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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@loriaakre

So sorry you have the numbness in the foot. Yes it is very uncomfortable. My Surgeon told me 1 to 2 years as nerves only heal 1 mm a day and it is a long way to your feet. Have them do an ABI test. It measures the pressure in your legs. It's just like a blood pressure test. that is how they determined that I had a blocked popliteal artery behind my knee that supplies blood flow to my foot and needed surgery to open it up. My toes were purple and foot was cold all the time. Half of the numbness went away right after that surgery and my toes were not purple and foot was warm, but still has some numbness and my foot feels cold but really isn't. They did put me on gabapentin which did help some of the pain, but not all of it. It took a lot to convince a dr. that it wasn't normal. It was my primary that finally said it was not normal. It was 60 days out from TKR that I had the popliteal artery surgery. I had also told the surgeon that my knee clicks all the time from day one. of course that is normal as well. well now I found out 7 months out that I have a fractured knee cap. I have an appoint next week with the surgeon. Will be interesting to see what he has to say now. The surgeon will NOT take responsibility for what they do wrong! I saw 5 different dr. who all said it was normal. I had had my other knee done in 2013 so I knew what normal should of been.
Take care of YOU! and be an advocate for yourself.

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Thank you for the information. I really appreciate you sharing your story with me. I called my family dr and I asked if I could get the ultra sound done on my feet. Maybe I'll get some answers.

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good luck! the ABI is a test on your legs. You could also have a nerve test done by a neurologist. I was going to have one done but since I am on Plavix (a blood thinner) he would not do one.
Wishing you the best.

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@sandie2749

Lori, now that you know what it is what are you doing for it? I just need to know which way to go with this. My foot was totally numb right after surgery which was May 21st, two weeks later I started pain And what everybody now was telling me my sciatica, however I have the foot neuropathy before the sciatica ever started acting up right now I feel I’m in limbo

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I think I am replying to the post by sandie? I am 6 months out from right tkr and what you are experiencing sounds like what I did right after surgery. I have gone to a neurologist, podiatrist and back to my surgeon a few times trying to figure out if it is a nerve or tendon problem. My foot pain started getting much better as I increased movement on stationary bike -about 2 months after surgery. Then the sensations changed, less numbness and pain, but fatigue feeling in the foot followed by pain, as well as ankle, but the knee felt fine. Then it all became worse at 5 months, and although I just reached a mini goal of cycling 50 miles yesterday, when I have only been able to do only 20-30 since I got on my road bike in June, I have extreme pain when I have my knee bent and move my leg to the left. Pain goes from the back of my knee, down the leg to the inside of my foot, and my big toe is usually numb. I also have extremely tight pulling behind my right hip or lower back. When I do heel slides or go down deep stairs, it pulls incredibly painfully. Do you have this? My podiatrist and PT think there was too much pressure on one of my nerves (maybe peroneal) during surgery. The surgeon denies any connection and will not talk about it. I had a nerve velocity test done and the neurologist was very skeptical, reported no sensation in a nerve that is not associated sith any symptoms or possible problems. I think he misreported, he was very rude to me, like "you are crazy to think it has anything to do with tkr". I am trying to get my surgeon to approve of a repeat test with someone else. Do you have pain down your leg? They think it may be my sciatic nerve with the tightness problem in my right lower back...just can't figure it out.

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@loriaakre

good luck! the ABI is a test on your legs. You could also have a nerve test done by a neurologist. I was going to have one done but since I am on Plavix (a blood thinner) he would not do one.
Wishing you the best.

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Thanks for the info i'll mention it to my family doctor. Have a good night.

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I’m a year and a half out from TKR and after a second surgery on it finally got flexion - but the inside of the knee and behind the knee still are bruised and painful. In addition, I have been unable to stand for more than 10 minutes or walk more than 30 for that year and a half. After the “not my problem” attitude from the original surgeon, I finally found a practice willing to take me. The knee surgeon in that practice referred me to a foot and ankle surgeon who diagnosed Tarsal Tunnel syndrome - a compression of the tibial nerve where it enters a narrow canal at the ankle. She prescribed more PT. The PT who has seen me since day one connected the dots between where I’ve been complaining about the knee and the new diagnosis on the ankle. He said my tibial nerve is probably compressed from either the continued swelling or actual knee replacement. That my complaints are all on the same nerve. I relayed his comments to the foot surgeon who then referred me to a neurologist for a EMG/NCS/NCV Test. If you have tingling / pain in your foot after TKR - ask for a referral and this test from your primary. It seems as though the knee surgeons won’t order it because they know they caused the issue.

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@melcpa86

I’m a year and a half out from TKR and after a second surgery on it finally got flexion - but the inside of the knee and behind the knee still are bruised and painful. In addition, I have been unable to stand for more than 10 minutes or walk more than 30 for that year and a half. After the “not my problem” attitude from the original surgeon, I finally found a practice willing to take me. The knee surgeon in that practice referred me to a foot and ankle surgeon who diagnosed Tarsal Tunnel syndrome - a compression of the tibial nerve where it enters a narrow canal at the ankle. She prescribed more PT. The PT who has seen me since day one connected the dots between where I’ve been complaining about the knee and the new diagnosis on the ankle. He said my tibial nerve is probably compressed from either the continued swelling or actual knee replacement. That my complaints are all on the same nerve. I relayed his comments to the foot surgeon who then referred me to a neurologist for a EMG/NCS/NCV Test. If you have tingling / pain in your foot after TKR - ask for a referral and this test from your primary. It seems as though the knee surgeons won’t order it because they know they caused the issue.

