Forefoot / Midfoot · Trauma · Infection & Wound · Standard
Yard Work
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
"My foot got caught in the lawn mower."
27-year-old male brought to the emergency department; podiatry consulted by the ED physician.
History of present illness
27-year-old male presents with a right lower extremity injury sustained about 4 hours ago while mowing the lawn.
- Foot struck by the mower blade; the 2nd toe was traumatically amputated and the hallux lacerated
- Bleeding controlled with direct pressure
- Immediate forefoot pain; able to move the remaining toes
- Amputated part not recovered (crushed and contaminated, not salvageable)
- Wound contaminated with grass and soil
- Last oral intake more than 6 hours ago (NPO status clarified for the OR)
- Tetanus: last booster approximately 8 years ago
- No head injury, no loss of consciousness, no other injuries
- No fever, chills or other constitutional symptoms
Questions a strong candidate asks at this step
- Time since injury (4 hours: within the 6-hour window for debridement)
- Mechanism: type of mower, blade, riding vs push, speed (high energy)
- Contamination: grass, soil, manure, standing water, farm setting
- Amputated part: recovered? (toe replantation is rarely indicated)
- Tetanus immunization status and date of last booster
- NPO status, current medications, allergies
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.