Clinical negligence claim for failed Akin osteotomy

In another case of admitted clinical negligence, my client (age 22) faces the prospect of further surgery and not being able to join the police. She was supposed to undergo routine surgery but that, the Trust admits, was not done to an appropriate standard. The result has been a truly torrid time for my client who had three further surgeries and can expect another, which will likely leave her with an increasing level of disability.

Aged 5 my client had been referred to a podiatrist for care of bilateral curly fourth and fifth toes. Orthotics therapy and splinting of the toes were instituted but ineffective so her GP referred her for orthopaedic opinion. Aged 17 my client’s treating surgeon diagnosed hallux valgus interphalangeus bilaterally and recommended rotational osteotomies to correct the deformity. The following year my client underwent bilateral Akin osteotomies.

An Akin osteotomy is a type of corrective surgical procedure where the bone of the great toe is manipulated in order to correct the deformity and a fix, screws in this case, are inserted in order to achieve greater alignment.

In the course of my client’s operation, a screw that was too short was inserted into the right great toe, but without adverse consequences. However, in carrying out the cuts to the left great toe, the cartilage to the proximal phalanx of the first metatarsophalangeal joint was breached, thereby giving rise to complication and subsequent degenerative change in the joint.

Unfortunately for my client, she developed a non-union on the left side. This is a known complication. For my client it meant a re-do had to be undertaken about 4 months after her initial procedure. Within 6 months her surgeon confirmed the osteotomy had united.

However, her problems including persistent pain continued and it was decided that she should undergo screw removal. That was done 6 months later but with no successful outcome. A matter in dispute between the parties is why only one and not both of the screws was removed at this time. One explanation is that the hospital realised part way through the procedure that the equipment to remove the second screw was unavailable. The Trust says there might be several reasons as to why only one screw could be removed. This however is contrary to the clear indication given to my client beforehand that both screws would come out.

A month later my client was still reporting problems with her left foot. Within the following 3 months the decision was taken to perform a minimally invasive cheilectomy (a type of bone shaving procedure) to help relieve crepitus and the associated pain. The problems persisted. The eventual outcome saw my client diagnosed with an arthritic joint (something a cheilectomy could never resolve).

It is understood that the arthritic changes now seen are consequent upon the cartilage breach at the joint, suffered at the time of the initial surgery. Given her young age, a fusion or joint replacement is not considered a solution at this stage and my client is now left to get on as best she can. When the pain becomes intolerable, one of the above-mentioned surgical interventions might help but there will be ongoing problems regardless of which she chooses.

Had the initial procedure been undertaken to an appropriate standard, my client could have enjoyed an uneventful recovery and with none of the symptoms from which she now suffers. My client had intended to pursue a career as a police officer. Left unable to run, the mandatory fitness tests are not now a possibility for her and she is left to re-consider her options.

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