09/24/2019 Pennsylvania Reporter Vol. 15
Podiatrist Fused Toe at Wrong Angle, Plaintiff Claimed (PA)
Case Summary: On March 31, 2014, plaintiff
Carletta Rochelle, a woman in her late 50s,
underwent surgery by defendant podiatrist. The
procedure was intended to remove a bunion on her
left first metatarsal, or big toe, and to treat
a stiff and painful joint, or hallux rigidus.
Plates and screws were implanted to correct the
bunion deformity and to fuse the first
metatarsophalangeal joint.
After the surgery, Rochelle developed an
infection at the site. On April 17, she was re-
admitted to the hospital and remained there a
few days for treatment. The wound was surgically
debrided, and she was given intravenous
antibiotics.
For the next three months, Rochelle suffered
infections causing pain and discomfort. During
this time, she had an open wound and remained
under the care of specialists in infectious
disease and wound care. According to Rochelle,
the hospital's infectious-diseases physician
recommended that the hardware be removed, but
defendant refused, determining that it had to
remain inplace to promote stability at the fused
joint.
On July 11, 2014, the surgical hardware was
removed. Rochelle came to believe that the
surgery had resulted in her toe being set at an
excessively elevated angle, which made it
difficult for her to walk. Rochelle sued
defendant and his practice, alleging negligence
amounting to medical malpractice. She also sued
defendant Hospital, which was dismissed, prior
to trial.
Counsel for Rochelle asserted that defendant
improperly performed the surgery because he
placed the first toe at an excessive post-
operative angle. Moreover, after the wound
became infected, he failed to promptly remove
the surgical hardware. Rochelle's expert in
podiatry testified that defendant had fused her
metatarsophalangeal joint at 30 degrees from a
supporting surface, otherwise known as the
ground. This was an excessive angle, which
caused her big toe to become permanently
elevated.
According to the expert, defendant should have
fused the joint between 15 and 18 degrees, and
no more than 20 degrees. The expert acknowledged
that some medical literature cites 30 degrees as
a potentially acceptable angle, but said that
each patient is different, and the range of
post-operative angulation must be based on each
patient's needs and anatomy.
Rochelle's expert further faulted defendant for
failing to immediately remove the surgical
hardware upon her infection. The expert
testified that x-rays taken between Rochelle's
April 17, 2014, hospitalization and the surgery
of July 11, showed signs of healing and joint
consolidation, so the hardware could have been
removed at the onset of the infection and
substituted with a splint or other device to
promote stability.
Defendant denied negligence in his treatment of
Rochelle. The defense's expert in podiatry
stated that the fusion of the
metatarsophalangeal joint at a 30-degree angle
was within a range considered acceptable in
medical literature, and adhered to the standard
of care. The expert determined that defendant
had appropriately performed the surgery. An
expert in infectious diseases opined that, while
it is ideal to immediately remove hardware if
there is an infection, it was appropriate for
defendant to have the hardware remain during the
weeks while the fusion healed.
Rochelle testified about her pain and
discomfort, and showed the jury the appearance
of her big toe. She relies on a cane and avoids
being on her feet for long periods. She sought
damages for past and future pain and suffering.
The defense counsel disputed that Rochelle was
as injured as she claimed and showed
surveillance footage of her walking without a
cane.
Result: The jury found that defendant was liable
and awarded Rochelle damages of $160,000.
Plaintiff Podiatric Expert: J. Christopher
Connor, DPM, Cherry Hill, NJ
Defendant’s Podiatric Expert: Steven Shannon,
DPM, Doylestown, PA
Source: Pennsylvania Reporter Vol. 15
