Foot Drop Following Spine and Nerve Procedures – When is it Medical Malpractice?

At Lupetin & Unatin, we have seen firsthand the devastating impact “Foot Drop” can have on your life.  We have represented numerous clients who suffered foot drop following a variety of neurologic and orthopedic spine surgeries and procedures.  This life-altering condition is much more than a foot that drops.  Those suffering from foot drop have to work to pick their leg up higher so their foot doesn’t drag or catch on the ground.  They must worry about tripping and falling.  They must worry about what other will think about the funny way they walk.  Their hip flexors tire from constantly having to lift their leg higher than normal.  This type of walking causes imbalance which leads to increased wear and tear on other parts of the body.  It is more difficult to put on and take off clothing, socks, and shoes.  May resort to using a brace to hold their foot in place, which carries with it a host of other difficulties.  The ripple effects are real and life changing. 

What is Foot Drop?

Foot drop is a medical condition characterized by the inability to lift the front part of the foot, causing it to drag on the ground while walking. This condition can significantly impact a person’s mobility, leading to difficulty walking and an increased risk of tripping and falling.

How Does Foot Drop Occur?

Foot drop occurs due to weakness or paralysis of the muscles that lift the foot, primarily the anterior tibialis muscle. This weakness or paralysis can be caused by damage or dysfunction of the nerves that control these muscles, particularly the peroneal nerve. Damage to this nerve can result from various conditions, including trauma, nerve compression, or medical procedures involving the spine and nerves.

How Often Does Foot Drop Occur After Spine and Nerve Procedures?

Foot drop is a recognized complication following surgeries and procedures involving the spine and nerves. That said, no patient consents to medical negligence.  While there are no published studies on the frequency of footdrop due to negligently performed medical procedures, it is helpful to know the numbers overall.

Although it is relatively uncommon, its occurrence can be distressing and debilitating for patients. The prevalence varies depending on the specific procedure and the patient’s overall health, but studies suggest that foot drop can occur in approximately 1-5% of patients undergoing certain spinal surgeries.

Medical Procedures That Can Cause Foot Drop

Several types of medical procedures, if not performed properly, can lead to the development of foot drop. These include:

• Spinal Surgeries: Procedures such as laminectomies, discectomies, and spinal fusion surgeries can potentially damage nerves if not executed with precision.
• Hip Replacement Surgery: Improper positioning or excessive retraction during the surgery can lead to nerve injury.
• Knee Surgeries: Operations like knee arthroscopy or total knee replacement can sometimes result in nerve damage, leading to foot drop.
• Peripheral Nerve Surgery: Procedures directly involving the nerves in the leg, such as decompression surgeries, can cause foot drop if the nerves are damaged.
• Spinal Injections: Any procedure that involves a needle or catheter inserted into or near the spinal cord or spinal nerves can result in a nerve injury that causes foot drop.  Lumbar epidural injections performed below the standard of care can cause footdrop as can epidural injections given to laboring mothers.

What are the Symptoms of Foot Drop?

The symptoms of foot drop can vary in severity and may include:

• Difficulty lifting the front part of the foot
• Dragging the foot on the ground while walking
• A high-stepping walk (known as steppage gait) to avoid dragging the foot
• Numbness or tingling in the foot and toes
• Muscle weakness or atrophy in the lower leg

How is Foot Drop Diagnosed?

Diagnosing foot drop typically involves a combination of physical examinations and diagnostic tests:

• Physical Examination: A doctor will assess muscle strength, reflexes, and the patient’s gait.
• Imaging Studies: MRI or CT scans may be used to identify any structural abnormalities or nerve compression.
• Electromyography (EMG) and Nerve Conduction Studies: These tests measure the electrical activity of muscles and the speed of nerve signals to detect nerve damage.

How is Foot Drop Treated?

