Yesterday, I had surgery to remove a neuroma in my foot. It was my second operation because, well, my first surgeon mistakenly believed it to be between my 2nd and 3rd toes and so removed the wrong nerve. When my symptoms never resolved, I waited till the fall to have it done again (by a different surgeon…).

So here I am, less than 24 hours after my surgery, with my laptop, and my foot propped up on 4 pillows and really, in very little pain having just taken some Tylenol. I thought about writing an article about neuromas, you know, diagnosis, treatment etc. but decided instead to write about the one question most friends and family asked me when they heard I needed to have surgery again: Are you going to sue the first surgeon? To answer that, I’m going to have to explain (briefly) what a neuroma is and how it’s diagnosed.

A neuroma occurs when a nerve gets irritated and inflammed and gradually enlarges. Although a neuroma can occur anywhere, in the foot it occurs most frequently between the 3rd and 4th toes at the base of the foot. As the nerve enlarges, it gets compressed against the ligament that runs above and across it. Every step causes compression from the ground up as well as from the top down from the ligament. Compression of the nerve can occur from wearing tight shoes or high heels which squeeze that area of the foot. As a result of all that, the nerve enlarges further, becoming fibrosed. (By the way, I didn’t get my neuroma from high heels or tight shoes.)

Neuromas are diagnosed by exam and rarely by MRI. A foot doctor can easily feel this by squeezing the foot and pushing with the thumb between these spaces. This illicits a palpable click and pain.

So how did I come to chose this surgeon in the first place? My physical therapist had actually recommended a podiatrist out in Boston. So I did my research about surgical techniques and about him and went out to see him. I was perfectly satisfied with him but because the drive to Boston was almost 2 hours, I decided instead to see a local orthopedic surgeon. To be perfectly honest, I leaned towards going with an orthopod because I thought an orthopedic surgeon would somehow be ”better” than a podiatrist – although I couldn’t articulate why. My orthopod was a fairly young surgeon who I believed had the benefit of recent training in the latest surgical techniques.

Anyway, convenience, coupled with the fact that a friend had seen him for some non-surgical work, led me to choose him. At our last visit before the surgery, he told me he thought the neuroma was between the 2nd and 3rd toe. I didn’t question him figuring that he had to know more than me about it.

When he stood at the foot of my bed post-surgery and told me how surprised he was that the nerve looked normal to him – not enlarged or fibrotic, warning bells went off in my head - how could that be after 15 years of chronic irritation? Heck, I could no longer walk bare foot because of the pain – in fact, I even had pain at rest. But I was still groggy from general anesthesia and, wishing for the best outcome, I pushed the thought aside.

What upset me the most about the rest of this story is how I was dealt with post-operatively. I had 2 follow-up visits – one with his physician’s assistant (PA) who was totally dismissive of my complaints of continued pain and discomfort telling me it was simply post-op swelling. Since the pathology report showed that the nerve had fibrotic changes, she informed me that it was highly unlikely that I had 2 neuromas on the same foot. I left there determined never to see her again.

At my second and final post-op visit, 3 months after my surgery, I told the surgeon that I felt he missed it. He was clearly uncomfortable and rambled on about how even if he had missed it, he wasn’t so sure he’d operate again – you know, try some conservative treatments instead - injections, orthotics etc. Then he mused aloud that he wished he had checked between the 3rd and 4th toes when he saw how normal the nerve looked. For whatever reason, he didn’t check.

I was quite annoyed when he suggested he probably wouldn’t do surgery again even if he operated on the wrong area. What?? How dishonest that sounded. I was there because all conservative treatment had failed.  

Providers are so fearful of lawsuits that they don’t know how to admit they could be wrong about anything. Yet time and time again, studies show that a sincere apology is often all a patient wants. The more evasive he was, the more disappointed I grew. I had thought better of him. He was a genuinely lovely young man but my disappointment grew as he continued to grasp for excuses. I pretty much kept quiet and let him ramble. I wasn’t in the mood to bail him out.

In the end he agreed to an MRI after I had initially suggested it. Now, foot specialists know that a MRI can miss a neuroma but those tend to be the small ones. That’s why MRIs are not usually used to diagnose. Still, if there was any time to order one, it was now. I was annoyed it took him so long to finally agree.

I waited to hear from him about the results, but he never did call – in fact, no one from his office ever called. I got the results from my primary care provider after she received a copy. I had the MRI center download the films on a disk and brought the disk back to the podiatrist in Boston.

My podiatrist told me when he was in school, his mother went to a surgeon who determined that her neuroma was between the 2nd and 3rd toe. He was acutely conscious of sounding like a know-it-all now that he was in school so he was very deferential when he called his mother’s surgeon to ask him to reconsider the location. Instead, the surgeon rudely informed him as an orthopedic surgeon, he ought to know more than a podiatry student. And so he removed the wrong nerve from his mother’s foot. His mother went on to have surgery from someone else, and has done fine ever since. This gave me hope.

So did I sue? No. I was pretty angry though and more than one expletive came out of my mouth when the neuroma was confirmed. I’m not sure if it’s because I’m a provider that I chose not to sue. I think it’s because I don’t want to dwell on the past. Besides, it wasn’t a life and death diagnosis.

Yes it caused me pain and suffering, especially because I developed a case of shingles post-operatively. It caused me to miss altogether, several weeks of work, and I was out of pocket for my share of the surgery and post-op visits.  And of course, it was a 3 month recuperation during which time I couldn’t fly, ski, snow-shoe or enjoy any of my outdoors activities.

But you know what? This experience taught me a number of lessons not the least of which relates to patient care. It re-affirmed the belief and commitment I have to always listen to my patients, to be honest and up-front with them, and to admit a mistake or oversight. 

I haven’t decided yet, but I’m thinking of sending the first surgeon a copy of the pathology report and a note telling him of my disappointment in the fact that he never even called about the MRI results. No angry tone or anything like that – just the facts.

You don’t cover up your mistakes by trying to forget them. It’s a lesson he needs to learn.