Post-Thoracic Surgery: Why Can't My Left Heel Support My Weight?

After thoracic spine surgery, the left heel is unable to bear weight?

Hello Doctor: I suffered a burst fracture of the twelfth thoracic vertebra last October and had steel rods and bone cement implanted.
Currently, I am able to walk with both legs.
However, my left heel cannot support weight on its own and tends to roll forward, making it impossible to walk on my heel, although I can support myself on my toes without any issues.
My right foot shows no symptoms.
The orthopedic department has been unable to determine the cause, so I was referred to a neurologist.
An electromyography (EMG) test revealed slight numbness on the outer side of my calf, and there is also weakness in the upward movement of my left big toe compared to the right.
The MRI report indicates that there is no compression on the L4 or L5 nerves.
There is no tenderness or pain in my heel, and the range of motion in the bare joints is normal.
I would like to ask the doctor what might be causing the inability of my left heel to support weight.
Thank you, Doctor.

wilson, 30~39 year old female. Ask Date: 2021/01/29

Dr. Chen Bochen reply Orthopedics

Based on the information you provided, it appears that the primary injury is to the L5 nerve.
The MRI shows no stenosis at the L4/5 level, but the L5 nerve may have been injured at the T12 level.
It is recommended that, in addition to investigating the cause, active rehabilitation is crucial.
You might also consider hyperbaric oxygen therapy for 10-20 sessions, as it may be beneficial.
Wishing you a speedy recovery.

Reply Date: 2021/01/29

More Info

Post-thoracic surgery complications can be complex and multifactorial, especially after significant procedures such as the one you underwent for a burst fracture at the T12 vertebra. Your symptoms of left heel instability and the inability to support weight on that heel, despite normal function in the toes and no apparent pain or tenderness, suggest a few potential underlying issues that may not be immediately apparent through imaging or standard neurological assessments.

Firstly, it’s important to consider the role of proprioception and balance. After a significant spinal injury and subsequent surgery, your body may have altered proprioceptive feedback mechanisms. Proprioception is the body’s ability to sense its position in space, and any disruption in this system can lead to difficulties in weight-bearing activities. The brain relies on input from various sources, including muscles, joints, and the vestibular system, to maintain balance and coordination. If the proprioceptive pathways from your left leg are compromised, this could explain why you feel unstable when attempting to bear weight on your left heel.

Secondly, muscle weakness or imbalance could also be contributing to your symptoms. Even if the MRI does not show nerve compression, there could be weakness in the muscles that control the ankle and foot, particularly those responsible for dorsiflexion and plantarflexion. The slight weakness in your left foot, as indicated by the inability to lift the big toe as effectively as the right, suggests that there may be some neuromuscular involvement that isn’t fully captured by imaging studies. Rehabilitation focusing on strengthening the muscles around the ankle and improving overall leg strength may help in addressing these issues.

Additionally, it’s worth considering the possibility of compensatory movement patterns that may have developed post-injury. After a significant injury, individuals often unconsciously alter their gait to avoid pain or discomfort, which can lead to further complications. This altered gait can place additional stress on certain muscles and joints, leading to weakness or instability in other areas, such as the heel.

Given that your symptoms have persisted despite thorough investigations, it may be beneficial to engage in a comprehensive rehabilitation program tailored to your specific needs. This program should include physical therapy focusing on strength training, balance exercises, and proprioceptive training. A physical therapist can provide targeted exercises to strengthen the muscles around your ankle and improve your overall stability, which may help restore your ability to bear weight on your left heel.

In summary, the inability of your left heel to support weight could stem from a combination of proprioceptive deficits, muscle weakness, and compensatory movement patterns following your thoracic surgery. A multidisciplinary approach involving orthopedic specialists, neurologists, and physical therapists will be crucial in addressing these issues effectively. Continued follow-up and possibly further diagnostic assessments may be necessary to monitor your progress and adjust your rehabilitation plan as needed.

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