Treatment for foot drop depends on the underlying cause and may include:

• Physical Therapy: Exercises to strengthen the muscles and improve gait.
• Braces or Splints: These can help support the foot and improve walking.
• Medications: To reduce inflammation and pain.
• Surgery: In cases where nerve damage is severe, surgical intervention may be necessary to repair or decompress the nerve.

What is the Recovery Period and Prognosis for Foot Drop?

The recovery period for foot drop can vary widely. Some patients may see improvement within a few weeks to months with appropriate treatment, while others may take a year or more to recover. In cases where nerve damage is severe and irreversible, foot drop may become a permanent condition.

Foot drop after surgery is likely to become permanent if there is no significant improvement within a certain timeframe, typically within the first year following the onset of the condition. Several factors can influence the likelihood of permanent foot drop, including the extent of nerve damage, the specific nerve(s) affected, and the effectiveness of treatment.

Here are key indicators that foot drop may be permanent:

• Severe Nerve Damage: If the nerve damage is extensive or the nerve has been completely severed, the chances of full recovery are diminished. Nerves have a limited capacity to regenerate, and severe damage may be beyond repair.
• Delayed Diagnosis and Treatment: Prompt diagnosis and treatment are critical for recovery. Delays in identifying and addressing the underlying cause of foot drop can result in prolonged nerve compression or damage, reducing the likelihood of recovery.
• Lack of Improvement Over Time: The first few months after the onset of foot drop are crucial for recovery. If there is no significant improvement in muscle strength or function within the first six months to a year, the condition is more likely to be permanent.
• Ineffective Rehabilitation: Consistent and targeted rehabilitation, including physical therapy, is essential for recovery. If rehabilitation efforts do not lead to improvement in muscle strength and function, the condition may remain permanent.
• Chronic Underlying Conditions: Certain chronic conditions, such as diabetes or severe peripheral neuropathy, can complicate recovery and increase the risk of permanent foot drop due to ongoing nerve damage.
• Age and Overall Health: Younger patients with good overall health are generally more likely to recover from nerve injuries. Older patients or those with multiple health issues may face a higher risk of permanent foot drop.

Given these factors, it is crucial for patients experiencing foot drop after surgery to seek immediate medical attention and follow a comprehensive treatment and rehabilitation plan. Early intervention and consistent therapy can significantly improve the chances of recovery and reduce the risk of permanent disability.

How Medical Negligence Can Cause Foot Drop

Medical negligence can lead to foot drop if healthcare providers fail to perform procedures correctly or do not take appropriate precautions to avoid nerve damage. This can occur through:

Incorrect Surgical Techniques

Incorrect surgical techniques can lead to foot drop by causing direct injury to the nerves responsible for foot movement or by creating conditions that lead to nerve damage. Here are some ways in which improper surgical practices can result in foot drop:

Direct Nerve Injury

1. Accidental Severing of the Nerve: During surgeries involving the spine, hip, knee, or peripheral nerves, a surgeon might inadvertently cut or sever the peroneal nerve, which is crucial for controlling the muscles that lift the foot. This can result in immediate and potentially irreversible foot drop.
2. Excessive Retraction: In many surgical procedures, retraction (the pulling back of tissues) is necessary to provide visibility and access. However, excessive or prolonged retraction can stretch or compress nerves, leading to damage. The peroneal nerve, due to its superficial location around the knee, is particularly vulnerable during knee surgeries.
3. Incorrect Placement of Surgical Instruments: Misplacement of surgical tools or implants can exert undue pressure on the nerves. For example, placing screws or plates in a way that compresses the peroneal nerve can cause damage, leading to foot drop.

Nerve Compression

1. Inadequate Handling of Soft Tissues: Surgeons must carefully handle and protect soft tissues, including nerves, during surgery. Failure to do so can result in nerve compression. For instance, if tissues around the spine are not properly managed during a spinal fusion, they can compress the nerve roots, leading to foot drop.
2. Improper Patient Positioning: The positioning of the patient during surgery is critical. Incorrect positioning can put undue pressure on the nerves. For example, during prolonged surgeries, improper positioning of the leg can compress the peroneal nerve at the fibular head, causing foot drop.

