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norby
@norby

Posts: 3
Joined: Nov 26, 2018

Foot neuropathy after total knee replacement

Posted by @norby, Mon, Nov 26 4:41pm

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?

REPLY

Hello @norby, I have small fiber PN with numbness and no pain and I am hoping for a TKR next spring for my right knee which is bone on bone. I have no medical training or background but am wondering if there was any possible nerve damage or compressed/pinched nerve that might be causing the foot pain. I'm tagging @contentandwell, @debbraw and @JustinMcClanahan to see if they are able to share any information with you.

I did find an article that may be helpful from the Wiley Online Library.
Risk factors for acute nerve injury after total knee arthroplasty
https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26045

Does your surgeon think it may be due to inflammation and eventually that will go away?

John

Thanks for your reply and referral to an interesting article. My surgeon does not believe that I have had nerve damage because I have good motor function. However, she does think that nerve compression from swelling is probably causing this. And that’s why she thinks this will “probably” improve with time. But there is always the qualifier that it may never get better.

Hello @norby. I would like to invite @gator1965 who has recently discussed neuropathic pain following a knee replacement, although I am not sure if it is located in the foot. I would also like to invite @gailfaith who also has some neuropathy in the foot and has also had a knee replacement. They may not be in the same situation as you, but may be able to offer some insight on having neuropathy as well as a knee replacement.

@norby, 10 weeks post op is still pretty recent. Although I did not personally deal with neuropathy, I did deal with prolonged swelling and pain. It took me a long time to recover from my knee replacement, but when I started to improve, it did come in what felt like waves rather than a slow progression. Has the foot pain got any better since its onset, or has it been constant? If you don't mind sharing, how are you doing with the gabapentin? Any side-effects?

The foot pain has been noticeable since I got off of opioids at about 10 days post op, although the numb feeling was present since the day of surgery. The pain is intermittent and can appear at random moments. It can feel like I am standing on hot coals; like I have needles inserted under my toenails; or like the side of my foot has been sliced with a knife. Sometimes anything that touches my foot can set it off, even a bed sheet. The gabapentin does help but it has been a little tricky getting to the right dosage. The only side effect that I have noticed is some drowsiness after taking it, although I can usually push past that if I need to.
I continue to have some swelling in the knee. My surgeon thinks that the neuropathy is related to this swelling and should improve in time. How long did your knee swelling last?
.

@johnbishop

Hello @norby, I have small fiber PN with numbness and no pain and I am hoping for a TKR next spring for my right knee which is bone on bone. I have no medical training or background but am wondering if there was any possible nerve damage or compressed/pinched nerve that might be causing the foot pain. I'm tagging @contentandwell, @debbraw and @JustinMcClanahan to see if they are able to share any information with you.

I did find an article that may be helpful from the Wiley Online Library.
Risk factors for acute nerve injury after total knee arthroplasty
https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26045

Does your surgeon think it may be due to inflammation and eventually that will go away?

John

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@johnbishop @norby I never had any unusual feeling in my feet after my knee replacements. I do find that the outside of my knee feels just slightly numb after exercising, I mostly notice it if I touch it. My ortho said that is normal and nothing to worry about. It really is not bothersome.
I know the doctor's response must not have been overly reassuring but I have a feeling that this will resolve itself in time, just something from the swelling. My swelling went down fairly quickly both times, I was lucky. As I have mentioned before, for the first six weeks my ortho does not want his patients to ice or use heat on the knee at all, he feels that it prevents the flow of blood to the knee. He has a great track record so I went along with what he said and I did heal well.
I've come to realize that I good at healing! The first time that came up was after my daughter was born caesarian, the nurses were amazed at how quickly I was up and walking around and the same has been true after my knee replacements and after my liver transplant. I feel very fortunate in that.
JK

@JustinMcClanahan

Hello @norby. I would like to invite @gator1965 who has recently discussed neuropathic pain following a knee replacement, although I am not sure if it is located in the foot. I would also like to invite @gailfaith who also has some neuropathy in the foot and has also had a knee replacement. They may not be in the same situation as you, but may be able to offer some insight on having neuropathy as well as a knee replacement.

