Foot neuropathy (numbness and pain) after total knee replacement (TKR)

Posted by norby @norby, Nov 26, 2018

I had a right total knee replacement 10 weeks ago and came out of surgery with numbness and intermittent pain on the bottom of my right foot. However, I do have good motor function in that foot. The knee has been healing and with PT, movement is on track, but the foot is a major challenge. The foot pain at times is worse than any from the knee. I have been able to generally manage the foot pain with gabapentin. My surgeon believes this may resolve in time but may take from 6-12 months. However there is a possibility that it will never go away. Has anyone else experienced foot neuropathy following knee replacement? If so, what was your experience with it?

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@norby I am new and learning how to post things. Please see a post i made that i did not mention to anyone. I got the numb tingly foot prob after right TKR found out from an ABI i have no blood flow from tne back of my knee to my foot. I am scheduled for surgery to have the vein fixed. Surgeon said it could also be nerve damage so i have appt with nerology too. But hope after i get blood flow back it solves at lest park of the prob. Will post after vein surgery on April 10th.

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@loriaakre

@norby I am new and learning how to post things. Please see a post i made that i did not mention to anyone. I got the numb tingly foot prob after right TKR found out from an ABI i have no blood flow from tne back of my knee to my foot. I am scheduled for surgery to have the vein fixed. Surgeon said it could also be nerve damage so i have appt with nerology too. But hope after i get blood flow back it solves at lest park of the prob. Will post after vein surgery on April 10th.

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Hi, @loriaakre and welcome to Connect.
I am so glad you were able to find a reason for your numbness. Sounds like you had a good doctor for him/her to have found the problem. I hope the surgery goes well, and perhaps you won't need anything further with a neurologist too.
Keep in touch. I had no problem like this after either of two TKRs, but it does seem as if you are not the only one who has. That's really valuable information for people to consider who do have similar problems.
JK

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@loriaakre

I had total right knee replacement 2.12.2019. Right after getting to my room I noticed my foot was numb yet tingly with a lot of pain in foot that shot through my whole body and had a lot of pain in my knee. I knew this was not normal as i had my left knee 5 years prior and did not have a numb tingly foot or the extreme pain in the knee. Never took anything more than Tylenol. Now i was taking nocor with no pain relief. So they added deloted in my iv. Still no pain relief. When the Surgeon visited the next day he just brushed it off. Hospital dr. said he had no clue and blamed it on diabetes ( i am recently diagnosed). At PT i could not do the exercises because flexing the foot now caused pain in the calf. They did ultrasound for blood clots, none found. When i tried to put weight on the foot/leg, my knee buckled. So they put a stabler on that leg which ment my leg was stiff so i could stand. 4th day after surgery i went home with numb tingly foot and pain killers which i had to refill and the get a different pain killer because nothing helped the pain and i wasn't sleeping. Went to PT and got a good bend 135% and 90% flat by my ck up. Went for followup 2 1/2 week checkup with surgeon and was just told foot numbness and tingly could be from nerve block after surgery for knee pain or tourniquet to the thigh during surgery.
Not satisfied with that i went to my endocrinologist to make sure it was not from diabetes. She confirmed that it would be both feet if from diabetes. She set me up with an appointment with a family practice dr. (primary not available, she was her associate). At that appointment she thought it could be a blood clot or damage to my circulation in my legs, since PT could feel lumps in calf. She did prescribe gabapentin to help with the pain , numbness, tingling in foot. It did help lessen the systems, but did not get rid of it totally., but can at least sleep better. Again ultrasound showed no blood clots, but she also ordered an ABI to check for circulation pressure. This showed the pressure on that right leg from the knee down is half what it should be. This news sent me to the cardiologist who didn't think it was circulation but numbers don't lie. I was then scheduled for an angiogram. This proved the main artery from my knee down was NOT receiving ANY blood flow. So sent to a surgeon who works with veins. He did not want to say it was diffently from my knee replacement, but more than likely was something that happened during knee surgery. So i am now set up for yet another surgery to fix the vein in the back of my knee. I have also been set up with a neurologist incase it was nerve damage. The surgeon thought it could be both. But my new knee has multiple clicks so hurts when it clicks when i walk. So when i get done with the vein surgery and see if there is nerve damage, i am going back to the doctor who did my knee.
I am still taking tramadol at bed time and IB/Tylenol or naproxen/Tylenol during the day for pain. The calf has lost most of its muscle so it tires after a few steps. My bend has gone backwards to hardly 90% flat is less as well. Was able to go up and down stairs normally. NOT any more.
Hope this info helps. We have to advocate for ourselves.

