Allegation

The patient’s estate alleged failure to timely diagnosis Charcot foot, inappropriate treatment with a CAM boot which led a permanent disability.

Case Details

A 39-YOF treated over 9 years for multiple podiatric conditions including plantar fasciitis, numerous stress fractures, heel pain, and ulcerations which was successfully treated with conservative measures. The patient had a history of lupus, DVT/PE, severe spinal stenosis, lumbar surgery, diabetes, fibromyalgia, neuropathy, and hypertension.

The patient sought care with the podiatrist with complaints of pain and swelling in her left foot. The patient complained of extreme discomfort at the talonavicular area as well as erythema. She denied a foot injury. The podiatrist obtained radiology images which was negative for fracture and the differential diagnosis was lupus.

The patient was placed in a CAM boot and the podiatrist recommended an MRI if the symptoms did not improve in 3 weeks.

The patient transferred her care to an orthopedic surgeon who diagnosed Charcot of the left foot. He treated the patient conservatively with left lower leg cast and instructed her to be non-weightbearing. Two months later the orthopedic surgeon noted the patients left Charcot foot had resolved with her left foot in plantigrade position and symptoms relieved with a CAM boot.

During the patient’s deposition, she testified that the insured instructed her to be “limited weightbearing,” which the insured denied. Unfortunately, the podiatrist did not document his instructions in the medical record.

In course of litigation, the patient developed pneumonia and sepsis which led to multi-system organ failure. The patient elected to receive hospice and passed away a brief time later.

Expert Testimony

The defense obtained expert reviews from two podiatric physicians and an orthopedic surgeon. All defense experts felt that the podiatrist treatment of the patient was within the standard of care, and that there was no evidence of delay in diagnosing or in treating the left foot Charcot.

Resolution

The jury delivered a verdict in favor of the podiatrist.

Risk Reduction Strategies

The following strategies can help enhance your practice.

• Listen attentively and discuss the treatment with the patient and their family. Allow time for patients to ask questions and consider their options.
• Document discussions with patients and the shared decision-making process in the medical record including the decision-making process and rationale for them.
• Provide the patient with detailed instructions and document the instructions given to the patient.
• Document all reassessments of the patient’s condition and your plan of care at each visit.

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