Bunion and Hammertoe Surgery: Complication or Negligence?

Elective forefoot surgery generates a large share of podiatric claims, for an understandable reason: the patient was not disabled before the operation. They came in with a bump, or a crooked toe, and they left with a foot that hurts more than it did. That emotional arc does not decide the case, but it does mean these matters are worth screening carefully before they are filed or defended.

Known complications, not departures

These occur in careful hands and are ordinarily disclosed as risks:

• Recurrence of the deformity over time
• Delayed union or nonunion at an osteotomy or fusion site
• Stiffness at the operated joint
• Prolonged swelling, sometimes for many months
• Scar tenderness or numbness from a cutaneous nerve branch
• Hardware that becomes symptomatic and needs removal
• Transfer metatarsalgia — pain shifting to an adjacent metatarsal

A case built on any of these alone is usually a consent case, not a technique case: the question becomes whether the risk was disclosed, not whether the surgery was performed negligently.

Findings that raise a real question

• Procedure selection that the imaging did not support. Certain corrections are appropriate for certain deformity magnitudes and joint conditions. Pre-operative radiographs are objective evidence, and they are usually in the file.
• Overcorrection or undercorrection well outside the expected range, visible on post-operative films.
• Shortening that leaves a toe non-functional — a floating toe, or a transfer lesion that was predictable from the amount of bone removed.
• Malunion in a position that no reasonable surgeon would accept, particularly rotational malposition.
• Hardware placed outside bone, or of a size the bone could not accommodate.
• Post-operative infection managed passively — redness and drainage documented across several visits with no culture and no change in plan.
• Operating on a foot with unaddressed vascular compromise.

The consent question

In elective forefoot surgery the consent discussion matters more than in almost any other podiatric setting, because the alternative to operating was usually to do nothing and live with the deformity. What a reviewer looks for is whether the record shows a real conversation: the specific risks of the specific procedure, the realistic recovery timeline, the possibility of recurrence, and what the patient was told about doing nothing. A signed generic form with no supporting note is weak evidence that any of that happened.

What to send for a review

• Pre-operative office notes and the consent documentation
• Pre-operative weight-bearing radiographs — these are essential and are frequently omitted from production
• The operative report
• All post-operative films
• Every post-operative office note, including phone messages
• Records of any revision surgery and the second surgeon’s notes

Without the pre-operative weight-bearing films, no expert can say much about whether the procedure chosen was reasonable. If they are not in the production, ask for them before anything else.