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?

@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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@prayinforhealin

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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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

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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.

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@loriaakre

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.

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@loriaakre I would be furious at my surgeon. Give it a year or two? Please! I am glad you pursued it and found out the problem and that things are much better now. I think when something is not right a person really needs to persist in trying to find out what the problem is, and not give up because one doctor brushes them off.
JK

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@loriaakre

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.

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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.

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@irol

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.

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The ABI was just scheduled by my primary and was done by an ultrasound tech. Took very little time to do. Just put blood pressure like cuffs on ankles and arms all at the same time. Then did ankles and top of thighs. I did have the EMG testing done, but he did not finish the testing because with one part of it he pressed behind my knee and the incision from my artery surgery started bleeding in one spot so he didn't finish the test. I am taking Plavix from my popliteal artery surgery and I do bleed and bruise easily. Just an FYI, my primary did tell me the EMG test is uncomfortable and can be painful.
My foot as well is better some days and worse if I am on my feet a lot. I have no swelling in the morning, but by evenings my calf and ankle is a little swollen. I am taking Gabapentin for the nerve pain which does help but does not totally get rid of the pain, but makes it tolerable.

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@irol

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.

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Your description sounds nearly exactly to my wife's: foot pain elevated at the end of the day, worse after a day of exercise, etc. She also has been wondering is if it is linked to swelling in the knee, much like you mention.I will encourage her to continue her flexion exercises — she does similar ones that you describe. Thanks for your information — I think your condition is just like my wife's.

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@johnbishop

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

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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.

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@prayinforhealin

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.

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@prayinforhealin, a neurologist would normally be the type of doctor you see who would order what they thought is needed for diagnosis. There is also another test that I've heard is more definitive for peripheral neuropathy but have no experience with it.

Skin biopsy: a new tool for diagnosing peripheral neuropathy (2007)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885305/

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I had a very similar pain in R foot following Right TKA. I was told pain may resolve as swelling does but not for certain. I am now almost 5 months out and the pain is still the same. I have found that Lyrica worked much better than Gabapentin for me anyhow. I would really like to get off the Lyrica but without it increased activity/exercising causes great pain in foot and difficulty sleeping at night. If I find any better advise I will be sure to pass it along.

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I can't find DISCUSS so I will make my post here. I had both knee replacements about ten years ago. I have been dealing with lack of balance for about five years and it is getting worse. I also have some neuropathy and was told it could be from the knee replacements. I have been having some physical therapy which hasn't really changed anything. The top of my feet feel tight but I don't have much pain. I am not diabetic. The area around one knee has always felt somewhat numb to the touch since the surgery. The surgeon did x-ray the knee years ago and couldn't see any issue. When I walk I almost feel like I'm walking on ice. I use a cane. It seems that every time I see a different health care provider there is a different answer. Eventually a person becomes tired of answers that are not the same or definite and hate to waste more time of the same old thing. I have fallen so the lack of balance is the main issue before I have to deal with a major issue from a fall. I don't know who to contact next to try to get a real diagnosis instead of someone's impression of the cause of my problem.

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