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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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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I am five months postop and I still have the neuropathy in my foot and to feel that a nerve was compressed. My surgeon keeps telling me that it will come back and that it could take a year. It’s the worst feeling ever and I still have a lot of pain behind the knee and he refuses to give me any pain meds. I’m getting very frustrated at this point, I am very active person And sometimes I can’t do anything.

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@sandie2749

I am five months postop and I still have the neuropathy in my foot and to feel that a nerve was compressed. My surgeon keeps telling me that it will come back and that it could take a year. It’s the worst feeling ever and I still have a lot of pain behind the knee and he refuses to give me any pain meds. I’m getting very frustrated at this point, I am very active person And sometimes I can’t do anything.

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So sorry to hear you have neuropathy in your foot. Yes it is miserable! Ask for an ABI test. It measures the pressure in your legs. That is how the determined I had a pinch artery. Half of my numbness and tingling went away right after the surgery to open the artery. I still have some but it's not as bad. I also take Gabapentin for the neuropathy and a blood thinner because of the artery surgery. My surgeon was no help keep telling me it was normal give it 1 to 3 years. Now I also ended up with a fractured knee cap on that knee. Surgeon is doing nothing. But don't give up. Be an advocate for yourself.

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I had total knee replacement about 8 weeks ago. My knee did great but I was having so much numbess and pain in my foot I thought something happened during surgery to cause a breakage or sprain to my foot. I returned to my surgeon and he did an x-ray but nothing was broken. He offered no further explanation. It's now about 5 weeks since and the numbness feels even stronger and the pain worse. I've done some research and even though my surgeon seems to be taking it lightly, I've found it's more common and debilitating than previously acknowledged. I'm not sure if I need an attorney at this point. I guess they don't think I'm serious!!!

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@o911

I had total knee replacement about 8 weeks ago. My knee did great but I was having so much numbess and pain in my foot I thought something happened during surgery to cause a breakage or sprain to my foot. I returned to my surgeon and he did an x-ray but nothing was broken. He offered no further explanation. It's now about 5 weeks since and the numbness feels even stronger and the pain worse. I've done some research and even though my surgeon seems to be taking it lightly, I've found it's more common and debilitating than previously acknowledged. I'm not sure if I need an attorney at this point. I guess they don't think I'm serious!!!

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Hi o911. I am almost 6 months out from surgery for a right tkr and had a similar experience. The symptoms really lessened once I was able to be more active and get on the stationary bike a lot. Then it came back more so! And some weeks are bad and others are better without being able to connect any specific or amount of activity to the changing symptoms. I can ride my bike up to 50 miles but to walk more than a block becomes very uncomfortable and then painful in my hip because the foot weirdness foes not allow me to walk right. The type of pain and numbness keeps changing over the months, and is way different now, than when I was first out of surgery. I could not even let the sheet touch my toes without extreme pain and discomfort the first few months! For awhile I thought the compression stockings were the culprit causing the problem. I would recommend having a nerve velocity study with a neurologist. I have seen a podiatrist to rule out any muscle or tendon damage in the ankle. She is befuddled and thinks it is definitely knee surgery related and is out of her domain legallyto pursue it farther akthough she suggested an mri of the foot. I am going to see an orthopedist who specializes in foot and ankle and who is not associated at all with the place where my ortho surgeon practices. I also see a chiropractor every week who keeps it under control. I am determined to find out what it is instead of taking medication that is suggested, such as gabertin or something like that. I am going go see if I can get an MRI of the knee. Of course my surgeon keeps dismissing the whole thing.

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@o911

I had total knee replacement about 8 weeks ago. My knee did great but I was having so much numbess and pain in my foot I thought something happened during surgery to cause a breakage or sprain to my foot. I returned to my surgeon and he did an x-ray but nothing was broken. He offered no further explanation. It's now about 5 weeks since and the numbness feels even stronger and the pain worse. I've done some research and even though my surgeon seems to be taking it lightly, I've found it's more common and debilitating than previously acknowledged. I'm not sure if I need an attorney at this point. I guess they don't think I'm serious!!!

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Hi there, I had a knee replacement 8 weeks post op as well and since I woke up in revovery my foot has been numb. My dr says that he may have stretched or pinched a nerve. I also had and still have a sore ankle. The dr had no explanation for it said nothing.
Maybe I should be doing something about this too. I went for my check ups and now he wants to see me in six months. No concern at all about my foot numbness. It is so frustrating and do umcomfortable.

Hope you feel better soon.

Josie

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@josie1957 Hi Josie, and welcome to Connect and the knee replacement discussions. I have had two TKRs but neither caused neuropathy. When your doctor said he may have stretched of pinched a nerve did he give you any indication if it would recover and if so how long that would take?

I would definitely push him for an answer on that. I hope it is temporary.
JK

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