Foot neuropathy after total knee replacement

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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@navyqas

Had a total knee replacement 9 days ago, had some toes tingle as soon as operation completed, by nightfall bottom of foot 80% numb, Knee doing fine BUT bottom of the foot (heal is area worst area) shows No improvement in 9 days? If I am stuck with this for life I wish I never had the knee replaced! Surgeon said nerve disturbed and could take VERY long to correct (1cm correction per day, knee to foot distance) Wonder if anyone else had the EXACT same situation.

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Hello
I have the very same problem. I woke up from surgery and had numbness on the bottom of my foot on the lateral side (baby toe side), in the arch area, and the total heel. When I walk if feels like there is a pad under my arch. I really don’t have pain but the feeling in the arch area is very annoying. Surgeon and PT techs have never heard of this. I’m 8 months post surgery and after visiting my surgeon March 16th 2020 I have been scheduled for a nerve study to try and determine nerve damage. I can only keep praying that my foot will be normal again. BTW I had a spinal block not general Anesthetic. What anesthetic did you have?

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I too had a spinal block and they tried to do just a pain block for the knee but could not find the nerve. Knowing what I know now, it's because my surgeon pinched not only my popliteal artery, but my nerves for the leg as well. An ABI test found the pinched artery. My foot got better after artery surgery, but not 100%. I'd say 50%. I have had nerve testing done and yes I have damage. Was told could take up to 3 years to heal or it might never heal because of the pinched artery that blocked blood flow to my foot which was 60 days. It was my primary that ordered the ABI and listened to me that purple toes and cold foot was not normal. She saved my leg. My TKR surgeon said I was lucky I didn't lose my leg. He was the one who said it was normal to have a numb tingly foot after TKR. It's not normal! I did find a chiropractor in Fargo, ND who said he can help the neurothapy in my foot. But due to pandemic, I've put it on hold for now anyway. Will post when I start those treatments. Good luck on the nerve testing. They kept telling me it was so painful!. It wasn't bad at all!.

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To 708: I also had spinal block also, I am very sad for both of us as it sounds identical. Wish I never had the operation now. Let me know of your outcome please.

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@tjh708

Hello
I have the very same problem. I woke up from surgery and had numbness on the bottom of my foot on the lateral side (baby toe side), in the arch area, and the total heel. When I walk if feels like there is a pad under my arch. I really don’t have pain but the feeling in the arch area is very annoying. Surgeon and PT techs have never heard of this. I’m 8 months post surgery and after visiting my surgeon March 16th 2020 I have been scheduled for a nerve study to try and determine nerve damage. I can only keep praying that my foot will be normal again. BTW I had a spinal block not general Anesthetic. What anesthetic did you have?

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To 708: I also had the spinal block also, I am very sad for both of us as it sounds identical. Wish I never had the operation now. Let me know of your outcome please. Note: my surgeon stated it could take a very long time for nerve correction, I was told by a friend (therapist) that she has seen this many times and to ice it, said it seems to happen to people who have no fat in their legs (thin people) as the swelling presses on the nerves far more.I have zero leg fat, who knows? I am icing, heating, deep tissue massaging with a kneading fingers machine, even using a TENS machine to jump start the nerve into working faster. Nothing ventured nothing gained. It's been two weeks and the the knee pain at night assures I get about two to three hours sleep at the most, I used to like hitting the sack, not anymore.

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I need help,my feet feels like that are on fire

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As I reported in this discussion before and as Norby mentioned in an article published regarding knee replacement and numbness in lower extremities, it appears that people with lumbar problems (of which I do not have) and those with the tourniquet left on along with longer anesthesia during surgery, were at risk for lower extremity numbness. Now that there is some evidence to conclude that this happened, I would like to know what can be done, if anything, for this problem. I have been on gabapentin for 2 months and I am still having numbness in my right large toe and right foot. I am curious to know if anyone out there has achieved success with the gabapentin, possibly by taking the drug for a longer duration?