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Thsnk you for your long response. I hope the surgery goes well and I will wait and see how it resolves fir you. When I came out of TKR surgery, my foot and ankle were extremely painful, like a truck was sitting on it, and felt like soneone had twisted it all the way around. Noone would tell me what was going on, and rhe nurses pur ice packs on it and forgot about it until my leg got cold burned. So I worked hatd at PT at home, am on bike 15 minutes, high resistance, over 120 flexion, but my foot feels like someone tied a string around some othe toes and numb on bittom. It is iff and on but really bad at night and kerps me from sleeping because it gets really painful. I have an apptment with GP to see what she tecommends as a specialist. I was extremely active 6 months before my surgery and still in really good shape, muscle tone, etc., no medical problems. I had the KR so I can enjoy cycling again, but if I have a painful foot, I can't even wear a sneakwr for a half hour without extreme pain. The surgeon dismissed it and said it was probably a back problem. I have never had, and don't have a back problem, as far as I know. It just seems like doctors deny things instead of being curious to look into it.

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Hi I had a right total knee replacement about 8 months ago and had numbness right away to the heel and right half of the bottom of the foot including my 4 and 5 baby toe
I asked my surgeon about it and he couldn’t explain why just that it can happen . He said it will take a while to improve and said the nerve comes back about a millimeter a day . I have had improvement but my heel has less feeling and my toes are over sensitive so I choose my shoes carefully and I am totally back to all activity as tolerated I have just found that the calf gets tired quickly and have to just work through it on walks . I did take nortryptiline for nerve pain instead of gabapentin less side effects and only needed it for a few weeks . My best advice is after 4 weeks get into physio in the pool. Walking against current in a lazy river and doing lunges etc. feels so much better than at physio . I was kicked out of physio at 6 weeks for doing to much but I still do the pool I will check back in a bit and let you know if the numbness resolved by 12 months or not . One recommendation is to get a crocus for the knee post surgery. Here in Canada it is mandatory to bring with you and it goes on right after surgery I used it all the time I was resting and it helps with the pain tremendously about 200 dollars. It is like Cooler filled with ice and water and it pumps through the knee cuff and doesn’t have a time limit like ice it is just circulated cold water

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@juliesknee

Hi I had a right total knee replacement about 8 months ago and had numbness right away to the heel and right half of the bottom of the foot including my 4 and 5 baby toe
I asked my surgeon about it and he couldn’t explain why just that it can happen . He said it will take a while to improve and said the nerve comes back about a millimeter a day . I have had improvement but my heel has less feeling and my toes are over sensitive so I choose my shoes carefully and I am totally back to all activity as tolerated I have just found that the calf gets tired quickly and have to just work through it on walks . I did take nortryptiline for nerve pain instead of gabapentin less side effects and only needed it for a few weeks . My best advice is after 4 weeks get into physio in the pool. Walking against current in a lazy river and doing lunges etc. feels so much better than at physio . I was kicked out of physio at 6 weeks for doing to much but I still do the pool I will check back in a bit and let you know if the numbness resolved by 12 months or not . One recommendation is to get a crocus for the knee post surgery. Here in Canada it is mandatory to bring with you and it goes on right after surgery I used it all the time I was resting and it helps with the pain tremendously about 200 dollars. It is like Cooler filled with ice and water and it pumps through the knee cuff and doesn’t have a time limit like ice it is just circulated cold water

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Hi @juliesknee - Welcome to Connect! You certainly shared some great information. I've had 2 TKRs - the most recent in January of this year - and I had never heard of the crocus. Can you share more about what you do in the pool? Is it mainly walking or also exercises? I'm getting ready to start going to the pool and that will be an incentive!

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@juliesknee -- I thought about buying one of those knee coolers but I already had a couple of large gel cooling pads. I think the crocus (brand name?) or a cooling pad is much better for the knee and easier to keep it against the knee. There are a lot of different ones on Amazon but this is one that I found.

https://www.amazon.com/dp/B07H3GW4W7/
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My wife had a TKR 4 months ago and also suffers from foot pain in that same leg immediately following the surgery. The knee is rehabbing fine but the foot pain is a significant complication for which she takes Lyrica and Tramadol. Her surgeon was of no use (he suggested seeing a podiatrist!) so my wife has seen a neurologist and a pain specialist. So far, no diagnosis or remedy but we keep trying.