Postoperative Complications

1. Hematoma or Swelling: After surgery, bleeding or swelling around the surgical site can compress nearby nerves. Surgeons must ensure proper hemostasis and manage postoperative inflammation to prevent such complications.
2. Failure to Monitor and Address Postoperative Changes: Postoperative monitoring is crucial for detecting and addressing complications early. Failure to recognize signs of nerve compression or ischemia can lead to prolonged nerve damage and foot drop.

Inadequate Surgical Planning

1. Lack of Preoperative Assessment: Thorough preoperative assessment is essential for identifying patients at risk of nerve damage. Inadequate assessment and planning can result in unanticipated nerve injury during surgery.
2. Failure to Follow Established Protocols: Deviating from established surgical protocols and standards can increase the risk of nerve injury. Surgeons must adhere to best practices and guidelines to minimize the risk of complications like foot drop.

Examples of Procedures Prone to Complications

• Spinal Surgeries: Procedures like laminectomies, discectomies, and spinal fusions involve manipulating structures close to nerve roots. Inadequate technique can result in nerve root compression or injury.
• Hip Replacement Surgeries: Incorrect positioning or excessive force during hip replacement can damage the sciatic or peroneal nerve, leading to foot drop.
• Knee Surgeries: During procedures such as total knee replacement or arthroscopy, improper handling of the knee structures can damage the peroneal nerve.

Preventive Measures

To minimize the risk of foot drop due to incorrect surgical techniques, surgeons should:

1. Undergo Thorough Training: Ensure comprehensive training and experience in the specific surgical procedures to avoid technical errors.
2. Use Advanced Imaging and Monitoring: Utilize intraoperative imaging and nerve monitoring to guide the surgery and protect nerves.
3. Adhere to Protocols: Follow established surgical protocols and guidelines meticulously.
4. Conduct Preoperative Assessments: Perform detailed preoperative assessments to identify and mitigate risk factors for nerve injury.
5. Ensure Proper Patient Positioning: Pay careful attention to patient positioning to avoid nerve compression during the procedure.

By understanding the potential pitfalls and taking appropriate precautions, surgeons can significantly reduce the risk of causing foot drop through incorrect surgical techniques.

Failure to Recognize and Address Nerve Compression During Surgery

Nerve compression occurs when excessive pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles, or tendons. This pressure can disrupt the nerve’s function, leading to symptoms such as pain, numbness, weakness, and, in severe cases, paralysis.

Mechanisms Leading to Foot Drop

1. Intraoperative Positioning: During surgery, patients are often positioned in ways that provide the best access to the surgical site. However, improper positioning can compress the peroneal nerve, especially around the knee where the nerve is superficial and vulnerable. If this compression is not noticed and corrected promptly, it can lead to foot drop.
2. Retraction of Tissues: Surgical procedures often require retraction (pulling back) of tissues to improve visibility and access. Excessive or prolonged retraction can compress nearby nerves, such as the peroneal nerve, leading to ischemia (restricted blood flow) and subsequent nerve damage if not recognized and relieved in time.
3. Use of Surgical Instruments and Implants: Incorrect placement of surgical instruments or implants (e.g., screws, plates) can inadvertently compress nerves. For example, in spinal surgeries, misplaced hardware can press against nerve roots. If the surgeon fails to identify and address this compression during the procedure, it can result in postoperative foot drop.

Consequences of Unrecognized Nerve Compression

1. Prolonged Ischemia: Nerves are highly sensitive to blood supply. Compression can lead to reduced blood flow (ischemia), resulting in nerve damage. If ischemia persists during the surgery without intervention, it can cause permanent nerve injury and subsequent foot drop.
2. Nerve Damage and Inflammation: Continuous compression can physically damage the nerve fibers, leading to inflammation and dysfunction. This can manifest as foot drop immediately after the surgery or develop over time as the nerve deteriorates.
3. Delayed Postoperative Complications: Even if initial surgery seems successful, unrecognized nerve compression can lead to delayed postoperative complications. Swelling or hematomas (localized bleeding outside of blood vessels) can exacerbate the compression post-surgery, resulting in foot drop days or weeks later.

