Podiatrist Fails To Diagnose Postoperative Bone Infection

This case involves a young professional athlete who developed a bony projection on his ankle. The treating podiatrist attempted to remove the projection through minimally invasive arthroscopic surgery. During the surgery, however, the treating podiatrist created tarsal tunnel syndrome in the patient’s ankle. In the weeks following the surgery, the individual experienced extreme foot and ankle pain, as well as chills and night sweats. The treating podiatrist assured him there was no cause for concern. The athlete eventually returned to the podiatrist with painful foot ulcers and was diagnosed with osteomyelitis. The athlete required several procedures to correct the osteomyelitis but was unable to continue playing football. It was alleged that the delay in diagnosing postoperative infection caused the patient to develop debilitating osteomyelitis.

Question(s) For Expert Witness

1. How frequently do you excise bony ankle projections?

2. What steps should be taken to avoid the development of tarsal tunnel syndrome?

Expert Witness Response E-250771

I am a board-certified foot and ankle surgeon and I'm one of the few podiatric surgeons in the country to have completed an orthopedic foot and ankle surgery fellowship in addition to my 3 years of podiatric surgical residency training. I excise ankle osteophytes (bony projections) arthroscopically on a regular basis, usually 2-3 cases per week. Tarsal tunnel syndrome of the anterior ankle is essentially a nerve injury to the front of the ankle which is very common and an expected complication from ankle arthroscopy. I have reviewed a number of similar cases involving nerve damage after an ankle arthroscopy. This is a common and expected finding after surgery and something that I warn patients about on a regular basis. The osteomyelitis component of the case would be noted as a much less common complication from arthroscopic ankle surgery. Infection risks are generally lower with arthroscopy due to the nature of the small portals where the work is done, but infection is not out of the question and again is a common risk associated with any foot/ankle surgical intervention including arthroscopy. It would be important to look at the patient/doctor records to have a full understanding of the situation and render a more educated and complete report on the standard of care.