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Forum Name: Rheumatology Topics

Question: Unexplained severe heel pain


 JP - Wed Jan 21, 2004 12:09 pm

After a recent elective 8 hr. surgery, my 54 year old husband developed severe pain in the heels of his feet. The doctor and the hospital seem to be stumped to what may of caused this. He cannot walk without a walker nor take any pressure, even slight, on the bottom of his feet. He is nearly bed-ridden with depression setting in and living 24/7 on strong pain killers, which are the only things that allow him sleep or relief of any kind. His surgery was on Jan. 9th and I am very concerned about the large amounts of medicines they have him on while we are in this 'wait and see if time helps' stage. No one seems to be able to put a name to this condition nor give us any answers about it or what to expect or even if he will recover from this. Has anyone ever heard of anything like this? I would appreciate any info that could steer me in the right direction to find some answers, whether it be an informative website, a name for this condition, or a specialist that we might seek out for help? We are desperate for any kind of information and would appreciate ANY imput you could share with us.

Thank you
 Dr. Tamer Fouad - Thu Jan 22, 2004 1:02 pm

User avatar JP,
What kind of surgery was that?
 JP - Thu Jan 22, 2004 1:15 pm

It was plastic surgery Doctor. Tummy tuck, chin uplift, and eyes tightened. Thank you
 Dr. Tamer Fouad - Thu Jan 22, 2004 1:52 pm

User avatar JP,
I would have to guess at this one.
There are many structures attached to the heel bone (calcaneus). The two structures primarily associated with heel pain are the plantar fascia (band of connective tissue along the bottom of the foot that supports the arch) and the flexor digitorum brevis muscle.

The causes of heel pain are many but most commonly:

Traumatic to the plantar fascia or the flexor muscle or the tissues in the heel area.

Entrapment neuropathy in which a nerve is compressed by surrounding tissues ,

Disc disease in which a disease of the vertebral disc causes compression of a nearby nerve that carries pain sensation.

Arthritis and connective tissue diseases can also cause pain in the heel. Tumors, infections and bone problems (calcaneal apophysitis) can all cause heel pain.

But none of these causes quite fit the description you stated. Most of these causes are chronic diseases except for trauma (which is easily excluded). We are left with one possibility and I must warn that this is only a thoery. One of the rather rare causes of heel pain is vascular compromise.

Now lets talk a little about abdominoplasty:
Several large studies address the issue of complication in liposuction patients: Teimourian (1989) conducted a national survery of 935 plastic surgeons who performed 76,000 “major” liposuctions from 1984-1989; overall complication rate was 0.1%; 2 deaths, one from pulmonary embolism and the other a fat embolus. Free fat can be found in the blood of all patients undergoing more than 900cc liposuction, according to one study. This is usually subclinical. Fat embolism syndrome is a separate entity that was first described in 1861, classically from a long bone fracture. Symptoms generally occur within 24 hours, they are tachycardia, tachypnea and fever; hemoptysis if there are pulmonary fat emboli, and neurologic symptoms if to the brain – the smaller fat globules go through the lung. The point is that an embolus which starts in a vein is usually caught up in the lung vessels before it goes to the heart. As I just stated if the embolus is small enough it passes through the lung vessels and reaches the heart. Once it reaches the heart there is no telling where it could end. So to state this remote theory clearly: The fat embolus from the abdominoplasty passed through the lungs to the heart and from there ended up in the heel vessels where they caused ischemia (or loss of blood to a small area in the heel). Ischemic pain is very painful and causes substantial compromise.

I would advise you to discuss this issue with your doctor. He is in a better position to judge what causes to include and which to exclude. Please do get back here after your visit and let me know how things went.

Best of luck!
 JP - Thu Jan 22, 2004 2:14 pm

As of this morning, my husband went to his surgeon for a check-up. Everything is healing well except his heels. The doctor told us that he didn't want to say anything in hopes that the heels would mend themselves. I guess when they put the restraints on my husband for surgery, they didn't pad them. Being that he was under so long and in a head-down position, oxygen and blood didn't get to his feet-hence the sever pain. The doctor said because of what happened to my husband, hospital policy on this matter will be changed for future patients. He said if this doesn't clear up soon, he will have to perform another surgery and cut out whatever dead tissue is causing the problem. He never really explained tho, what we might be facing and if we will have a "full recovery". I'm not really sure how he can know the extent of damage done without some kind of test as I researched your response the best I could, being I by no means, understand most of this medical mumbo-jumbo :), but I guess some of my concerns were answered between you and what the surgeon had to say today. I can only hope that we can get him off these 50 or so heavy pain killers every 3 days soon and be able to put the walker to rest for good.It will be nice to have our "Mr. Sunshine" back instead of the mad-wheeling walker grouch. lol In his search for youth, (have to LOVE the mid-life crisis thingee!), I personally wonder if it was worth the price. Thank you so very much for your concern, your prompt replies and for "being here" for us. God Bless you and your staff.
 Dr. Tamer Fouad - Thu Jan 22, 2004 3:28 pm

User avatar JP,
Your doctor's explanation is very credible indeed. Like I mentioned earlier it seemed like a vascular thing. I just could not imagine what would lead to ischemia during a surgery of this kind.

Hope your husband husband will have a quick recovery.
 dalton - Sun Sep 18, 2005 1:56 am

:roll: Wow: i have never joined a foum via a more circuitous route, having to register mutiple times despite being told not to. But here was a patient in distres so I felt I ineeded to heed the call. How many still beleive in the Hippocrtic Oath?

Painful heels. I am a foot doctor so i would hope that the services of a foot doctor (podiatrist) were considered for this patient.

Vasculalr etiology would make sense for acute heel pain but did anyone pay attention to the positioning of the patient during the procedure. Positioning that somehow compressed the feet, that is compressing the posterior tibial nerves or medial calcaneal nerves sould cause a suddnen onset of heel pain.

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