Rearfoot / Ankle · Trauma · Advanced
Missed Step
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 down my stairs and my ankle is killing me."
40-year-old male seen in the ED with diffuse ankle pain and swelling.
History of present illness
Fell down a flight of stairs at home about 3 hours ago, landing with the foot forced up into dorsiflexion. Immediate pain and swelling across the front of the ankle; unable to bear weight since.
- No head strike or loss of consciousness; no neck, back, hip or knee pain
- Pain 8/10, deep and constant, worse with any attempted motion
- No numbness, tingling or coldness of the foot
- No open wounds
- Last meal 5 hours ago; tetanus up to date
Questions a strong candidate asks at this step
- Primary survey first in any fall: Airway (with C-spine control), Breathing, Circulation, Disability, Exposure
- Mechanism: height, position of the foot at impact (forced dorsiflexion?), twisting
- Head strike / LOC, other injuries (spine, hip, knee)
- Weight-bearing ability immediately and now
- 6 Ps — pain out of proportion, pallor, pulselessness, paresthesia, paralysis, poikilothermia
- Open wounds; NPO status (6–8 h for surgery); 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.