Examples of Surgeries Where Nerve Compression is a Risk

• Spinal Surgeries: Procedures such as laminectomies, discectomies, and spinal fusions involve working close to nerve roots. Misplacement of surgical tools or implants can compress these nerves.
• Hip Replacement Surgeries: Excessive force or improper positioning during the surgery can compress the sciatic nerve or its branches, including the peroneal nerve.
• Knee Surgeries: Total knee replacements and knee arthroscopies can risk compressing the peroneal nerve around the fibular head.

Preventive Measures

To prevent foot drop caused by unrecognized nerve compression, surgeons should implement the following measures:

1. Preoperative Planning: Thoroughly plan the surgical approach, considering the anatomy and potential risks of nerve compression.
2. Intraoperative Monitoring: Utilize nerve monitoring techniques during surgery to detect and respond to any nerve compression in real-time.
3. Careful Positioning: Ensure proper positioning of the patient to avoid undue pressure on vulnerable nerves, and frequently check and adjust positioning during lengthy procedures.
4. Gentle Tissue Handling: Use appropriate retraction techniques and avoid excessive force to minimize the risk of compressing nearby nerves.
5. Postoperative Monitoring: Closely monitor patients postoperatively for signs of nerve compression, such as changes in sensation or muscle strength, to address any issues promptly.

Inadequate Postoperative Care

Here are the ways in which inadequate postoperative care can lead to foot drop:

Failure to Monitor for Complications

1. Delayed Detection of Nerve Compression: After surgery, patients should be closely monitored for signs of nerve compression, such as changes in sensation, muscle weakness, or pain. Inadequate monitoring can result in delayed detection of these signs, allowing nerve compression to persist and cause damage.
2. Undiagnosed Hematomas or Swelling: Hematomas (localized bleeding) or postoperative swelling can compress nerves. If postoperative care does not include careful monitoring for these conditions, they may go unnoticed and untreated, leading to nerve damage and foot drop.

Inadequate Pain Management and Rehabilitation

1. Poor Pain Control: Effective pain management is crucial for postoperative recovery. Inadequate pain control can lead to increased stress and muscle tension, which may exacerbate nerve compression or inflammation, contributing to the development of foot drop.
2. Neglecting Physical Therapy: Physical therapy is vital for recovery, especially after surgeries involving the spine, hip, or knee. Inadequate physical therapy can result in muscle weakness and decreased mobility, increasing the risk of foot drop. Proper rehabilitation helps to strengthen muscles, improve blood flow, and promote nerve recovery.

Improper Handling of Postoperative Infections

1. Infections Leading to Inflammation: Postoperative infections can cause significant inflammation and swelling, which can compress nearby nerves. Inadequate care in identifying and treating infections can lead to prolonged nerve compression and damage, resulting in foot drop.
2. Failure to Address Surgical Site Infections: Surgical site infections can directly affect nerves if not promptly treated. Infections can lead to abscess formation or increased scar tissue, both of which can compress nerves and cause foot drop.

Poor Patient Education and Follow-Up

1. Lack of Patient Education: Patients need to be educated about the signs and symptoms of complications, including nerve issues. Inadequate patient education can lead to delays in reporting symptoms such as numbness, tingling, or weakness, which are early signs of nerve compression.
2. Insufficient Follow-Up Appointments: Regular follow-up appointments are crucial for early detection and management of complications. Inadequate follow-up care can result in missed opportunities to address nerve compression or other issues before they lead to permanent damage.

Inadequate Management of Comorbid Conditions

1. Neglecting Underlying Conditions: Patients with conditions like diabetes or vascular disease are at higher risk for nerve damage. Inadequate postoperative care that fails to manage these comorbid conditions can exacerbate the risk of foot drop.
2. Ignoring Nutritional Needs: Proper nutrition supports healing and nerve health. Inadequate nutritional support during the postoperative period can impair recovery and increase the risk of complications, including foot drop.