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@sap09

As I reported in this discussion before and as Norby mentioned in an article published regarding knee replacement and numbness in lower extremities, it appears that people with lumbar problems (of which I do not have) and those with the tourniquet left on along with longer anesthesia during surgery, were at risk for lower extremity numbness. Now that there is some evidence to conclude that this happened, I would like to know what can be done, if anything, for this problem. I have been on gabapentin for 2 months and I am still having numbness in my right large toe and right foot. I am curious to know if anyone out there has achieved success with the gabapentin, possibly by taking the drug for a longer duration?

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After reading about gabapentin, I would rather take my chances with nature on my nerve. I have a total numb heal and partial ball of my foot also numb, Talk about being on target with with your Norby article, I have lumbar problems + tourniquet left on VERY long (3 hours) 3 hours anesthesia also when I was told 1.5 hours was typical. I went into this operation in top physical condition (except for the knee) now I hurt not just in my knee, now my foot also. Sleep about 3 hours a night due to the knee pain, and foot pains me when walking, it's been 3.5 weeks since the operation. Surgeon stated nerves take a very long time to correct, kinda wish I never let him touch me now.
I believe your nerve will either correct itself in time or not on it's own, I would not destroy other good parts of my body with chemicals trying to fix something (your nerve) that may come around in time.

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@jill31

I too experienced changes in the feeling of the souls of my feet after knee replacement surgery. For me, the sensations or feeling were like intense and continuous pins and needles in the souls of my feet. Taking off -and putting in – bed socks has helped but eight weeks after surgery, the sensations or feelings remain uncomfortable and at times, prevent sleeping.
Like the earlier correspondent, I have been advised (by my surgical team) that the discomfort may subside as time goes on, but they also said that the discomfort may never go away completely.
I do think that there seems to be a whole range of disability aspects that may remain after total knee surgery, which are not made plain before surgery. These various outcomes (ie. continuing numbness of areas around the knee, the aforementioned souls of the feet numbness and pins and needles sensations etc.,) should really be known, as possible outcomes, by patients, before surgery occurs.

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I specifically asked my surgeon what possible downsides that could happen after knee replacement, he said always chance of infection and a slight clicking in the knee, NOTHING about this numb foot and nerve damage. Now he says probably a back problem, ha ha. But the total bill for the THREE hours was over $180,000, they got 34K from the insurance and I am worse off then I was. What a system we have here, they say it's the best, hate to see the worst!

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In reply to: @sap09 and @navqas
I was just told numbness and tingling in the foot/leg was normal. Not in my case. I was black and blue from to tourniquet for weeks. They could not find the nerve for the nerve block to my knee to help with pain after surgery. BUT the worst was the surgeon pinched the popliteal artery behind my knee cutting off the blood supply from the knee to the tip of my toes. tried several Drs. got same answer…that's normal!! Finally had appt. with my primary and she said no it is not normal to have numbness, purple toes that turned white sometimes, and ice cold foot all the time and ordered an ABI test of my legs. test showed pressure of 1.6 left leg/.4 right leg. and was sent to cardiologist who ordered an angiogram that proved the artery was truly BLOCKED because of the knee replacement surgery. SO another 6+ hour surgery to open the artery and put on blood thinners for months! BUT since it was 60 days without blood flow to my foot, not ALL the numbness and tingly was gone, but it is better compared to what it was before. I still have some numbness but stopped the gabapentin (felt no different after than before) and it is now 14 months from my TKR. My artery surgeon said I could have permanent damage to the cells and nerves in my foot with the lack of blood flow. TKR surgeon says could take 3+ years to heal nerves at 1mm a day from back to foot. He has never said he's sorry that this happened and that he did anything wrong!!! just I suppose there is a law suit and I'm sure you wished you never came to me! He was supposed to be the BEST knee and hip person in the area.
I hate the feeling in my foot and can't go barefoot even in the house. I have to have shoes on or it gets worse and feels cold.
I did find a chiropractor that says he can help but with COVID-19 I haven't been back to him since the consult and testing he did to get results and his plan.
Best of luck!

