Misdiagnosed Plantar Neuroma After Two Foot Surgeries in Korea

Case Overview

A woman in her early thirties went to the orthopedic department of a university hospital with two complaints: a lump beneath the scar on the sole of her foot, and a sharp pain in the front of the foot when she walked. As a child she had stepped on a piece of glass, and the wound had been sutured. The physician examined the foot and told her that the lump was a simple granuloma — an inflammatory mass forming around retained foreign material — and that a straightforward excision would leave her pain-free within about two weeks.

She underwent the operation under general anesthesia. The findings did not match the explanation. After surgery, the surgeon reported that the mass had involved a nerve branch leading to one of her toes and had been removed. Pathology identified a neuroma, a benign growth on a nerve, not a granuloma.

Her pain changed character after the operation. Instead of the sharp forefoot pain she had described before surgery, she developed neuropathic pain — a burning pain caused by injury to the nerve itself. Her foot also began to turn inward involuntarily, and she experienced abnormal sensation. Walking became difficult.

A neurologist at the same hospital advised continuing conservative treatment, including medication, and observing the condition over time. Roughly two weeks later, the orthopedic surgeon recommended a second operation. The second excision was wider, the scar was nearly twice as long, and her symptoms did not improve. At another university hospital she received a diagnosis of a post-surgical neuroma. She later underwent implantation of a spinal cord stimulator, a device that applies electrical stimulation to the spinal cord to reduce pain.

Taeshin Law Firm represented her in a claim for damages against the hospital. The court ultimately issued a settlement recommendation decision providing for payment of 110 million won, with the client waiving the remainder of her claim.

Background

A neuroma in the foot is a benign growth arising from a nerve. It can produce sharp, burning, or electric-like pain in the forefoot that worsens with walking or pressure. Some neuromas are associated with prior trauma, so the client's history of a glass injury and a scar on the sole was relevant from the first consultation. Diagnosis is ordinarily based on the history, physical examination, imaging where indicated, and — in appropriate cases — tests designed to distinguish a nerve lesion from other soft-tissue masses.

Imaging obtained before the first operation showed two masses with indistinct borders. The records nevertheless reflected a diagnosis of a foreign-body granuloma, a different condition with a different cause and a different treatment path. Conservative measures such as medication, physical therapy, and footwear adjustment are commonly considered before surgery for a neuroma; excision is generally reserved for cases in which those measures do not provide adequate relief.

The client's first operation was performed under general anesthesia. The operative note and pathology report described a nerve-related mass and a neuroma. In the postoperative period her symptoms evolved into neuropathic pain, with involuntary inward movement of the foot and sensory disturbance. The neurology department recommended continued conservative care. Within about two weeks, however, a second operation was performed, with a wider resection and a longer scar. The symptoms persisted. A second university hospital diagnosed a post-surgical neuroma, and a spinal cord stimulator was implanted.

Medical Issue

The central medical question was whether the mass should have been recognized as a possible neuroma before the first operation. The client had a relevant trauma history, symptoms typical of a nerve lesion in the forefoot, and imaging that showed two ill-defined masses. According to the claim, the workup consisted of palpation and X-ray, without the diagnostic testing that would have helped distinguish a neuroma from a foreign-body granuloma. The discrepancy between the preoperative diagnosis and the surgical and pathological findings became a focus of the case.

A second question concerned treatment sequencing. The claim argued that conservative treatment should have been tried before surgery and that, once the first operation had failed to relieve the symptoms, a second operation about two weeks later was not supported — particularly when the neurology department had recommended continuing conservative care. The second procedure enlarged the resection and the scar without improving the client's condition.

A third question concerned explanation. The client stated that she had been told only that this was a simple operation. She said she had not been informed of alternative treatments or of the risk that pain could persist or that the problem could recur. Under Korean law, a physician's duty to explain supports a patient's right to make an informed decision; a failure to provide the information needed for that decision can give rise to a separate claim, independent of whether the treatment itself was negligent.

Key Legal Issues

Four issues framed the litigation.