When is Foot Drop Likely the Result of Medical Negligence?

Foot drop may be the result of medical negligence if:

• There is evidence of improper surgical technique or deviation from the standard of care.
• Nerve damage was not promptly identified or treated.
• The patient was not adequately informed of the risks associated with the procedure.

How a Medical Malpractice Lawyer Can Help

A qualified medical malpractice lawyer plays a crucial role in helping patients who believe they have developed foot drop due to medical negligence. These legal professionals have the expertise to navigate the complexities of medical malpractice cases and can provide invaluable assistance in several ways:

Case Evaluation

1. Initial Consultation: A medical malpractice lawyer will conduct an initial consultation to understand the details of the patient’s case, including their medical history, the surgical procedure, and the onset of foot drop. This helps determine whether there is a potential case of medical negligence.
2. Review of Medical Records: The lawyer will obtain and thoroughly review the patient’s medical records to identify any deviations from the standard of care that could have led to foot drop. This includes examining surgical notes, postoperative care records, and any diagnostic tests performed.

Expert Consultation

1. Medical Experts: The lawyer will consult with medical experts to evaluate whether the care provided was substandard. These experts can provide opinions on whether the surgical technique, postoperative care, or other medical practices fell below the accepted standard, leading to nerve damage and foot drop.
2. Second Opinions: In complex cases, the lawyer may seek multiple expert opinions to strengthen the case. This ensures that the patient’s claim is well-supported by credible medical evidence.

Legal Strategy and Representation

1. Building a Case: The lawyer will gather all necessary evidence, including medical records, expert testimonies, and witness statements, to build a strong case. They will identify key elements such as proof of negligence, causation, and the extent of damages suffered by the patient.
2. Filing a Lawsuit: If the evidence supports a claim of medical negligence, the lawyer will file a lawsuit on behalf of the patient. This involves drafting legal documents, including the complaint, which outlines the allegations against the healthcare provider and the basis for the malpractice claim.
3. Representation in Court: A qualified lawyer will represent the patient in court, presenting the case to a judge or jury. They will make compelling arguments, cross-examine witnesses, and present evidence to demonstrate that medical negligence led to the patient’s foot drop.

Negotiation and Settlement

1. Settlement Negotiations: Many medical malpractice cases are settled out of court. The lawyer will negotiate with the healthcare provider’s insurance company or legal representatives to reach a fair settlement that compensates the patient for medical expenses, lost wages, pain and suffering, and other damages.
2. Maximizing Compensation: The lawyer’s goal is to maximize the compensation for the patient. They will assess the full extent of the patient’s injuries and losses, including future medical needs and long-term impact on the patient’s quality of life, to ensure a fair settlement or verdict.

Support and Advocacy

1. Guidance Throughout the Process: The lawyer will guide the patient through every step of the legal process, providing clear explanations and advice. This helps the patient understand their rights and options, reducing the stress and uncertainty associated with pursuing a medical malpractice claim.
2. Emotional Support: Dealing with the aftermath of medical negligence can be emotionally challenging. A compassionate lawyer provides not only legal support but also emotional reassurance, helping the patient feel heard and validated throughout the legal proceedings.
3. Protecting Patient Rights: A qualified medical malpractice lawyer is dedicated to protecting the patient’s rights and ensuring they receive justice. They will work tirelessly to hold negligent healthcare providers accountable and secure the compensation the patient deserves.

At Lupetin & Unatin, our experienced medical malpractice lawyers understand the devastating impact foot drop can have on a patient’s life. We are committed to providing compassionate and skilled legal representation to help our clients achieve justice and fair compensation. If you or a loved one has suffered from foot drop due to medical negligence, our team is here to help you navigate the legal process and secure the best possible outcome for your case.