Forefoot / Midfoot · Diabetic Limb & Charcot · Infection & Wound · Standard
Old Amputation
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 have a sore on the end of my foot that won't close."
67-year-old male seen in clinic with his daughter, 5 years after a right transmetatarsal amputation (TMA).
History of present illness
Right TMA performed about 5 years ago healed uneventfully. Over the past 7–9 months he has had a wound at the distal end of the stump. He and his daughter have been doing local care with topical creams and dressings without any decrease in size. They are here asking about options for wound closure.
- Light clear (serous) drainage; no odor
- No redness around the ulcer or streaking up the leg
- Denies nausea, vomiting, fever or chills in the past month
- Diabetic who does NOT check his blood sugars — his brother (not medically trained) told him alcohol helps diabetes and lowers glucose
- No known trauma; walks in regular shoes with a toe filler
Questions a strong candidate asks at this step
- Onset, duration and how the wound started (trauma, shoe, blister?)
- What has been tried: topicals, dressings, offloading, prior debridement, antibiotics
- Drainage (amount, color), odor, spreading redness, red streaks
- Constitutional symptoms: fever, chills, nausea, vomiting (N/V/F/C)
- Original reason for the TMA and how it healed
- Glucose monitoring and recent A1c; footwear and activity on the stump
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.