This case involves a forty-two-year-old female who suffered from synovitis of the foot. Subsequently, the patient 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 severe postoperative pain and swelling. Upon ambulation, she experienced significant hind foot pain and her gait was significantly altered compared to her status 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. A second opinion was sought and the recommendation by the surgeon was that the patient underwent an unnecessary calcaneal osteotomy which resulted in misalignment of the calcaneus bone and severe chronic pain.
Question(s) For Expert Witness
- 1. Was this procedure indicated given the effect on the patient's gait?
Expert Witness Response E-001037
A calcaneal osteotomy is not commonly required and the risks far outweigh the benefits in most cases of mild injury. The risks include infection, nonunion, over correction and under correction, neurovascular injury, and 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 most, repair of the ligament would be appropriate. In the majority of cases, a sprain will heal with conservative treatment and will not require surgery.