@norby, 10 weeks post op is still pretty recent. Although I did not personally deal with neuropathy, I did deal with prolonged swelling and pain. It took me a long time to recover from my knee replacement, but when I started to improve, it did come in what felt like waves rather than a slow progression. Has the foot pain got any better since its onset, or has it been constant? If you don't mind sharing, how are you doing with the gabapentin? Any side-effects?

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I am nearly 8 months following my total knee replacement. I have a neuropathic type of pain which has been present since the replacement. I have a numbness and tingling type sensation which is constant, and i cannot bear anyone or anything touching this part, it sends out a shooting type of pain. Initially I could not even have a sheet over it. I also have a burning type of pain down my leg. My physio recommended that I try different textures rubbing the knee to desensitise the area from towel, tissue to toothbrush! I haven't tried the toothbrush yet!!
I do still experience swelling to the leg
My surgeon prescribed baclofen and amitriptyline at night. My GP is still juggling the dosages around, and I am still taking regular paracetamol and brufen.

@gator1965

I am nearly 8 months following my total knee replacement. I have a neuropathic type of pain which has been present since the replacement. I have a numbness and tingling type sensation which is constant, and i cannot bear anyone or anything touching this part, it sends out a shooting type of pain. Initially I could not even have a sheet over it. I also have a burning type of pain down my leg. My physio recommended that I try different textures rubbing the knee to desensitise the area from towel, tissue to toothbrush! I haven't tried the toothbrush yet!!
I do still experience swelling to the leg
My surgeon prescribed baclofen and amitriptyline at night. My GP is still juggling the dosages around, and I am still taking regular paracetamol and brufen.

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@gator1965 If your pain has been going on for that long I would definitely get a second opinion from the best possible orthopedic surgeon you can find.
I have had two knee replacements and never experienced anything like that. There are a couple of private groups on Facebook that are just for people with knee replacements. That can be a good source of information also because most of the people who are part of the group are there due to problems. It can't hurt to check as many resources as you can find. There really is no monitoring of those groups though as there is on Mayo Connect.
I hope you can find some answers and are able to get some help in alleviating the pain. As I said up top, the first thing I would do is get a second opinion.
JK

Liked by gator1965

@contentandwell

@gator1965 If your pain has been going on for that long I would definitely get a second opinion from the best possible orthopedic surgeon you can find.
I have had two knee replacements and never experienced anything like that. There are a couple of private groups on Facebook that are just for people with knee replacements. That can be a good source of information also because most of the people who are part of the group are there due to problems. It can't hurt to check as many resources as you can find. There really is no monitoring of those groups though as there is on Mayo Connect.
I hope you can find some answers and are able to get some help in alleviating the pain. As I said up top, the first thing I would do is get a second opinion.
JK

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I have arthrofibrosis following my knee replacement.
I went back to work 3 weeks ago after a year …….i have been issued with a formal written warning….

@gator1965

I have arthrofibrosis following my knee replacement.
I went back to work 3 weeks ago after a year …….i have been issued with a formal written warning….

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@gator1965 You have been issued with a "formal written warning"? Is that from your medical team or your work? If from work I presume it must be that if you do not get back to work you will be terminated. I'm sorry if that is the case, and I hope you can manage to keep up with your job despite the pain.
My doctor is doing a small procedure on me, probably next month, to go in and get rid of some of the adhesions that prevent me from having better flex. It's called "arthroscopic lysis of adhesions". Does that sound like something that could help you? The procedure was described as follows by the doctor's NP — "goes in with a small camera and a small tool that burns the scar tissue away". This is an outpatient procedure and you can immediately put your weight on the leg. The incisions are only about a half inch long.
I do not have pain, just poor range of motion. He said I could never get along in Japan with my lack of flexion. I do get along here, but it is difficult to do certain things so I hope I will gain a bit more flex from the procedure.
I hope your doctor, or another if you get a second opinion, can give you some help.
JK