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@loriaakre

In reply to: @sap09 and @navqas
I was just told numbness and tingling in the foot/leg was normal. Not in my case. I was black and blue from to tourniquet for weeks. They could not find the nerve for the nerve block to my knee to help with pain after surgery. BUT the worst was the surgeon pinched the popliteal artery behind my knee cutting off the blood supply from the knee to the tip of my toes. tried several Drs. got same answer…that's normal!! Finally had appt. with my primary and she said no it is not normal to have numbness, purple toes that turned white sometimes, and ice cold foot all the time and ordered an ABI test of my legs. test showed pressure of 1.6 left leg/.4 right leg. and was sent to cardiologist who ordered an angiogram that proved the artery was truly BLOCKED because of the knee replacement surgery. SO another 6+ hour surgery to open the artery and put on blood thinners for months! BUT since it was 60 days without blood flow to my foot, not ALL the numbness and tingly was gone, but it is better compared to what it was before. I still have some numbness but stopped the gabapentin (felt no different after than before) and it is now 14 months from my TKR. My artery surgeon said I could have permanent damage to the cells and nerves in my foot with the lack of blood flow. TKR surgeon says could take 3+ years to heal nerves at 1mm a day from back to foot. He has never said he's sorry that this happened and that he did anything wrong!!! just I suppose there is a law suit and I'm sure you wished you never came to me! He was supposed to be the BEST knee and hip person in the area.
I hate the feeling in my foot and can't go barefoot even in the house. I have to have shoes on or it gets worse and feels cold.
I did find a chiropractor that says he can help but with COVID-19 I haven't been back to him since the consult and testing he did to get results and his plan.
Best of luck!

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I feel so badly for your situation. I had various weird nerve problems in my foot after I had tkr last year. Had neurology snd muscle tests, etc. It seemed to be a lot better when I was really active, like going on a 50 mile bike ride. When winter came again, Inwas working out in gym and using a stayionary bike at home. The numbness and problem hardly ever appeared and then just about exactly a year after surgery in Feb I broke a bone in that foot (A ladder broke and I fell off of it). I have had to wear an air boot all of rhe time for past 3 months. I started having the problems all over again and now it feels like the second and third toes are melded together. They are all cold all the time and numb. I am hoping that it is because I have not been using them or moving them much. The doctor said "oh, you had a problem before, right?" And that is all. As if that is a reason not to be concerned or do anything about it. They all think I am crazy.

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@navyqas

I specifically asked my surgeon what possible downsides that could happen after knee replacement, he said always chance of infection and a slight clicking in the knee, NOTHING about this numb foot and nerve damage. Now he says probably a back problem, ha ha. But the total bill for the THREE hours was over $180,000, they got 34K from the insurance and I am worse off then I was. What a system we have here, they say it's the best, hate to see the worst!

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I had tkr a year ago and I am still numb in foot plus knee clicks with every step. I woke up with neuropathy in my foot and was told wii take up to a year to heal. Here we are a year later and still there. Ready to call a lawyer

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@sandie2749

I had tkr a year ago and I am still numb in foot plus knee clicks with every step. I woke up with neuropathy in my foot and was told wii take up to a year to heal. Here we are a year later and still there. Ready to call a lawyer

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@sandie2749 I can understand you wanting to call a lawyer after being in pain for so long, but honestly, most probably nothing will come of it. I knew a woman who was in agony for two years. She finally found an orthopedic surgeon who figured out her problem, and it was definitely an error on the part of the original surgeon. He fixed it and she tried to sue but it was impossible. I think there has to be willful neglect which is impossible to prove.
I hope you are seeking other opinions, from the best possible orthopedic surgeons available. Go out of the area where the original doctor is, doctors tend to be reluctant to say anything negative about another doctor in the same area. We are in southern NH and the surgeon who found the problem and fixed it is in Boston, at a major medical center. Those are the best places to go for something like this.
I hope you can find a resolution to your problem, no one should be in real pain like that for so long. I have had two TKRs. Granted, when I do a lot of exercise one in particular will be uncomfortable the next day but I wouldn't say it's pain. My biggest problem is that I don't have quite as much flex as I would like, but I can live with what I have — about 120°.
JK

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