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Information provided before administration of steroid injection (12HDC00347)
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(12HDC00347, 20 June
Podiatrist ~ Steroid injection ~ Care ~ Informed consent ~
Administering injection ~ Documentation ~ Rights 4(1), 4(2), 6(1),
A woman underwent ankle fusion surgery on her left ankle, which
left her with a long-standing scar. She also sustained nerve damage
to the left side of her left foot, which had not caused her any
trouble. A few years later, the woman developed problems with her
right ankle, and subsequently consulted a podiatric surgeon. She
was diagnosed with peroneal tendonitis of the right foot. At this
consultation, the podiatrist injected the woman's right foot with
local anaesthetic and Kenacort, a corticosteroid.
At the next consultation orthotic therapy was initiated. The
podiatrist also recorded that there was a discussion about treating
the entrapment neuropathy in the woman's left ankle by steroid
The woman returned for a check of her orthotics, and the
podiatrist administered a Kenacort injection with local anaesthetic
to her left foot. She stated that the podiatrist did not inform her
of the risks of tissue breakdown associated with having the
Kenacort injection into her left ankle. Within one week of the
injection being administered, the old scar line on her left ankle
became inflamed, and she had heightened sensitivity and pain. She
was also experiencing problems with the orthotics dispensed by the
At her next consultation six weeks later she was reassured by
the podiatrist that her left foot looked good, that she should
expect pain in her left ankle, and that she did not require
antibiotics. He also advised that it was normal to have difficulty
wearing the orthotics, and she needed to get used to them.
Nine days later the woman consulted her GP who noted that she
had an open wound on the left ankle at the site of the injection,
along with a 6mm infected ulcer. Her GP cleaned and dressed the
wound, and prescribed a course of flucloxacillin.
Over the next four months, the woman had her wound cleaned and
dressed by the nurses at her medical centre. She was referred to a
plastic surgeon who advised her that the steroid injection had
caused her wound breakdown, and recommended surgical revision as
the best treatment option.
The woman underwent debridement and repair surgery to her left
ankle, performed by the plastic surgeon. Unfortunately, the
surgical wound broke down and she continued to require follow-up
care for her left ankle at her medical centre. The woman required
new orthotics, which were dispensed to her by another podiatrist.
She was also referred for surgery to repair the tendon and ligament
in her right foot.
It was held that the podiatrist failed in his duty to provide
the woman with information on the risks and complications
associated with a corticosteroid injection into her left foot.
Accordingly, it was found that the podiatrist breached Right 6(1)
by failing to provide the woman with information that a reasonable
consumer in her circumstances would expect to receive.
As the woman did not receive sufficient information, she was not
in a position to provide informed consent for the corticosteroid
injection to her left ankle. Accordingly, the podiatrist breached
The woman had a history of Type II diabetes and previous wound
breakdown. These factors placed her at increased risk of tissue
breakdown, and certain assessments should have been carried out and
precautions taken in relation to the steroid injection in her left
foot. In particular, the podiatrist should have considered the
option of an X-ray, and should have performed a lower limb
neuropathy and venous return assessment, carried out an early
review of her foot, and suggested prophylactic antibiotics
following the injection and ensured that antibiotics were
prescribed when the woman later complained of increased sensitivity
in her foot and tenderness at the injection site. By not carrying
out these assessments and taking these precautions, the podiatrist
failed to provide services with reasonable care and skill, and
breached Right 4(1).
The podiatrist's documentation lacked sufficient detail, and did
not provide an adequate clinical picture of the woman's medical
history and the treatment he provided to her. His substandard
clinical documentation was a breach of professional standards and,
accordingly breached Right 4(2).