Rearfoot / Ankle · Trauma · Advanced
Holiday Ladder
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 and ankle are killing me on the inside."
39-year-old male transferred to the ED from an outside facility after a fall from a ladder; trauma work-up already negative.
History of present illness
Was hanging holiday lights when his RIGHT foot caught in the ladder and he fell. Sharp dorsomedial foot and ankle pain since, unable to bear weight. Transferred from an outside hospital within 5 hours of injury and arrives in a posterior splint.
- Fall of roughly 6-8 feet with the foot trapped in the rungs, forced dorsiflexion and inversion
- No head strike or loss of consciousness; no neck, back, pelvic or knee pain; trauma work-up negative
- Pain 8/10, sharp, localized to the dorsomedial foot and ankle, worse with any movement
- No numbness, tingling or coldness; no open wounds
- Last meal several hours ago; tetanus status unknown
Questions a strong candidate asks at this step
- Time of injury and mechanism: height, foot trapped, dorsiflexion/inversion, axial load?
- Head strike / LOC; spine, pelvis, knee pain; was the trauma work-up completed?
- Pain: location, quality, severity, radiation, what helps
- Able to bear weight? What was done at the outside hospital (reduction, splint)?
- The 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
- Open wounds or skin tenting?
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.