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Thank you for the info. I will ask my Dr. To schedule the other w tests.
The neurologist I did see did start an EMG but didn't finish because I
reminded him I was still on plavix from the artery surgery after he broke
that incision open. My tkr surgeon too does not take responsibility for the
pinch popliteal artery that he did during my tkr. His response we was why
did I wait 60 days to get it fixed then most people loose their legs if
that happens. I see him again on Oct 3. I'll see what he says about my now
fractured knee cap. Who he will blame that on besides me again. Good luck
with your foot n knee.

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I had my left knee replaced in June of 2010 and my right knee replaced in February 2011. Before replacements I already had neuropathy. Unfortunately it has just gotten worse. I also don’t have great range of motion. I had an injury to my right knee in 2012, a freak accident. I began experiencing a greater loss of range of motion and I couldn’t get my doctor to listen to me regarding the increased pain and decreased motion. I researched trying to figure out what was going on. I had a physical therapist tell me he thought I may have arthrofibrosis. I began to research specialists that can deal with this and found a doctor with the Hughston Clinic in Columbus, GA. I went for a consult and he could see a calcification in the Xray that my doctor could not see in the Xray they took. It turned out my patella was shattered and the bone from my femur or tibia had been damaged and had began to grow between the artificial joint blocking my already limited range of motion and it felt like it was pushing upward into the tissue of my thigh. Prior to having this surgery completed to figure out what was going on, this doctor also told me that I had an ankle condition, mild valgus ankle, but enough to effect the outcome of my knee replacement. He advised I should have had my ankles repaired before having the knee replacements. At 55 years old and overweight I wasn’t going to have ankles repaired with no guarantee it will improve my range of motion in the ankle or the knee. Ankle surgery also takes about a year to completely heal from and I’m single and must work. I’ve always had fat ankles and flat feet and I’d had no doctor tell me there was a problem. I’m now 59 and my neuropathy is almost unbearable. I’d been on Lyrica prior to the replacements, covered by Workman’s Comp because the left knee was under a work injury, and this controlled the neuropathic pain. Almost immediately after the 2nd surgery I was taken off the Lyrica by a PA that told me “you don’t have neuropathy any longer you don’t need the Lyrica”. I told him yes I did have neuropathy but he just refused to listen. This pain has just gotten worse through the years instead of better. I can’t afford Lyrica, it’s not covered by my insurance. I hope the generic version that is out now will work if I can get someone to prescribe it for me. I’ve been on Gabapentin through a pain clinic and it just doesn’t work for me. Some generics don’t work for me, apparently I lack certain enzymes to metabolize some medications properly. My life has been a real struggle since having the knee replacements. They did need replaced, the pain was uncomfortable but I didn’t go into the surgery well informed. Now the pain is almost unbearable. Get 2nd opinions, shop around. An assessment needs to be created to help determine a persons mobility limitations from early adulthood if possible. I realize now that there have always been certain movements I could never do, sitting cross-legged for example, sitting back totally flat on my feet, etc., again I’m having more pain in my right knee and I can’t get my same local knee doctor to hear me. As much as I hate going out of State I’m seriously thinking of going back to Georgia for an update. From my understanding my Georgia doctor had never seen bone growing between the prosthesis before so who knows maybe it is trying to grow again. I hate to take the time off from work and I dread going through a full open knee recovery for the fourth time.

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@kapmul - I'm so sorry to hear about the struggle you have had with your knee replacements. I'm glad you found Connect! Welcome! I have had two TKR's also and having recovered from both in a fairly uneventful way, I can truly say that reading about your situation with bone growing into the artificial joint just sent shivers up my spine. That must have been excruciating. You didn't mention where you are located, but you did mention "going back to Georgia." Have you considered getting another opinion elsewhere? I would totally recommend Mayo in Jacksonville, FL for the great work their orthopedic surgeons do. Is that too far away for you to travel?

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@debbraw

@kapmul - I'm so sorry to hear about the struggle you have had with your knee replacements. I'm glad you found Connect! Welcome! I have had two TKR's also and having recovered from both in a fairly uneventful way, I can truly say that reading about your situation with bone growing into the artificial joint just sent shivers up my spine. That must have been excruciating. You didn't mention where you are located, but you did mention "going back to Georgia." Have you considered getting another opinion elsewhere? I would totally recommend Mayo in Jacksonville, FL for the great work their orthopedic surgeons do. Is that too far away for you to travel?

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Hi Debbra. I do live in Jacksonville. I’ve thought of Mayo, I’m actually a medical social worker and interned with Mayo when I was in Graduate school. Believe it or not my local doctor used to be with the orthopedic program at Mayo. Maybe even over it. I think he’s good at what he does, meaning the technical part and I have unusual issues. I’ve been to Mayo 2 times in the past for different issues. I do think they have excellent providers so for a second opinion it may be the thing to do. I really trust and respect the surgeon in Columbus. He is outstanding.

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@kapmul

Hi Debbra. I do live in Jacksonville. I’ve thought of Mayo, I’m actually a medical social worker and interned with Mayo when I was in Graduate school. Believe it or not my local doctor used to be with the orthopedic program at Mayo. Maybe even over it. I think he’s good at what he does, meaning the technical part and I have unusual issues. I’ve been to Mayo 2 times in the past for different issues. I do think they have excellent providers so for a second opinion it may be the thing to do. I really trust and respect the surgeon in Columbus. He is outstanding.

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@kapmul - I totally understand that trust issue. When you have it, that's half the battle. I'm glad you trust your Columbus surgeon. And I'm glad you have options for a 2nd opinion. In case you decide to go there for a 2nd opinion, my OS was Dr. Ortiguera. If you can get him, he is fabulous. What are you doing for the pain now?

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