomiting or purulent drainage
- Previous operations included debridement/resection of infected bone and internal fixation hardware that remains in the first ray
Questions a strong candidate asks at this step
- Onset and duration of the wound; what has been done to treat it so far (dressings, antibiotics, offloading)
- Prior treatment of the bone infection: how many operations, what was done, culture and pathology results, antibiotic course
- Pain: location, severity, character, medications used
- Drainage, odor, redness, swelling, progression
- Constitutional symptoms: fever, chills, nausea, vomiting, malaise
- Footwear, offloading and weight-bearing practices
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.