with an incidence rate of 0.92% , maternal puerperal lower extremity nerve injuries are rare .
lateral femoral cutaneous neuropathy ( meralgia paraesthetica ) is the most common , followed by femoral neuropathy .
nerve injuries are more likely to occur in nulliparae , in cases of prolonged stages of labour and assisted vaginal deliveries .
the presented case involved a 32-year - old woman with bilateral heel numbness due to bilateral neuropathy of the medial calcaneal nerve due to external compression during vaginal delivery .
a 32-year - old woman presented to our neurology outpatient clinic with tingling and numbness in both heels .
she continuously complained about these sensations ever since she had given vaginal birth to her first child 3 months earlier in a hospital .
spinal analgesia ( lumbar level , bupivacaine / sufentanyl bolus , followed by a continuous administration of 8 ml / h ) was used during labour .
the first stage of labour was prolonged , and because of fetal compromise during the expulsion phase , a vacuum delivery system ( palmpump kiwi ) , together with episiotomy , was used for fetal extraction .
after delivery , the epidural analgesia was continued during the closure of the episiotomy with sutures .
the patient did not use any other medication and had no history of neurological disorders or risk factors for neuropathy ( diabetes , hypothyroidism or hereditary liability to nerve pressure palsy ) . on examination , she had hypoaesthesia in the area of both heels .
the strength of both the leg and foot muscles was normal , and so were the deep tendon reflexes .
, a near - nerve needle conduction study of the medial calcaneal nerve was not performed .
a diagnosis of bilateral neuropathy of the medial calcaneal nerve , most likely due to longstanding pressure on both heels with epidural analgesia as a predisposing factor , was made .
three months after presentation ( 6 months after delivery ) , her numbness had diminished , but had not completely disappeared .
bilateral neuropathy of the medial calcaneal nerve due to external compression during delivery using epidural analgesia is very rare .
only 1 patient with numb heels has been reported in a large study , describing 2,615 women who received epidural anaesthesia during delivery .
however , no details about delivery or analgesia in that patient were mentioned . in epidural analgesia during delivery , a motor block is unwanted , and thus voluntary muscle movements are possible , which makes longstanding external compression of nerves uncommon . in our patient ,
prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy probably masked signs of external compression on both heels .
the medial calcaneal nerve arises from the tibial nerve at the medial side of the ankle , perforates the laciniate ligament , travels downwards , passing the bony projection below on the inner side of the ankle , and supplies the skin over the medial aspect of the heel .
patients with risk factors , such as diabetes , are at a greater risk of developing neuropathy during epidural anaesthesia .
however , also without any risk factors , the clinician should be aware of the absence of the normal reaction to longstanding pressure on a nerve during epidural analgesia .
preventative measures like soft gel pads or intermittent posture changes could possibly prevent neuropathy of the medial calcaneal nerve in long - lasting epidural analgesia .
bilateral medial calcaneal nerve neuropathy as a result of external compression is a rare complication of epidural obstetric analgesia .
 we describe the case of a 32-year - old woman who developed bilateral heel numbness after obstetric epidural analgesia . 
 we diagnosed her with bilateral neuropathy of the medial calcaneal nerve , most likely due to longstanding pressure on both heels . 
 risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy . 
 padded footrests decrease pressure and can possibly prevent this neuropathy . 
Introduction
Case Report
Discussion
Conclusion
Disclosure Statement