Ongoing problems caused by heel injury and not by treatment at Trusts

What happened

Mrs M fell down some stairs in summer 2011. She was away from home at the time and was taken by ambulance to Leicester Royal Infirmary (the Leicester Trust). A doctor from trauma and orthopaedics saw her and diagnosed a broken heel. Staff told Mrs M that she would need to stay in Leicester for initial treatment, but her treatment would then be with her local hospital in Lincoln, which was part of the Lincolnshire Trust.

The immediate priority for treatment was to reduce the swelling. Clinicians expected this to take two to three days. Mrs M said she was told the swelling would be reduced by keeping her foot elevated and placing it in an iceboot, a boot filled with ice water. She was told she would have a cast on for around six to eight weeks and then she would be allowed to walk on her foot.

Mrs M expressed concern that Leicester Trust staff did not give her an iceboot and she also had to ask for a pillow to keep her foot elevated. On the fifth day of her admission, staff put her foot in a cast and discharged her.

Following discharge, Mrs M said, she said she could feel her foot 'hitting the cast' and she had severe pain. She phoned an NHS helpline and was advised to go to a hospital.

Soon after, Mrs M went to Lincoln County Hospital, part of the Lincolnshire Trust, where staff removed her cast in A&E. They asked her to go back the next week, when she was admitted to the Lincolnshire Trust.

Mrs M again felt she did not receive appropriate treatment as there was no elevation for her foot and she felt the ice pack available to her was too small. She also said she fell during the night on the ward whilst trying to transfer herself from the wheelchair to the toilet. She saw a doctor the next day and was discharged later the same day.

Following her discharge from the Lincolnshire Trust's outpatient department in early autumn 2011, Mrs M said she was referred for many appointments by her GP for scans and further treatments. She was left with pain, mobility and other long–term health problems. She said that because she has had to walk with her weight on her right foot, she has lost muscle in her left leg, has problems with both knees and has suffered spinal problems. She is now having a special boot fitted to try to keep her foot straight to improve her mobility. She felt that this could have been avoided had she been properly cared for by both Trusts.

Mrs M complained to both Trusts during 2012 and 2013. Although the Trusts offered apologies for some aspects of her care, they offered no acknowledgement that the problems she continued to experience were related to the way the Trusts had treated her shortly after the injury. As she was unhappy with the final responses, Mrs M brought her concerns to us.

What we found

We did not uphold this complaint. Although the Leicestershire Trust apologised that at the time of her admission there was no ice available for her, there were insufficient frames to help her walk and that the person applying the plaster cast was working alone, our review of the clinical records shows that the Trust followed established good practice in treating Mrs M and that there were no serious failings in her care.

The treatment given to Mrs M by the Lincolnshire Trust was also in line with established good practice and there were no failings.

The choice of conservative (that is, non-surgical) treatment for Mrs M was designed to relieve pain, reduce swelling, make sure the fracture healed with the heel properly aligned and safely mobilise and rehabilitate Mrs M. Whilst the availability of ice or equipment may help reduce swelling, it is not essential and does not affect the long-term outcome.

Mrs M has unfortunately continued to suffer severe pain. Her joint pain and chronic regional pain syndrome are both a consequence of the injury, not her treatment. Her treatment was in line with established good practice and her experience, although very unfortunate, is a consequence of this type of injury and is not an outcome of her treatment by either Trust.