**Employee:** David M. Porting
**Injury No.:** 03-054540
Sometime prior to March 2003, Claimant developed a blister on his right big toe from the rubbing of his work boots. He indicates he had a callus on the toe for a period of time before the blister developed. Eventually the condition became painful and Claimant sought medical treatment.
Claimant's treatment history is summarized from his testimony and the medical records and reports. Mr. Porting sought treatment at Barnes Jewish Hospital on March 27, 2003, for a complaint of a toe callous that wasn't healing. An x-ray showed mild osteoarthritis at the interphalangeal joint of the first toe, but no fractures or dislocations. Claimant was assessed with abscess/cellulitis of the right foot. Mr. Porting was then admitted to the hospital due to cellulitis. On March 28, 2003, he underwent an MRI of the right great toe which revealed osteomyelitis of the distal phalanx of the right great toe and osteoarthritis of the right first metatarsal phalangeal joint.
Claimant required long-term course of antibiotics due to his osteomyelitis. He underwent Hohn catheter placement on March 30, 2003. Claimant was discharged from the hospital on April 4, 2003, with the diagnosis of osteomyelitis of the ankle/foot, ulcer of the foot, unspecified cellulitis and abscess of the toe. He was released with instructions to continue taking medications.
Claimant was released back to work with no restrictions on June 10, 2003. He testified that after he was released from care, his diabetes, which was problematic during treatment, was brought back under control. He further testified he was able to go back to work and had no ongoing physical difficulties from the March 2003 injury.
On July 24, 2003, Claimant was injured while attempting to adjust the deck of the street sweeper he was operating. The chain holding the rear skid slipped off a bolt which was holding it up, and the skid dropped onto his right second toe.¹
Claimant returned to Dr. Polish, an infectious disease specialist, on July 29, 2003, and it was noted his foot had healed and was doing much better until being struck with the metal plate. He was treated with Bactrim DS and was sent for an x-ray of the foot, which revealed osteoarthritis of the MTP, interphalangeal joint and sesamoid-metatarsal joint of the great toe. The film also showed bunionectomy defect, but there was no fracture demonstrated of the first or second toe. Mr. Porting then sought treatment at Barnes Jewish Hospital Emergency Room on August 7, 2003, for a complaint of right second toe pain. An x-ray of the right foot revealed soft tissue swelling, distal aspects 2nd toe right foot without underlying bony destruction; bunionectomy defect right foot; osteoarthritis of the metatarsal phalangeal joint and interphalangeal joint of the great toe of the right foot; osteoarthritic changes of the mid foot and dorsal soft tissue swelling is noted of the right foot.
Mr. Porting was then admitted to Barnes Jewish Hospital due to an abscess or possible osteomyelitis of the second toe. He underwent an MRI of the lower extremity the next day which reported: Right second toe ulcer with associated new focus of osteomyelitis involving the distal
¹ The injury described here is the subject of Injury No. 03-124837, the hearing for which was held in conjunction with the instant case.
WC-32-R1 (6-81)
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phalanx with second toe. There is no non viable bone and no abscess; improving osteomyelitis of the great toe distal phalanx; and progressive tearing of the flexor hallucis longus tendon which shows now a high grade partial rupture at the level of the sesamoids.
On August 9, 2003, Claimant underwent a Hohn catheter placement and he was discharged from the hospital the next day to continue on intravenous Ceftriaxone. Claimant was admitted to Barnes Jewish Hospital again on August 24, 2003, due to right neck pain and fever. An x-ray of the chest showed the lungs were well expanded and clear bilaterally without infiltrates, nodules or effusions. The film revealed no pneumothorax or edema, but there was a mildly tortuous aorta. Cardiac silhouettes were normal and the right internal jugular Hohn catheter was seen with its distal tip overlying the superior vena cava.
Claimant was discharged from the hospital on September 3, 2003, with the diagnosis of right upper extremity septic thrombophlebitis with right upper extremity deep venous thrombosis, coagulase-negative staphylococcus bacteremia related to the Hohn, right upper extremity deep venous thrombosis, and chronic pain syndrome. His discharge medications included intravenous Vancomycin, Lovenox, and Flagyl. Claimant returned to Dr. Polish on September 30, 2003, and was advised to continue his antibiotics for right foot osteomyelitis. It was also suggested he continue the Lovenox and Coumadin for his right upper extremity deep venous thrombosis. On October 16, 2003, Claimant underwent a left upper extremity venography and single lumen PICC line placement due to his PICC line breaking apart after getting caught in a laundry basket. He then continued to follow up with Dr. Polish and on November 18, 2003, and it was noted his osteomyelitis had healed. His Hohn catheter was then removed and he was scheduled for PICC line removal on November 21, 2003.
Claimant testified after his toe healed, he was released from care, but never returned to work for Employer. He testified he was advised by Dr. Polish that he should not return to heavy work while he was still taking blood thinners. Claimant has not returned to work since being released in November, 2003.
Claimant testified regarding his preexisting back and neck injuries. In 1991, he injured his back, and he reinjured it in 1993. He ultimately had to have a fusion at L5-S1. During his physi