Revision THR Hip toe pain connection?<<

[Rouxby]

Hi, just had left hip replaced 3 weeks ago. Hip doing great but toes on surgery leg are killing me. Feels like they are broken, slight swelling, wee redness, but nothing showing as dramatic as the excruciating pain feels. Don’t know how I am going to do PT. I did not come home with this, it has developed as the days go along anyone else having this and is there an end in sight???

Thank you for listening, I am so frustrated!
Surgery date: August 22 2018

 

[Layla]

Hi! Welcome to BoneSmart. Thanks for joining us.

Please provide your surgery date to be added as your signature.

Below you will find the Recovery Guidelines which include the Big Tip -
BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

So...no need to worry about PT if you're not feeling up to it currently.
I'm not sure about the swelling but gravity tends to pull things downward Post op and you're very early into recovery. Check with the office of your OS if you're concerned. I'm sure they'll be able to offer you some reassurance.

Stop by often, we'd love to follow your Recovery and offer you support along the way.


Hip 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!)​

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

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key

Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

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 a 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 history before providing advice. @Rouxby

 

[Josephine]

Don’t know how I am going to do PT.

You know what? Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

Those foot pains are common after surgery and will go away in time. You're not even 3 weeks out yet. Give it at least another 12 weeks.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Rouxby]

Yes, I would love some help Josephine, I cannot put my foot to the floor without excruciating pain, I don’t cry, this has made me cry

 

[Layla]

I will tag @Josephine for you so she sees this.
I'm sorry your pain is so excruciating. I hope Josephine can provide some insight.
Wishing you comfort!
@Rouxby

 

[Rouxby]

Thank you for your kindness

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

4a. Tell me about the pain in your foot/feet. I'll give you this chart to help

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Rouxby]

Thank you, give me some time to fill this out, they are whirlwinding through appointments and tests!

 

[Rouxby]

Sorry, it’s been one thing or another, here we go

4cd 5cd 6bcd 7bcdn, mirrored on other side.


1. posterior left

2. about a 4 unless I am trying to walk

3 Tramadol 50mg tabs every 6 hours
oxycodone 5mg every 4 hours (I have not been taking)
Gabapentin 100mg 3x first 2 weeks, extra strength Tylenol in between.

4. Icing 20 minutes 4 times a day, trying to keep elevated as much as possible

5. Not doing much, assist hubby cooking, little dusting and minor cleaning

6.
Heel slides 3 sets of twelve, 2 or three times a day,
quad sets every time I think about it,
foot and ankle flexes 3 sets of 12 5-6 times a day,
side kicks at sink,
toe raises 3 sets of 12 4 x day.
Elastic band side stretches 3 sets 5 times

HHN felt the issue with the toe was vascular recommended antibiotics, went to doctor, did xray of foot, CT scan of hip to check for screw pushing on nerve, neurologist for nerve tests, inconclusive. Meantime antibiotics started, to work 2 days, swelling down, redness minor, can walk and toes touch floor.

Still have feeling of very tight ace bandage around foot and ankle, numb but can feel. Foot swells a bit keep it elevated and iced as much as possible.

BUT now, pain very bad in groin, seems to involve knee into Achilles tendon must rely heavily on cane to walk, started two days ago.

I am so incredibly frustrated, this could drive me to drink! Here I thought my hip was doing great, silly me.

Thank you for letting me vent.

 

[Josephine]

6. Heel slides 3 sets of twelve, 2 or three times a day, quad sets every time I think about it, foot and ankle flexes 3 sets of 12 5-6 times a day, side kicks at sink, toe raises 3 sets of 12 4 x day.

I did ask that this be a list and not an essay! Would you be so kind as to list them all for me.

HHN

What does HHN mean?

 

[Rouxby]

amended above, hopefully to your satisfaction, HHN is home health nurse

 

[Ausman]

Dearest Rouxby-

Sorry I only just today saw your post. Your THR was one day before mine. But both of us, at about the two week point, developed severe foot pain. Mine somewhat in my toes, but more in the bones at the top of my foot between the ankle and the toes. The metatarsals felt as though they had been beaten with a hammer. That would be about F6 to G6.

Now, as I start week 5, that has reduced quite a bit. I hope the same is true for you. But I wanted you to know that this foot pain is not unique. I am inclined to attribute it to the leveraging on our feet or ankles necessary to dislocate us during surgery.

