Allegation
The patient alleged that the podiatrist injured her Achilles tendon during an endoscopic gastrocnemius recession, plantar fasciotomy, and Topaz treatment.
Case Details
A 66 YOM (6’5” 350 lb.) was seen for a 30-year history of bilateral heal pain. He had a past medical history of hypertension, cardiovascular issues, sciatica, obstructive sleep apnea, depression, and diabetes.
The podiatrist diagnosed him with plantar fasciitis/bursitis and ankle equinus. He was managed by conservative treatment consisting of anti-inflammatory medications, orthotics, physical therapy, and a steroid injection was initiated. The patient failed to respond to three months of conservative treatment and the podiatrist discussed surgical options with the patient. The patient agreed and an endoscopic gastrocnemius recession, plantar fasciotomy, and Topaz treatment of the plantar fascia were performed a month later.
At six weeks post-op, the patient reported moderate pain with activity. The podiatrist referred the patient for physical therapy.
At four months post-op, the patient reported he was doing well and had minimal discomfort which he described as tightness to the gastrocnemius muscle. The patient stated he had been going to physical therapy with good overall improvement. However, he admitted he did not go as often as prescribed.
The podiatrist instructed the patient to return in two months after additional physical therapy.
At his next appointment, the patient complained of pain and reported he could not walk a long distance. The podiatrist noted palpation of the Achilles tendon region was pain-free, but there was a palpable dell and lack of tension along the tendon. The patient was instructed to continue with physical therapy and orthotics. The patient returned five weeks later and reported it was difficult to push off with his toes. The podiatrist diagnosed Achilles weakness and a rupture of the gastrocnemius.
An MRI was performed which demonstrated a partial rupture of the gastrocnemius without signs of Achilles rupture. The podiatrist recommended the patient obtain a second opinion.
The patient sought care from an orthopedic surgeon who noted the patient had a lack of propulsion in gait and pain with palpation at the midportion of his Achilles and recommended an Achilles repair. The orthopedic surgeons post-op note did not reflect that the tendon appeared to be cut. However, at a post-op appointment three months later, he noted that the patient had an iatrogenic tear of the Achilles at the insertion of the musculotendinous junction with subsequent degeneration of the Achilles tendon.
Expert Testimony
Strong expert testimony from podiatric and radiology supported the care that was given to the patient. The defense’s podiatry expert supported the podiatrist’s care but believed the documentation could have provided better evidence of the surgery. For example, the operative report did not include the exact location of the incision of the resection site.
The radiologist expert for the defense reviewed all radiographic studies and determined that the patient had a degenerative process rather than an iatrogenic injury of the tendon. The medical records of both the podiatrist and physical therapist indicated the patient was progressing well, with no indication that the Achilles was injured. It was noted the podiatrist had failed to electronically sign the encounter notes for several months after the patient’s visit.
Resolution
The jury delivered a verdict for the defense.
Risk Reduction Strategies
The following strategies can help enhance your practice and help mitigate litigation risks.
- Document a complete and thorough operative report including the specific level/location of the surgery performed.
- Punctually address any changes or unexpected events and document your rationale for treatment decisions.
- Promptly authenticate medical record entries. Delayed authentication opens the physician up to allegations of medical record alteration.
For more information see https://picagroup.com/
