Forefoot / Midfoot · Trauma · Standard
Four Meters
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 fell off a roof and my left foot is killing me."
17-year-old male seen in the emergency department after a fall from height.
History of present illness
Fall from about 4 meters (roughly 13 feet), landing on his feet. Immediate severe midfoot pain and swelling of the left foot; unable to bear weight. Pain is 9/10, constant, worse with any movement.
- Foot was plantarflexed and twisted on landing (axial load through the forefoot)
- No loss of consciousness, no head, neck, back or other extremity pain; cleared by the trauma team
- Numbness/tingling: none; pain not escalating out of proportion on arrival
- Last oral intake several hours ago; tetanus status up to date
Questions a strong candidate asks at this step
- Mechanism: height of the fall, landing position, axial load on a plantarflexed foot
- Polytrauma screen: spine, calcaneus (bilateral heels), pelvis, head injury, other limbs — ATLS clearance
- Weight-bearing ability, pain trajectory (escalating pain = compartment syndrome)
- Numbness, tingling, color change (6 Ps)
- Open wounds or bleeding; tetanus status
- NPO status and time of last meal (possible OR)
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.