She currently complains of intermittent pain in the lateral aspect of the right ankle, which is aggravated by prolonged standing or walking, as well as carrying heavy weights, as she recently experienced when she moved house.
Examination of the right ankle revealed a 10 cm well-healed surgical scar over the distal fibula and lateral malleolus, with mild tenderness, but no indication of neuroma formation. Lower limb reflexes were normal, with variable non-dermatomal sensory changes. Range of motion of the right ankle and the right hindfoot was normal.
No medical imaging was made available to the Panel, but the Panel noted a report of plain X-rays of the right ankle dated 18 January 2015, which was reported to show open reduction and internal fixation of a right distal fibula fracture, with plate and screws in an appropriate position. The Panel considered that no additional medical imaging or other investigations were necessary for it to answer the medical question.
The Panel noted the instructions on page 3/14 of Chapter Three describing the use of diagnostic procedures that states: "such procedures should be done only if necessary and relevant, and they should not be ordered without consideration of costs as well as benefits." The Panel further noted there is no clinical indication of an arthritic process in play that would warrant the use of ionising radiation, to assess permanent impairment of the right ankle. The Panel considered that weight bearing X-rays (performed in accordance with Section 3.2g of Chapter Three of the Guides) of the right ankle are not clinically indicated and would be unlikely to provide additional information for the purposes of impairment assessment, and therefore are unnecessary and irrelevant in this instance.
The Panel concluded that the claimant is suffering from persisting symptoms in the lateral aspect of the right ankle, as a consequence of a healed fracture of the right distal fibula, treated surgically ...
The Panel conducted an impairment assessment according to the methods prescribed in the American Medical Association Guides to the Evaluation of Permanent Impairment (Fourth Edition) ("the Guides") as required by Section 28LH of the Wrongs Act 1958 ("the Act"). The Panel considered that no further information was required from the claimant's treating practitioners to carry out the assessment.
The Panel considered that the most appropriate method of assessment of the claimant's right ankle and hindfoot impairments was by reference to range of motion pursuant to Section 3.2e.
The Panel assessed the appropriate whole person impairment for loss of range of motion of the right ankle and the right hindfoot pursuant to Tables 42 and 43 of Chapter Three.