First, the claim alleged negligence in the diagnostic process. The client argued that her history, symptoms, and imaging called for a differential workup aimed at identifying a neuroma, and that the failure to carry out that workup led to an operation for the wrong condition.

Second, the claim challenged the choice of treatment. It asserted that conservative care should have preceded surgery and that the decision to proceed to a second operation so soon after the first — despite contrary advice from the neurology department — fell below the applicable standard of care.

Third, the claim raised informed consent. The client contended that she had been given a simplified description of the procedure, without a discussion of alternatives or of the risk of persistent pain and recurrence, and that this deprived her of the information she needed to decide whether to undergo surgery.

Fourth, the parties disputed damages. The court-ordered physical appraisal assessed a 10 percent loss of earning capacity. The claim also addressed past treatment costs, including the spinal cord stimulator implantation, and future costs such as ongoing medical care, medication, and replacement of the device's battery.

Before litigation, the dispute went through a medical dispute mediation process. The hospital maintained that the diagnosis had not been a misdiagnosis and that it was not responsible for the symptoms the client continued to experience.

Taeshin's Approach

Taeshin Law Firm built the claim around the diagnostic pathway rather than treating the case as a single unfortunate surgical result.

The firm reconstructed the record in chronological order, from the first consultation through the first operation, and organized the circumstances showing that differential testing had been omitted. It emphasized that the trauma history, the typical forefoot symptoms, and the imaging findings all pointed to the possibility of a neuroma, yet the diagnosis rested on palpation and X-ray alone. It also highlighted that the operative findings and the pathology report differed from the preoperative diagnosis, a discrepancy that supported the claim that the earlier assessment had been incomplete.

The firm then turned to the treatment decision. It submitted medical literature and case reports addressing the diagnosis and management of neuromas, including reports describing traumatic neuromas mistaken for foreign-body granulomas. Those materials supported two points: that conservative treatment is generally tried before surgery, and that operating on an existing neuroma can add surgical trauma to an already injured nerve, producing neuropathic pain and unwanted movement. The firm also relied on the neurology department's recommendation for conservative care and on the short interval before the second operation.

On explanation, the firm used a recording the client had made during a consultation. After preparing a transcript, it submitted the conversation as evidence that surgery had been presented as the only solution, without a discussion of alternatives or complications. That formed the factual basis for the argument that the client's right to self-determination had been compromised.

Finally, the firm recalculated the loss after the physical appraisal. Applying the assessed 10 percent loss of earning capacity, it revised the claim for lost future income. It treated the spinal cord stimulator implantation as a past treatment cost and claimed future medical expenses, medication, and battery replacement as future treatment costs.

Outcome

The court issued a settlement recommendation decision. Under its terms, the hospital was to pay the client 110 million won by a specified deadline, the client waived the remainder of her claim, and each side was to bear its own litigation costs.

In Korean civil procedure, a court may recommend settlement terms when it considers that a resolution along those lines is appropriate. If neither party objects within the statutory period, the recommendation becomes final and operates in a manner comparable to a settlement, ending the dispute without a further judgment. A settlement recommendation is not a judgment that resolves every factual and legal allegation in the case. For that reason, the outcome should be understood as the terms the court considered appropriate for resolution, rather than as a judicial finding on each element of the claim.

What This Case Shows

The case illustrates how a medical malpractice claim in Korea can be built from the diagnostic process rather than from the operation alone. The key questions were what information was available before surgery, what testing was done, and whether the treatment plan followed from a proper assessment.

It also shows why the sequence of care matters. When conservative treatment is the ordinary first step, a decision to proceed directly to surgery — and then to a second operation within weeks — can become a central issue in the case, and can support an argument of hospital negligence.

The record was decisive. Imaging reports, operative notes, pathology results, the neurology consultation, and the transcript of the consultation each contributed to the claim. For patients, the case is a reminder that obtaining and preserving medical records, and noting what was and was not explained, can materially affect the ability to pursue a claim.

Finally, the case reflects how damages are assessed in Korean medical malpractice claims. Lost earning capacity must be supported by a court appraisal, and future treatment costs — including the long-term costs of implanted devices — can form a substantial part of the resolution.