Forefoot / Midfoot · Infection & Wound · Medicine & Peri-op · Standard
Neglected Wound
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 hurts and I can't walk on it."
85-year-old female brought in from home with pain and inability to ambulate.
History of present illness
Open wound on the medial forefoot (great toe / first ray region) that began about 35 days ago and was left untreated.
- Progressive pain, redness, swelling and warmth; now unable to bear weight
- Blind oral antibiotics were started shortly before presentation (amoxicillin-clavulanate 1 g twice daily plus clindamycin 300 mg twice daily)
- No fever reported
- Mechanism of the original wound not recalled (history limited by dementia; history partly from caregiver)
Questions a strong candidate asks at this step
- Onset and mechanism of the wound (trauma, shoe pressure, puncture, ulcer)
- Duration (35 days), progression, drainage, odor
- Treatments to date: antibiotics (which, how long), dressings, any prior debridement
- Fever, chills, rigors, confusion change, nausea (SIRS/sepsis screen)
- Pain and ability to bear weight; prior ambulatory status
- Diabetes symptoms, prior wounds, claudication/rest pain (6 Ps of the limb)
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.