Rearfoot / Ankle · Infection & Wound · Medicine & Peri-op · Standard
Paged to ED
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 is rotting and the pain is getting worse."
66-year-old male brought to the ED with a large, foul-smelling wound of the right foot and rapidly worsening pain.
History of present illness
Large right foot wound with foul-smelling discharge and intense, progressively worsening pain, with swelling and discoloration of the dorsal foot and ankle. No history of trauma. A heel pressure ulcer (decubitus) has been present on the right for about 3 months. He has been taking NSAIDs for the pain.
Questions a strong candidate asks at this step
- Onset and speed of progression (hours to days = fulminant)
- Mechanism: trauma, puncture, injection into the leg or foot, insect or marine exposure
- Pain character: out of proportion to the exam? Subsequent numbness?
- Drainage, odor, color; fever, chills, rigors, confusion
- Prior care of the heel ulcer; prior antibiotics or debridement
- Last oral intake (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.