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

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.

I have had the exact same problem with numbness and tingling on the bottom of my foot with my little toe sending a zinger if you touch it. My PT was going well with good bend and straightening, but my calf was getting weaker and I was losing muscle tone. My TKR surgeon told me give it a year or two. Being a advocate for myself that did not set with me because my foot was cold all the time and my toes would turn purple and then a ghostly white. I went to my primary Dr. and she suggest having an ABI test done that measures the pressure in your legs. Found it was .40 on my TKR leg (right) and 1.26 on my left leg which I had done back in 2013 with NO issues afterwards. After that test I was sent to a cardiologist who sent me for an angiogram which showed I had NO blood flow from behind my surgery knee to my foot! My Popliteal Artery had been pinched off during my TKR. So was sent to a surgeon and was set up to open the back of my knee (10 inches). He cut open the popliteal artery 5 inches and cleaned out 2 inches of dead dried blood!!! coming out of surgery my foot was warm, my toes were purple, and SOME of the tingling and numbness was gone, but there was still some left. I Had another ABI test and now both legs are 1.40 for pressure. I went to the neurologist and I do have nerve damage to my foot that again might or might not correct itself in a year. He gave me directions to: eat an egg a day, eat vegetables and fruits, and take the following vitamins: B1 Thiamine-100 mg; B12 5 mg sublingual (under the tongue): CoQ10 + E (Qunol) 100 mg capsule; B Complex; and Aplha Lipoic Acid 100 mg. He has had other patients with same issues and he has had great success, but it takes time.
I did go back to my TRK surgeon to tell him what had happened...Basically said you sound like you are angry with me... YES I AM! He sent me for x-rays. When I got back he had a different attitude! Then he said why did I wait 60 days to get the artery fixed... SAID NO ONE WOULD LISTEN TO ME! Then he told me "I have seen this happen and you know you could have lost your leg!" the ABI test is a simple test. just like taking blood pressure only on your legs with special cuffs. Hope this helps and doesn't scare you.

I have had the exact same problem with numbness and tingling on the bottom of my foot with my little toe sending a zinger if you touch it. My PT was going well with good bend and straightening, but my calf was getting weaker and I was losing muscle tone. My TKR surgeon told me give it a year or two. Being a advocate for myself that did not set with me because my foot was cold all the time and my toes would turn purple and then a ghostly white. I went to my primary Dr. and she suggest having an ABI test done that measures the pressure in your legs. Found it was .40 on my TKR leg (right) and 1.26 on my left leg which I had done back in 2013 with NO issues afterwards. After that test I was sent to a cardiologist who sent me for an angiogram which showed I had NO blood flow from behind my surgery knee to my foot! My Popliteal Artery had been pinched off during my TKR. So was sent to a surgeon and was set up to open the back of my knee (10 inches). He cut open the popliteal artery 5 inches and cleaned out 2 inches of dead dried blood!!! coming out of surgery my foot was warm, my toes were purple, and SOME of the tingling and numbness was gone, but there was still some left. I Had another ABI test and now both legs are 1.40 for pressure. I went to the neurologist and I do have nerve damage to my foot that again might or might not correct itself in a year. He gave me directions to: eat an egg a day, eat vegetables and fruits, and take the following vitamins: B1 Thiamine-100 mg; B12 5 mg sublingual (under the tongue): CoQ10 + E (Qunol) 100 mg capsule; B Complex; and Aplha Lipoic Acid 100 mg. He has had other patients with same issues and he has had great success, but it takes time.
I did go back to my TRK surgeon to tell him what had happened...Basically said you sound like you are angry with me... YES I AM! He sent me for x-rays. When I got back he had a different attitude! Then he said why did I wait 60 days to get the artery fixed... SAID NO ONE WOULD LISTEN TO ME! Then he told me "I have seen this happen and you know you could have lost your leg!" the ABI test is a simple test. just like taking blood pressure only on your legs with special cuffs. Hope this helps and doesn't scare you.

Thank you for the detailed information. I have had numbness and pain in my right foot after TKR in that leg. The surgeon said it has nothing to do with the surgery and that I probably have back issues. It was excruciating for months after surgery, and the sheet touching my big toe would be horrible. I am three months out from surgery now and it has improved incredibly. My foot does not keep me awake at night now the way it did. It seemed like as my flexion degrees increased gradually, the foot pain decreased. It coincided when I started focusing earnestly on stretching the quads by pulling my leg up towards my buttocks with a strap while lying on my stomach. When I did the flexion exercise for my knee by bending it up with a strap while lying on my back, I could feel a psinful pull along the outside if my foot. Everything was so tight. Some exercises I coukd not do because of the pain in my foot so it was getting in the way of rehabbing the knee. It seems that when I started going on my bike (on a trainer) longer and more rigorously, the foot pain was very bad,with my sneaker exacerbating it, but then it got gradually less. It is weird that it comes and goes. Some days I barely notice it and other times it gets very noticeable at the end of the day. I started doing lunges this week and now the foot is acting up. I have taken the attitude that I Will not focus on it and just work through the rehab exercises for my knee, expecting that it will graduslly subside. I do have an appointment with a neurologist fir an EMG. What specislist will do an ABI? I want to look into that. My foot used to be extremely cold and get white. Now the color and temperature are fine! Another thing I should say is that from my observation, it seems to be linked to the swelling in my knee. My knee was extremely swollen all the time until a couple of weeks ago, but it seemed to make my whole leg, back, quads,hamstring, very tight, which seemed linked to the foot problem.

Thank you for the detailed information. I have had numbness and pain in my right foot after TKR in that leg. The surgeon said it has nothing to do with the surgery and that I probably have back issues. It was excruciating for months after surgery, and the sheet touching my big toe would be horrible. I am three months out from surgery now and it has improved incredibly. My foot does not keep me awake at night now the way it did. It seemed like as my flexion degrees increased gradually, the foot pain decreased. It coincided when I started focusing earnestly on stretching the quads by pulling my leg up towards my buttocks with a strap while lying on my stomach. When I did the flexion exercise for my knee by bending it up with a strap while lying on my back, I could feel a psinful pull along the outside if my foot. Everything was so tight. Some exercises I coukd not do because of the pain in my foot so it was getting in the way of rehabbing the knee. It seems that when I started going on my bike (on a trainer) longer and more rigorously, the foot pain was very bad,with my sneaker exacerbating it, but then it got gradually less. It is weird that it comes and goes. Some days I barely notice it and other times it gets very noticeable at the end of the day. I started doing lunges this week and now the foot is acting up. I have taken the attitude that I Will not focus on it and just work through the rehab exercises for my knee, expecting that it will graduslly subside. I do have an appointment with a neurologist fir an EMG. What specislist will do an ABI? I want to look into that. My foot used to be extremely cold and get white. Now the color and temperature are fine! Another thing I should say is that from my observation, it seems to be linked to the swelling in my knee. My knee was extremely swollen all the time until a couple of weeks ago, but it seemed to make my whole leg, back, quads,hamstring, very tight, which seemed linked to the foot problem.

You might find the follow site helpful for explaining neuropathy and the tests used to diagnose.

NIH - Peripheral Neuropathy Fact Sheet
-- https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet

John thank you for this information. I reviewed the link with my wife last night and we noticed there are 2 common tests conducted for Peripheral Neuropathy: 1/ Nerve conduction velocity (NCV) test, and 2/ Electromyography (EMG) test. She had an EMG about 2 months ago which the Dr. said indicated "irritated nerve". But she did NOT have an NCV test which "measure signal strength and speed along specific large motor and sensory nerves". Would a Neurologist order such a test ? That's the path we are going down currently.