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@loriaakre

I had total right knee replacement 2.12.2019. Right after getting to my room I noticed my foot was numb yet tingly with a lot of pain in foot that shot through my whole body and had a lot of pain in my knee. I knew this was not normal as i had my left knee 5 years prior and did not have a numb tingly foot or the extreme pain in the knee. Never took anything more than Tylenol. Now i was taking nocor with no pain relief. So they added deloted in my iv. Still no pain relief. When the Surgeon visited the next day he just brushed it off. Hospital dr. said he had no clue and blamed it on diabetes ( i am recently diagnosed). At PT i could not do the exercises because flexing the foot now caused pain in the calf. They did ultrasound for blood clots, none found. When i tried to put weight on the foot/leg, my knee buckled. So they put a stabler on that leg which ment my leg was stiff so i could stand. 4th day after surgery i went home with numb tingly foot and pain killers which i had to refill and the get a different pain killer because nothing helped the pain and i wasn't sleeping. Went to PT and got a good bend 135% and 90% flat by my ck up. Went for followup 2 1/2 week checkup with surgeon and was just told foot numbness and tingly could be from nerve block after surgery for knee pain or tourniquet to the thigh during surgery.
Not satisfied with that i went to my endocrinologist to make sure it was not from diabetes. She confirmed that it would be both feet if from diabetes. She set me up with an appointment with a family practice dr. (primary not available, she was her associate). At that appointment she thought it could be a blood clot or damage to my circulation in my legs, since PT could feel lumps in calf. She did prescribe gabapentin to help with the pain , numbness, tingling in foot. It did help lessen the systems, but did not get rid of it totally., but can at least sleep better. Again ultrasound showed no blood clots, but she also ordered an ABI to check for circulation pressure. This showed the pressure on that right leg from the knee down is half what it should be. This news sent me to the cardiologist who didn't think it was circulation but numbers don't lie. I was then scheduled for an angiogram. This proved the main artery from my knee down was NOT receiving ANY blood flow. So sent to a surgeon who works with veins. He did not want to say it was diffently from my knee replacement, but more than likely was something that happened during knee surgery. So i am now set up for yet another surgery to fix the vein in the back of my knee. I have also been set up with a neurologist incase it was nerve damage. The surgeon thought it could be both. But my new knee has multiple clicks so hurts when it clicks when i walk. So when i get done with the vein surgery and see if there is nerve damage, i am going back to the doctor who did my knee.
I am still taking tramadol at bed time and IB/Tylenol or naproxen/Tylenol during the day for pain. The calf has lost most of its muscle so it tires after a few steps. My bend has gone backwards to hardly 90% flat is less as well. Was able to go up and down stairs normally. NOT any more.
Hope this info helps. We have to advocate for ourselves.

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Thank you for the advice on the ABI. My wife had a TKR 4 months ago and post surgery the foot pain came and soon was far more of a problem than the knee rehab. The knee is rehabbing great, but the foot pain is a significant complication for which she takes Lyrica and Tramadol. Her surgeon was of no use (he suggested seeing a podiatrist) so my wife has seen a neurologist and a pain specialist. So far, no diagnosis or remedy but we keep trying. I think having an ABI run makes sense ...

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@prayinforhealin

My wife had a TKR 4 months ago and also suffers from foot pain in that same leg immediately following the surgery. The knee is rehabbing fine but the foot pain is a significant complication for which she takes Lyrica and Tramadol. Her surgeon was of no use (he suggested seeing a podiatrist!) so my wife has seen a neurologist and a pain specialist. So far, no diagnosis or remedy but we keep trying.

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Hello @prayinforhealin, welcome to Connect. There is another discussion here on Connect that may be helpful.

> Groups > Neuropathy > Myofascial Release Therapy (MFR) for treating compression and pain
-- https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Did your wife's neurologist do any tests for neuropathy?

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@johnbishop

Hello @prayinforhealin, welcome to Connect. There is another discussion here on Connect that may be helpful.

> Groups > Neuropathy > Myofascial Release Therapy (MFR) for treating compression and pain
-- https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Did your wife's neurologist do any tests for neuropathy?

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Thank you for quick response. My wife's neurologist ordered an EMG test from a physiologist. Results said the nerves were all intact but "overactive" and should settle down. But that was 4 months ago and the condition is not much better so we continue to look. I was reading about a Nerve Conduction Velocity (NCV) test so we might want to pursue along with the ABI blood flow test that was mentioned in an earlier post.

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