TKR Anterior tibial/ ankle pain following TKA

[uscterp]

I had TKA on May 3, 2022 and was progressing as expected. My femoral nerve block wore off about 24 hrs. after surgery and the knee joint and bruising from the procedure were painful, but tolerable. Started gently working on flexion/extension ROM and quad sets/SLR exercises. Pain was manageable at 4 days post-op and then something unexpected showed up. I began to experience "pins and needle" type pain in my anterior tibia (shin) and ankle. This progressed over a 24 hr. period to extreme pain whenever I put my leg down in a dependent position. Walking became unbearable and I had to use a rolling walker to get around. Called my physician after two days and he had me come in to have an x-ray to rule out tibial fx and an ultrasound to rule out a blood clot. Both tests were negative (good news), but the pain has not subsided. This is so frustrating because I am now 10 days post-op and my knee looks and feels great, but this lower leg/ankle pain is limiting my walking and ability to exercise. If my leg is elevated with ice, I have zero pain anywhere, but swing my leg to the floor to get up, and the pain in my lower leg is insane. Does anyone have a similar experience and even better, any ideas as to what is going on or what I might do to treat this?

 

[WFD]

I had a similar problem (not quite over it yet.) It was so bad at one point I had to scoot on my butt to get to the bathroom - I couldn't even walk with a walker.

My surgeon's office said that swelling compressed the peroneal nerve (the peroneal nerve crosses over the head of the tibia right below the outside of your knee, where swelling from your knee surgery can affect it), which then causes pain down the shin and into the ankle. Extreme cases can cause 'foot drop', where you cannot flex your ankle and raise your foot up.

It was *the* most painful thing I've experienced in my entire life, and I've had seven knee surgeries.

With rest etc., it eventually got better, but I am not 100% out of the woods yet. My surgeon's office said it can take 'several months' to resolve (I am about one month in.)

One thing I noticed is that while I have this the affected foot is extended relative to my good side, and my calf felt tight and short on that side. I started doing gentle calf stretches on the affected side about 6 times a day and it helped a lot. I speculate that stretching the calf and allowing the ankle to flex relaxes the anterior tibialis muscle on the front of the shin, taking the stress off the nerve. Gentle calf stretches are pretty harmless, so maybe give it a try?

Another thing I did was buy a brace on Amazon that is meant for people suffering from plantar fascitis - it holds the foot at 90° while I sleep. I wear it at night and it makes a big difference in terms of how I feel when I get up in the morning.

Obviously you shouldn't let a stranger on the internet diagnose your problem, so if this does not improve, you should go back to your doctor and maybe get a referral to a specialist if necessary.

Here is a picture of the brace I got (though from a different vendor):

 

[Jockette]

Hi and Welcome!

A lot was done to your leg during this surgery and you are going to have pain show up here, there, and everywhere, and fluctuate. Especially at only 10 days post op, these pains are par for the course and do subside as you heal. The good news is that you have no pain when you are elevated with ice.

What are you doing at PT? Not all PTs really know how to rehab a joint replacement, especially this early, and they give us exercises that can increase our pain.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[campcol1]

Hi, hope it's going better for you. I recently had a rtkr 5/11. My ankle on the inside is sore and bruised. I don't think it's surgical. I think it has more to do with learning to walk with the new knee and a different gait. It's starting to subside. Hope you are feeling better.