Medico-legal issues in the foot and ankle specialty

Like all subspecialty areas within orthopaedic surgery, foot and ankle work carries risks, complications and the potential for litigation. Certain areas of this work have been highlighted for this article to aid the surgeon in appropriately counselling the patient, and improving understanding of major risk areas and knowledge of the outcomes of injury and surgery. Historically, information on litigation claims has been difficult to acquire because it involves obtaining information from a number of different bodies. There is no mechanism for compulsory reporting of complications, coding accuracy is usually found wanting, and most claims are either dismissed or settled without going to court. However, in 2014, Ring1 provided an analysis of 1214 National Health Service Litigation Authority (NHSLA) claims in England, involving foot and ankle surgery, over 17 years. These represented 12.6% of orthopaedic claims. Thirty-four per cent of claims involved the ankle, with 73% resulting from trauma. Twenty-one per cent involved the first ray, of which 98% involved elective surgery. Nineteen per cent of claims involved diagnostic errors, 19% were for alleged incompetent surgery, and a further 13% for mismanagement. The authors recognised that reducing incorrect, delayed and missed diagnoses was a key area for improvement. #### Medico-legal implications: Nerve injury is a common foot and ankle surgical complication, with the most frequent causes being inadvertent laceration, entrapment under metalwork, contusion/soft-tissue swelling and accidental injury from suture needle placement. This may result in diminished sensation, painful neuroma formation, adverse effects on mobility and problems with footwear. The sural, superficial peroneal, deep peroneal, saphenous and tibial nerves can all be injured. Bai2 reported a …