This case involves a male patient who underwent a routine foot surgery, performed by a podiatrist. During the procedure, the podiatrist cut through the plantar nerve. He also completely lacerated a major tendon. These injuries went unrecognized during the surgery. During a second surgical procedure, he found the injuries and looked for a plastic surgeon in the hospital, but could not find one. He then simply sutured the nerve together. No treatment was rendered for the lateral injured nerve. Subsequently, the patient did poorly and recently had a plastic surgeon graft the two nerves, though he still lacks feeling on the bottom of his foot.
Question(s) For Expert Witness
- 1. Do you perform this surgery?
- 2. What are the common complications associated with this surgery?
- 3. What measures should be taken to prevent injury to the nerves?
- 4. Should the injuries have been recognized / treated sooner?
Expert Witness Response E-008407
I have performed these procedures in the past. Cutting both nerves is not a common complication of this procedure and should have been avoided by appropriate dissection techniques. The nerve injuries are sometimes difficult to recognize if you don’t know that you cut them during the procedure. In this case, I’m not sure how the DPM found the injuries 3 weeks later. It’s much more difficult to find the injuries during the repeat procedure unless he cut the nerves during the repeat procedures. The way to know is to see if the patient was complaining of nerve symptoms after the 1st procedure. Despite finding and repairing the nerves, however, it’s very difficult to regain the sensation.