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Leg length difference after TKR! What can be done?

Posted by Mamie @mamie, May 12, 2018

My sister, who also has chronic venous insufficiency, had a total knee replacement at the end of February. Has been doing exercises, going to PT, but after more pains, her PT suggest she start using a cane. Pain in legs and lower back. Finally PT measured her and said her "new knee" leg is 1.6 inches!!! longer than the other one. She is devastated that she is now in worse pain than she was before TKR. She was told to build up the shoe of her shorter leg and find someone to add to the bottom of the shoe as well. Now she can't walk around barefoot anymore but has to put on shoes to ease the pain even a little. What can she do? Any suggestions?

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arthriticgrammy | @arthriticgrammy | 4 days ago
In reply to @arthriticgrammy "I'm 77 years old and live in Maine. The right side of my right foot hurts..." + (show)
@arthriticgrammy

I'm 77 years old and live in Maine. The right side of my right foot hurts so much that I limp and hobble. Yesterday, a podiatrist said there's a 0.8 inch discrepancy between the length of my legs.

Due to arthritic pain, an orthopedic surgeon did some minor surgical adjustment to my left knee in 2016, but to hurt more than before. I needed two TKRs, but he refused to do the left knee 1st. So I had the right TKR in 2017 and the left TKR in 2018.

I recovered with the usual pain, pills, ice water wrap, and PT. Soon I easily walked miles at a time. Both knees remain stiff, so I cling to railings on steps and stairs (should probably get more PT for this, but we downsized to a 1-story house).

The podiatrist wrote there's a "limb length discrepancy causing foot inversion, which stresses the peroneal tendon. The right leg is much shorter than left, 2.2 cm [0.87 inches], likely due to knee replacements about 7 or 8 years ago. You will need a right heel lift to help offset this limb length issue, stop the foot inversion, and solve the tendonitis."

He placed a ½ cm lift ("double felt") under the heel of the insole of the right Brooks shoe and suggested we order a heel lift on Amazon that comes with 4 quarter inch layers. I'm to experiment with different sizes. He said, "one half inch may work best" and told me to apply diclofenac gel to the area and ice as needed." I have another appointment in 4 weeks.

Walking is still agonizing but I limp less for an hour or two after rubbing in the gel. He said it will take 2 or 3 weeks for my leg to adjust to the heel insert. At least now I have a bit of hope for improvement. I love to walk, and spring is coming!

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UPDATE: Just back from the ER here in central Maine, wearing a plastic boot. I'd done my normal morning chores wearing a shoe with an elevated heel, walked across my soft bedroom rug, and felt something go SNAP! From that instant, I've been unable to put any weight on the right foot.

The ER doc did an x-ray, said no fracture (probably only an MRI would clarify but it would take >4 months to schedule one due to my pacemaker).

From my discharge: The right ankle is moderately swollen with no warmth, erythema, ecchymosis or deformity. There is ttp [must mean tenderness to palpation, since I don't have thrombotic thrombocytopenic purpura!] over right mid-foot with no induration, deformity, no open wound.

"The achilles is intact included a normal Thompson test and ankle drawer is stable. There is normal sensation to pin-prick and normal capillary refill. There is a normal dp and p.t. pulse, stable, symmetric knees on anterior, posterior, valgus or varus stress."

They're calling it "an injury to one of the ligaments in the feet. Ligaments are strong tissues that connect bones to each other. The ligament can be stretched too much. In some cases, it may tear. A tear can be either partial or complete. The severity of the sprain depends on how much of the ligament was damaged or torn."

They advise: "Rest, ice, pressure (compression), and elevation (RICE--raising your injured foot, and keeping your foot in a fixed position (immobilization) for a period of time. This is done if your ligament is overstretched or partially torn. The purpose of the walking boot is to keep your foot from moving until it heals."

Geez, just when I thought the heel riser had me halfway recovered from the pain on the side of my foot.

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