Our client indicates that on November 30, 2017, his foot got run over with car while working on a highway in Jacksonville, Florida. Initial ankle surgery was 6 months after the initial injury by Gregory Solis, M.D. at Baptist South. The screws started coming out of his ankle.
On June 20, 2024, our client underwent hardware removal and gastrocnemius recession by Vikram Bala, DPM at St. Vincent’s Southside in Jacksonville, FL with a left-sided popliteal/saphenous nerve block preoperatively. Postoperatively, the client experienced left foot drop. He was referred to Baptist Neurology Group where he was diagnosed with deep peroneal neuropathy at the dorsal ankle. The EDB is atrophic. 4+denervation is present with no motor units generated.
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Do you believe there might have been medical error?
Based on the provided information, there are indications that could suggest a potential medical error, particularly concerning the development of left foot drop and the diagnosis of deep peroneal neuropathy following the recent surgery. It raises questions about whether adequate precautions were taken during surgery or if there was a failure in monitoring the patient's condition and nerve function afterward. However, to definitively assess the likelihood of medical error, a more thorough review of surgical protocols, intraoperative findings, and postoperative management would be necessary. Given these considerations, I would rate the likelihood as a 5 - Less Likely Than Not. This acknowledges the possibility of medical error while recognizing that additional information is required to make a conclusive judgment.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The reasoning for this assessment stems from the timing and nature of the client's postoperative complications. After undergoing hardware removal and gastrocnemius recession, the development of left foot drop and the diagnosis of deep peroneal neuropathy indicates a direct connection to the surgical intervention. The presence of atrophy in the extensor digitorum brevis (EDB) and denervation suggests that there may have been an injury to the nerve during surgery or subsequent mismanagement of nerve function. Given that these complications occurred shortly after the procedure, it supports the notion that medical error related to the surgical process or postoperative care may have contributed to the injury experienced by the client.
What makes you a good expert for this case?
As a board-certified podiatrist, I have extensive training and experience in diagnosing and treating conditions related to the foot and ankle, including complications arising from surgery. I understand the complexities of surgical procedures, such as hardware removal and nerve-related issues, and am familiar with the standard of care required in postoperative management. My knowledge of anatomy, biomechanics, and rehabilitation allows me to evaluate the potential causes of complications like deep peroneal neuropathy, and I can critically assess whether medical errors may have occurred in this case. This expertise equips me to provide informed insights into the client's condition and the implications of their surgical experience.
How often do you encounter cases similar to this one in your practice?
I encounter cases similar to this one relatively frequently, particularly involving post-surgical complications like nerve injuries or hardware-related issues. It’s not uncommon for patients to experience challenges after procedures such as hardware removal or reconstructive surgeries, especially those involving the ankle and foot. I routinely manage cases of neuropathy, atrophy, and other complications, which underscores the importance of diligent postoperative care and patient follow-up to ensure optimal outcomes.
Do you believe there might have been medical error?
Neuropathy and foot drop are known possible complications after gastrocnemius recession. Early recognition and treatment are necessary to salvage the leg and foot. I have reviewed very similar cases where the surgeon resected the nerve during surgery and was directly responsible for the patient's subsequent disability. It is a good case to litigate. I would be happy to review the details in the medical records and render an opinion as to whether the medical standard of care was met.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As I previously noted, the surgeon likely resected the nerve during surgery, making him directly responsible for the patient's subsequent disability.
What makes you a good expert for this case?
I have reviewed very similar cases recently. I have been in practice for 35 years, am board certified in foot surgery, have a FL expert witness ID#, was chief of podiatric surgery at our hospital and review potential malpractice cases on a weekly basis.
How often do you encounter cases similar to this one in your practice?
Often. Achilles injuries and surgeries are common in our practice.
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