@contentandwell

@gator1965 You have been issued with a "formal written warning"? Is that from your medical team or your work? If from work I presume it must be that if you do not get back to work you will be terminated. I'm sorry if that is the case, and I hope you can manage to keep up with your job despite the pain.
My doctor is doing a small procedure on me, probably next month, to go in and get rid of some of the adhesions that prevent me from having better flex. It's called "arthroscopic lysis of adhesions". Does that sound like something that could help you? The procedure was described as follows by the doctor's NP — "goes in with a small camera and a small tool that burns the scar tissue away". This is an outpatient procedure and you can immediately put your weight on the leg. The incisions are only about a half inch long.
I do not have pain, just poor range of motion. He said I could never get along in Japan with my lack of flexion. I do get along here, but it is difficult to do certain things so I hope I will gain a bit more flex from the procedure.
I hope your doctor, or another if you get a second opinion, can give you some help.
JK

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Yes it is a formal written warning from my employer. i have had 4 lots of surgery since November 2017.My sickness prior to this was no days off sick.
Yes I had arthroscopic arthrolysis and debridment of left knee at the end of September. It has improved my flexion from 70 degrees to 96.
I still have significant discomfort

@gator1965

Yes it is a formal written warning from my employer. i have had 4 lots of surgery since November 2017.My sickness prior to this was no days off sick.
Yes I had arthroscopic arthrolysis and debridment of left knee at the end of September. It has improved my flexion from 70 degrees to 96.
I still have significant discomfort

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@gator1965 That's a lot of pressure to be under.
Your flexion is still not optimal of course, they generally want it to be at least 120°. I think mine is at around 112° now, but as I said, I do not have any discomfort. The other knee that was done about 6 years ago has slightly better flex but when I do much walking that one does hurt. I used a different surgeon and got a different knee for that one.
Does your doctor have any idea what is causing the discomfort? I would want to know that. I had a friend who went two years with pain before she found a highly rated orthopedic surgeon, and he found the problem and fixed it. I hope you will find a surgeon who can do the same for you.
JK

@contentandwell

@gator1965 That's a lot of pressure to be under.
Your flexion is still not optimal of course, they generally want it to be at least 120°. I think mine is at around 112° now, but as I said, I do not have any discomfort. The other knee that was done about 6 years ago has slightly better flex but when I do much walking that one does hurt. I used a different surgeon and got a different knee for that one.
Does your doctor have any idea what is causing the discomfort? I would want to know that. I had a friend who went two years with pain before she found a highly rated orthopedic surgeon, and he found the problem and fixed it. I hope you will find a surgeon who can do the same for you.
JK

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I am due to see my surgeon on Thursday evening, so I will discuss my pain issues, he will say that there is nothing wrong with the replacement ! The xrays look perfect..i agree they do. But something is not right.

@gator1965

I am due to see my surgeon on Thursday evening, so I will discuss my pain issues, he will say that there is nothing wrong with the replacement ! The xrays look perfect..i agree they do. But something is not right.

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@gator1965 Something is definitely not right for you to be in so much pain for so long. If I recall correctly, the cause of the problem the woman I knew who had pain for two years was that it was from something in the extensions being too long. I really do not remember clearly but I know it was something like that. She did some research and found a top orthopedic surgeon and he was able to fix it. The new surgeon took the knee replacement out and put a whole new one in and she was fine.
JK

Liked by gator1965

@contentandwell

@gator1965 Something is definitely not right for you to be in so much pain for so long. If I recall correctly, the cause of the problem the woman I knew who had pain for two years was that it was from something in the extensions being too long. I really do not remember clearly but I know it was something like that. She did some research and found a top orthopedic surgeon and he was able to fix it. The new surgeon took the knee replacement out and put a whole new one in and she was fine.
JK

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Well the surgeon discharged me, he was happy with the flexion being between 96 to 100 degrees. My pain he says is neuropathic, and will take a while to resolve.

@gator1965

Well the surgeon discharged me, he was happy with the flexion being between 96 to 100 degrees. My pain he says is neuropathic, and will take a while to resolve.

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@gator1965 I am glad that the surgeon is happy with your flexion, and hope he is right, that the pain will resolve in a time — hopefully not too much time. Did he mention how long that should take? That would give you an idea of when you should get in touch with him again if you are still in pain. Are there any exercises you can to help the pain?
JK

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