TKR out of the question when you've got PN?

Hello, lynfrommn (@lynfrommn)

It sounds like you and I are at a similar place on our PN journeys. I only have the one TKR (right knee), but that was done long before I began to show any signs of PN. I nearest I can come to stated the nature of my PN is chronic idiopathic axonal polyneuropathy. I've no pain, just my wonky balance.

I'll be meeting with my orthopedist next Wednesday and we'll discuss the future of my left knee (my arthritic knee). I'm not so much concerned that a second TKR might worsen my balance as I am (as my orthopedist might, too) worry that a fall post-TKR (due to my poor balance) could imperil my new TKR.

I've not fallen in quite some time, and none of my long-ago falls did me any damage (other than embarrassment 🙂 ), so falling is not an immediate concern. With a new TKR, however, it most likely would be a concern. Also, I live alone. That would add to any post-TKR concern.

Thanks for your reply! I wish you all the very best!
Ray (@ray666)

Hello, projfan (@projfan)

I am go glad you did NOT hesitate to suggest gait therapy! I've suspected for the longest time that, if there were a way to narrow down the focus of the PT I'm currently doing, it would be to place top emphasis on GAIT.

My gait is a mess. I know that. I've known it for years. It began with the ache of severe flat feet, genuinely relieved by orthotics (since the 1980's); then a drop-foot episode (in the 2000's), the gradual addition of arthritis (ankles, knees, hips); then my one TKR (in the 2010's); and now my PN.

To really mess up my gait, I was laid up (mostly off my feet, recliner-bound, and shoeless) for 14 months, the result of a sepsis infection (which produced a grotesque 8" wound in my left foot). It's hardly surprising that my gait is all messed up! After all that time, just learning to wear shoes again was a reall challenge.

Your message (which I've saved) has inspired the heart-to-heart conversation I'm going to have with my therapist when I see him next Monday. Our topic? GAIT! 🙂

Tell me more of your experience in recovering your gait, but only if you wish and you've time.

And thank you a millionfold, projfan, for your message!

Best wishes!
Ray (@ray666)

@ray666

You are very welcome, and, wow. That's quite the saga.

I will say that not every PT is qualified to do this, or has the training and experience to do it well, so that's a question worth pursuing.

The PT I worked with was a deep believer in strengthening muscles rather than using supports to replace muscles, and had me buy new shoes without any sort of arch support. I had been using custom insoles for decades after plantar fasciitis surgery, and ceasing to use them was very strange. I now switch off between shoes with mild arch support and a large toe box, and barefoot shoes with no support and also a large toe box -- made the shift after the peripheral neuropathy diagnosis about a year ago.

Gait is a commitment on your part. It took at least six months before I stopped focusing on how my foot performed with every step I took. The hip brace came partway through, when it became more clear that changing how the muscles in my feet operated was insufficient. I now know that all this eventually traced to back scoliosis that was sufficiently minor that it was never treated, but which caused torque through my entire lower body, and is ultimately why my pain focuses in my right hip and left knee. (I wore the brace for several months on my left hip, and to this day I need to focus not to stand hip-shot with my weight on a single leg when I stand still.)

This is probably not your issue, so I give you the saga mostly to show that you need someone who can really pick apart the details of how you stand and move, grasps the root causes, and has the experience and patience to gradually change that. It was not a lot of physical labor -- it's hardly cardio -- but it is a lot of focused attention every. frigging. time. you. stand. and. walk. Which can get a bit old. But as I was, you sound motivated.

I also did not have balance issues at the time. If you need to tackle both at once, it's even more important to have someone who can adapt to your more complex situation. It wouldn't surprise me if that's a big reason why this is not a common solution -- between the skill your PT needs, and the habit changes you need, and (at least in my case) the stripping away of supports that were recommended by a doctor in the first place, I can see why most doctors just wouldn't go there.

But it's pretty harmless, you can stop at any time, you do see (slow) progress as you go along, and it doesn't interfere with meds, etc. I suspect that if you are using a walker or cane or walking poles routinely now, it may take even longer to resolve, but that doesn't mean it can't be done -- it just means the process might be a bit trickier and have more steps.

Babies start with crawling, right? So we've already done something like it once, and now we just need to substitute some discipline for the enthusiasm that pushed us through the first time!

You'll have to keep us posted.