This case involves a 46-year-old female who suffered from synovitis of the foot and subsequently underwent surgical treatment due to several failed attempts to treat the condition with conservative medical management. The surgery was uneventful and proceeded without complication but the patient experienced some post-operative pain and swelling. At the point in which the patient tried to ambulate she experienced significant hind foot pain and her gait was altered compared to her state before the surgery. The surgeon noted in his reports that the patient displayed signs of a varus mal-alignment and that she may need an additional surgery to slide her heel back and close the wedge that had developed.
Question(s) For Expert Witness
1. Is it possible that the surgeon performed an unnecessary calcaneal osteotomy which resulted in misalignment of the calcaneus bone and severe chronic pain?
Expert Witness Response E-001282
A calcaneal osteotomy is not commonly required. The risks of a calcaneal osteotomy include infection, nonunion, over correction and under correction, neurovascular injury, metal breakage if metal is used. I really cannot imagine that a sprain would be a reason for a calcaneal osteotomy. A sprain is a ligament injury and at the most, repair of the ligament would be appropriate. In the majority of cases a sprain will heal with conservative treatment and never require surgery. As far as this particular case, the primary justification for calcaneal osteotomy would be malalignment such as hindfoot valgus (basically a severe flat foot) or less commonly hindfoot varus which is where the back part of the foot is turned in toward the other foot. Sometimes if there is an angular deformity after fracture it can require osteotomy to correct.
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