Glad to hear though that your doctor is at least conducting appointments and tests. Despite my best efforts, I couldn't interest my surgeon in seeing me even once between my surgery and this past Friday- 4 weeks. So I am glad to hear you are getting proper care.

Sending you positive and pain-free thoughts and prayers!

 

[Rouxby]

Dear Ausman,
Good to know others have had the foot problems, though I am sorry for your pain, it was quite excruciating.

Yes, toes are better, but now I am having pain from groin down thru knee to shin don’t know what this new development is, but is keeping me reliant on my cane to walk.

Sorry to hear your surgeon is not addressing your issues, guess he expects these things in the first month. Best wishes on your continued improvement, keep me posted on your recovery and may it be rapid!

 

[Josephine]

HHN is home health nurse

4cd 5cd 6bcd 7bcdn, mirrored on other side.

So approximately like this then?

2. about a 4 unless I am trying to walk

And then what does it become?

3 Tramadol 50mg tabs every 6 hours
Gabapentin 100mg 3x first 2 weeks, extra strength Tylenol in between.

Well for starters, since Gabapentin isn't a pain med, there is nothing to be gained by taking Tylenol in between doses of it! But I do suggest you include Tylenol in with the Tramadol! Here is a chart that I developed for my first TKR. I suggest you try it

4. Icing 20 minutes 4 times a day, trying to keep elevated as much as possible

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

5. Not doing much, assist hubby cooking, little dusting and minor cleaning

Good!

Heel slides 3 sets of twelve, 2 or three times a day,
quad sets every time I think about it,
foot and ankle flexes 3 sets of 12 5-6 times a day,
side kicks at sink,
toe raises 3 sets of 12 4 x day.
Elastic band side stretches 3 sets 5 times

These are what is causing your pain and mostly likely the pain in your foot too! Did you miss this in amongst the recovery guidelines?

Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

HHN felt the issue with the toe was vascular recommended antibiotics, went to doctor, did xray of foot, CT scan of hip to check for screw pushing on nerve, neurologist for nerve tests, inconclusive. Meantime antibiotics started, to work 2 days, swelling down, redness minor, can walk and toes touch floor.

Never thought it was any of those!

Still have feeling of very tight ace bandage around foot and ankle

Yes you will - it's called pain! So I would suggest that your pain score (Q2) is quite a bit higher than 4!

BUT now, pain very bad in groin, seems to involve knee into Achilles tendon must rely heavily on cane to walk, started two days ago.

Well stop the exercises!
Increase the icing and change your medication schedule as I've suggested!

 

[Rouxby]

Thank you very much Josephine, on ice as much as possible, have started your medication suggestions as well, hopefully this will reduce the pain on walking as it can quickly go to a 10, and getting to the bathroom in time can be a problem since I seem to not be able to hold it very well. So sorry didn’t find you in the beginning, I wouldn’t feel like I am going backwards! Hope I have not done damage to it

 

[Rouxby]

Hey guys!
Anyone regressed during recovery? I have gone from walking with a cane back to the walker, the pain is too much to trust to the cane, going into 5th week, hurts down front of groin into thigh, big ouch!

 

[Ausman]

Hey guys!
Anyone regressed during recovery? I have gone from walking with a cane back to the walker, the pain is too much to trust to the cane, going into 5th week, hurts down front of groin into thigh, big ouch!

Hi Rouxby-

I did go back from cane to walker for a couple days around week 4. Back with the cane now. Do be sure to let your OS know if this persists. Are you medicating and icing adequately? Sending you positive thoughts and healing prayers!

 

[Rouxby]

Thanks @Ausman, yes, taking my tramadol and Tylenol and sitting on ice. So glad to hear you are doing great! When do you start pt?

 

[Layla]

Hi @Rouxby
If you've ventured into the ODIC from exercise or over activity, Josephine has mentioned before that it can take weeks, not just days, to recover. Hopefully with lots of rest, your meds and ice you'll recover more quickly.
I wish you speedy relief and a great weekend!

 

[Rouxby]

Thank you @Josephine, I am not very good with this forum, I had already thanked you but weren’t sure you saw it, so I’m repeating it! Following your advice on everything. I’m back on the walker, hurts too bad to put much weight on it, had I just found you first!!! Hopefully this will settle down again eventually. So once again, thank you.