Response to scans
11. Mr O complains the Trust failed to properly respond to the results of the scans he underwent during his rehabilitation treatment. He believes they showed changes that required treatment, such as arthritis and bone fragments. He believes the Trust’s failure to properly manage these changes has caused him severe pain and difficulty in his daily management. The Trust say Mr O’ X-rays were normal and his other scan results did not suggest the need for intervention.
12. The records show Mr O underwent an X-ray on 27 May 2022, a CT thorax (middle section of the spine) on 22 June 2023, MRI of the lumbar spine (lower spine) on 23 June 2023, 22 September 2023, and 28 October 2023, as well as an MRI of the cervical spine (neck region of spine) on 23 June 2023.
13. The initial X-ray Mr O underwent on 27 May 2022 was reported as an avulsion fracture to the knee (when a bone fragment separates from the rest of the bone). However, this was promptly reviewed by a senior radiologist, who confirmed the diagnosis was calcific tendonitis (when calcium deposits build up in your tendons or muscles, causing pain).
14. Royal College of Radiologists (RCR) Standards for the Reporting and Interpretation of Imaging Investigations 2018 says that diagnostic errors, such as an initial misreporting, should be promptly reviewed by a senior radiologist or consultant. The records reflect the Trust followed this guideline since the initial X-ray was mistakenly reported as a fracture but promptly reviewed to confirm the correct diagnosis of calcific tendonitis.
15. Our adviser explains guidance from the Clinics in Shoulder and Elbow Journal is applicable to tendonitis in other areas of the body.
16. This states: ‘Patients with acute calcific tendonitis respond well to conservative treatment and rarely require surgery’ Therefore, the Trust should have been treating Mr O with a view to preventing his conditions from worsening and allowing his injuries to heal naturally. The records show the Trust managed Mr O conservatively, such as advising him not to mobilise and by providing anti-inflammatory medication. Our adviser explains this was appropriate.
17. Royal College of Radiologists (RCR) Standards for the Reporting and Interpretation of Imaging Investigations 2018 say ‘A radiology report should be actionable and prompt appropriate care for the patient’.
18. The information from all the scans was reported into Mr O’ records and shared with the treatment team, according to the notes from each scan. Our neurological rehabilitation adviser explains these scans did not show any significant changes that would have required medical intervention from the Trust.
19. There is nothing to suggest any further action should have been taken. This is in line with the RCR guideline. In addition, our adviser also stated there are no alternative treatments that would have resulted in a better outcome for Mr O.
20. Therefore, there is nothing to suggest the Trust should have acted on the scans or changed the treatment it was providing based on them. We completely appreciate how difficult it must be for Mr O to manage his long-term injuries and the several health problems he has suffered from since the incident. The records demonstrate the Trust managed the information obtained from the scans appropriately and communicated this information effectively with the appropriate departments. Our adviser has also explained there would have been no other course of treatment that would have led to a better outcome for Mr O. As such, we do not consider the Trust has failed in it’s provision of treatment to Mr O, in response to the scans he had.
Insoles
21. Mr O complains the Trust failed to provide him with insoles at the appropriate time, during his physiotherapy treatment between January and April 2022. He says it took around six weeks to provide him with anything. Mr O says he now suffers from flat-footedness as a result.
22. The Trust say throughout his time with the physiotherapy department, he was progressing with his ambulation (walking) and regularly stood using a standing frame. It says this would have happened without insoles initially as they need to be specifically tailored to each patient. It says it provided insoles to Mr O in April 2022.
23. The NICE Guideline for Rehabilitation after traumatic injury also applies to Mr O. It details ‘If needed, provide aids, splints or orthotics to maintain range of movement or protect the injury”, “Regularly review the use of splints consider an orthosis…’ ‘…Maintain joint range of motion … consider early use of splints and orthoses…’.
24. Mr O was transferred to the Spinal Injuries Centre (NSIC) at the Trust on 18 March 2022. On initial assessment by the physiotherapist on 19 March 2022 it is recorded that Mr O had a decreased range of motion. It is noted multiple times that Mr O’s ankle range of movement and power were affecting his walking. There are no records that describe any concerns with Mr O’s foot movements, ranges or positioning relating specifically to flat footedness.
25. Throughout Mr O’s stay at the NSIC he trialled at least five variations of Ankle Foot Orthosis (a splint to help correct the position of the foot and ankle) (AFO) for both his left and right ankles and feet. According to the records he had an off the shelf AFO on 5 April, a medium AFO 12 April, a UPFO (Universal Plantar Fasciitis Orthosis) on 28 April, a leaf sprung AFO (a slimline AFO that is characterised by a thin strut located at the rear of the leg) and a blue rocker AFO (designed to manage foot-drop) on 26 May 2022.
26. His orthotics were reviewed multiple times during his inpatient stay: on 5 April, 12 April, 13 April, 28 April, 29 April, 11 May, 26 May, 9 June, 14 June. Within six weeks of his transfer on 28 April 2024, he was seen by an orthotist who ordered bespoke insoles for both his left and right feet to aid with his ankle range during his walking.
27. There is no specific requirement in any guidelines for the amount or type of orthotic to provide. Our adviser explains the Trust provided a significant amount of aids, splints and orthotics to Mr O and reviewed these regularly. As such, the records demonstrate the Trust followed NICE NG211 guidance.
28. Regarding the timing of the Trust providing the insoles, GMC Good Medical Practice requires medical professionals to ‘promptly provide or arrange suitable advice, investigations or treatment where necessary’. There is no specific timeframe outlined in any guidance relating to the provision of insoles.
29. The records show that treatment was progressive and there is no indication in the documentation that insole requirement was urgent. Our adviser explains six weeks is a normal wait time for orthotics for the general public, when the care is not deemed as urgent. The records show that Mr O’s needs were reviewed and assessed at multiple occasions and our adviser explains the provision of orthotics and insoles were timely, appropriate and in line with good medical practice.
30. We completely appreciate Mr O believed the insoles should have been provided sooner than six weeks into his treatment. We understand this does seem like a long time. However, the records show there was no delay with the insole provision and the Trust carried out several reviews to ensure the insoles provided were appropriate. Our adviser says the provision of orthotics and insoles was in line with GMC Good Medical Practice. Therefore, we are satisfied the Trust appropriately managed provision of insoles for Mr O.
31. To conclude, we appreciate Mr O has experienced a very difficult time with his injuries. We can also appreciate he had to wait several weeks before receiving his insoles and that this must have been stressful for him, during a difficult period in his life. We are satisfied the Trust acted appropriately in response to his scans and regarding his insoles. Therefore, we are not upholding the complaint.