Rearfoot / Ankle · Trauma · Infection & Wound · Advanced
Stairwell Fall
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 ankle — it's killing me."
26-year-old female who fell down the stairs, seen in the ED with severe, excruciating right ankle pain.
History of present illness
Fell down a flight of stairs about 1 hour ago, twisting the RIGHT ankle (foot planted and turned outward). Immediate severe pain, deformity and bleeding from a wound on the inside of the ankle. Unable to bear weight. Brought in by EMS with the leg splinted and the wound covered.
- Pain 10/10, constant, at the ankle
- No head strike or loss of consciousness; no other injuries
- Wound occurred on the stairwell (indoor, dirt and debris possible)
- No numbness or tingling in the foot
- No antibiotics given yet in the field
- Last meal 5 hours ago; tetanus status unknown
- No fever, chills, nausea, vomiting, chest pain or SOB
Questions a strong candidate asks at this step
- Time of injury (antibiotics within 1 hour of arrival; I&D timing)
- Mechanism and foot position — how did the foot twist? Height of fall?
- Head strike / LOC, other injuries (ATLS — trauma team clearance)
- Where and how did the wound occur — environment and contamination (barnyard, water, soil)?
- Neurovascular status: numbness, tingling, coldness; 6 Ps
- Pain level; able to bear weight?
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.