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PART 1Client’s Initial Injury

1/24/05Xray showing broken 4th and 5th toes

1/24/05• Illustration

1/27/05Foot is casted after fracture

02/08/054 weeks post fracture foot is immobilized with CAM walker to promote healing

03/02/058 weeks post fracture CAM walker continued, fracture still well defined

1/27/05Foot is casted after fracture

04/25/0514 weeks after accidentRadiologic exam revealsbone callus formationand progressive trabeculation across the fracture site consistentwith normal bone healing.

03/28/0510 weeks after accidentRadiologic exam reveals evidence of bone callust formation and trabeculation across the fracture site consistent with delayed union.

04/25/0514 weeks after accidentRadiologic exam revealsbone callus formationand progressive trabeculation across the fracture site consistentwith normal bone healing.

07/05/05MRI report was read and noted in chart. “No significant osseous or tendonous pathology noted pain and swelling mostly soft tissue with fracture 5th toe healing.

6/29/05232 individual MRI images of right foot were obtained.

10/06/05 Radiologic exam reveals normal bone healing. Dr. discusses conservative treatments and possible surgery.

PART 2Client’s Secondary Injuries

11/22/05 Consult with Dr.Client was told he needed surgery on 1st, 4th , and 5th toes.

02/16/06Surgery: 1st, 4th, 5th toes

BIG TOE (1st):Incision was made over the 1st joint.Bone was drilled at the center to open a space for the implant. See post op x-ray. LITTLE TOE (5th): Incision made over 5th joint revealed healing fracture. Bone was cut away from the head of the metatarsal and the base of the phalanx. A Silastic implant was installed.

4TH TOE: Incision over capsule and periosteum revealed “4th metatarsal head has healthy good cartilage” that demonstrated “gliding motion” and had “good range of motion”

BIG TOE (1st):Incision was made over the 1st joint.Bone was drilled at the center to open a space for the implant. See post op x-ray. LITTLE TOE (5th): Incision made over 5th joint revealed healing fracture. Bone was cut away from the head of the metatarsal and the base of the phalanx. A Silastic implant was installed.

BIG TOE (1st):Incision was made over the 1st joint.Bone was drilled at the center to open a space for the implant. See post op xray. LITTLE TOE (5th): Incision made over 5th joint revealed healing fracture. Bone was cut away from the head of the metatarsal and the base of the phalanx. A Silastic implant was installed.

04/10/06SURGERY HAS FAILED

In his 4/10/06 office visit with Dr., Client is told the surgery will need to be revised and that he has a new problem that will require surgery.

detail from office note

05/26/06Xray demonstratesdeformities causedby joint implant andother complications

Hammertoeis exacerbated

Implant is too large.

Hammertoe

Infection atnail boarder

05/26/06Xray demonstratesdeformities causedby joint implant andother complications

Hammertoeis exacerbated

Implant is too large.

Hammertoe

Infection atnail boarder

07/24/06 2nd SurgeryRight 5th joint opened, the failed implant is removed, more bone is cut away and a smaller implant is installed

07/24/06 2nd SurgeryRight 1st joint re-opened , bone spurs were cut from the metatarsal head

07/24/06 2nd SurgeryAn infection at the nail boarder was cut down to the matrix

06/07/07SECOND SURGERY HAS FAILED

Client has new complaints at this follow up visit with Dr.:Pain at inner ankleCannot bend first toeCannot bear weight on 5th toe

06/13/07 MRINew Findings:Partial tendon teartenosynovitis around 1st toe

06/29/073rd SurgeryHemi implant is removed. More bone is cut away and a total joint implant was cemented into place.

06/29/07 3rd SurgeryBoth scar tissue and a neuroma was removed from around the nerve at the 5th toe

08/21/07THIRD SURGERY HAS FAILED

Client has new complaints at his follow up visit with Dr.:Increased pain over 1st jointAllergic reaction to implant with Staph infection

office notedetail from

04/02/08MRINew tendonopathies in Client’sright ankle are diagnosed.

05/02/08 4th SurgeryLITTLE TOE (5TH).Boney overgrowth was cut away fromaround the implant.

BIG TOE (1st):Total implant was removed from thefirst toe. The joint was fused with bone chips and cement. It was fixatedexternally with rods and bone screwsinserted through the skin. ANKLE:An athroereisis was installed through incision at sinus tarsi. This bone screwwas used to immobilize part of the ankle joint.

(continued)

05/02/08 4th SurgeryINNER ANKLE:Skin was incised and a tendongraft was installed to preventradiating pain at arch

Before

Silacone ImplantImplant removalSilacone ImplantImplant removalRemoval of condyleRemoval of neuroma

Hemi implantHemi implant removalTotal joint implantRemoval of ostephytesTotal joint removalFusion

Arthroereisis implant subtalar joint