TKR Meecies musings (questions, comments, maybe some venting here and there too)

[meecies]

That, together with the multiple abnormalities on the MRI and my severe hip and back pain convinced me that any surgical risks were worth it in my case.

how did you get an MRI?

how did you know from looking in a mirror that you were at least 20 degrees valgus?

my question was more how can he quantify it without measurements- but you seem to be able do it using a mirror....?

I know it's deformed, I knew that years ago, because after I was hit by the car, I could no longer ride a bike. My knee had not collapsed to the extent it has now, but my right foot turned out so much I could not pedal the bike. I was heart broken because I loved riding my bike...
but then I had a baby and forgot all about bikes. (Today is her 46th birthday.)


I know I have a valgus knee but the actual degree has never been mentioned and the surgeon who kept telling me that "surgery is the only cure" refused to acknowledge the deformity at all

so it's interesting to see a podiatrist say it's severe.......
when the knee surgeon wont' even address it

 

[Layla]

There is a short 41 second video on YouTube titled - Alignment by Goniometer - that you can watch for a visual explanation of measuring to determine varus or valgus degrees.

Valgus - characterized by an abnormal outward turning of a bone, especially of the hip, knee or foot.
Varus - an excessive inward angulation towards the body's midline, the opposite of valgus.

I hope this helps.

 

[EalingGran]

how did you get an MRI?

I got an MRI of my knee,hip and back on the NHS. It was requested by my surgeon ( although he put me on the waiting list for my partial just on the basis of clinical examination and some extra Xrays in flexion, which he said showed up lateral damage better) and the MRI appointment took about 6 weeks.

how did you know from looking in a mirror that you were at least 20 degrees valgus?

my question was more how can he quantify it without measurements- but you seem to be able do it using a mirror....?

I know you need Xrays to really accurately measure things like the Q angle. But just standing in front of a mirror with a straight object in the centre of the pelvis/ symphysis pubis- you can see and approximately measure the angle that the lower leg, below the knee diverges from straight.
I was clearly around 20 degrees off at my worst. I wish now I had taken photos but I hadn't realised how bad it had got and I was shocked and upset by my appearance, so didn't think to record it.
After my surgery, at my 6 week follow up- my husband admitted that he hadn't liked to point out how deformed I had gotten. My surgeon just laughed and said that was probably wise......
I must say that straightening my leg has made a huge difference for me.
According to my husband, I was already walking better/ straighter and faster by 6 weeks. I now can walk long distances.
My hip pain has disappeared and my most recent hip Xrays are actually a bit better than 2 years ago. My sciatica and back pain is not cured but is more manageable.

 

[meecies]

I hope this helps.

it does
thank you

 

[meecies]

I feel sick

I compared the foot surgeons notes to the podiatrists notes

first off, both of them have things in their notes that they never told me

secondly, they are vastly different-
the foot surgeon was obviously disinterested and didn't even notice that my right foot turns out
and I have zero faith in his opinion or advice

the podiatrist noted that I've got a flat foot (he used the medical term and I had to look that up) he did NOT tell me my right foot is flat now so I had no opportunity to ask if this is permanent or if there's anything I can do about it

I literally feel sick that 2 drs can come up with such different opinions just weeks apart

how the hell do you know who to trust and who is right?

the podiatrist's explanation about the foot pain makes sense and on some level I knew this was the case but am in denial because I am not able to yet handle what this means

let me have my denial as long as I need it please

but good gawd, they want to operate on me and I have little faith that they know what the hell they are doing

I am trying to get in to see a specialist but have no idea how to go about that- I'm being denied access to a physiatrist

and they won't tell me why


it's bad enough to have to deal with this pain and worsening level of disability but the fight for decent care is an extra level of difficulty and frustration I am just not mentally up for

I'm not
I'm exhausted

 

[meecies]

There is a short 41 second video on YouTube titled - Alignment by Goniometer - that you can watch for a visual explanation of measuring to determine varus or valgus degrees.

I think my PT may have one of these

in any case I can see from the video that my right knee probably exceeded 20 degrees before PT but with the hip strengthening exercises, I've been able to pull it back to around 20 degrees

I can't get it any straighter than that though, no matter how hard I try
I'll see if the PT can figure something out

the pain in my feet is from the knee (the knee still doesn't hurt much, go figure) but the pain in my feet is horrible
and the pain in my right ankle is unbearable but thankfully only brief, when first standing in the morning mostly
I keep crutches by the bed

 

[mendogal]

If you have flat feet - technical term is overpronation - you were likely born with it, as were my dad and I; in your case it may have been worsened by that long ago accident.

When we look at our feet we seem to have a normal arch, but biomechanically when we walk our feet go inward, the arch reduces or disappears. Over time, as the repeated turning inward of the foot results in the knee also turning inward, it contributes to valgus knee.

It makes me wonder about the location of your pain. Flat feet is associated with a higher risk of plantar fasciitis - inflammation of the thin connective tissue supporting the arch. For most people that creates terrible heel pain, and sometimes causes heel bone spurs.
My plantar fasciitis was different - 40 years ago my pain was in the arches of both feet. It felt like a sharp knife would tear the underside of my foot apart. I spent a couple of months semi disabled with my feet taped up before getting custom orthotics.

If your podiatrist has diagnosed overpronation then the custom orthotics he prescribed will address the need for arch support.

BTW, I have only ever heard of podiatrists diagnosing and addressing flat feet/overpronation. Certainly orthopedic surgeons and PTs working on my knees have never ever considered that a pre-existing foot issue might be involved, even when watching me walk!

It seems to me that you're better off pursuing non-surgical podiatry and PT related measures at least for now.

 

[EalingGran]

the pain in my feet is from the knee (the knee still doesn't hurt much, go figure

I had surprisingly very little pain in my knee. My pain was mainly in my hip and back.
My surgeon said that lateral arthritis presents very late and pain is often absent until there is dramatic deformity.

 

[meecies]

If you have flat feet - technical term is overpronation - you were likely born with it, as were my dad and I; in your case it may have been worsened by that long ago accident.

no I was not born with flat feet! in fact I have a very high arch
He did not mention overpronation, I will copy and paste what it says

Deformity:
‌ pes planovalgus deformity to the Right foot, likely exacerbated by severe valgus knee deformity. Left foot appears to be neutral. Limb length discrepancy with long Right versus short Left.

Googled pes planovalgus and it came up flat foot
but reading further done there is another definition,
"Pes planus is a relatively common foot deformity that refers to the loss of the medial longitudinal arch of the foot, resulting in this region of the foot coming closer to the ground or making contact with the contacting the ground."

If your podiatrist has diagnosed overpronation then the custom orthotics he prescribed will address the need for arch support.

he did not diagnose overpronation

these are the Dx he wrote:

Bilateral foot pain (Primary)
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment

Callus of foot
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment

Acquired valgus deformity knee, right
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment

Lower limb length difference
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment
- Rfl Durable Medical Equipment
~~~~~~~~~~~~~~~~~~

It seems to me that you're better off pursuing non-surgical podiatry and PT related measures at least for now.

this is exactly what I am doing. I saw this podiatrist to see if custom orthotics would help and what else might be done
My PT is giving me as much info as he can before I run out of visits, then I will be on my own

I am trying to find out if they make telescoping crutches- when the pain in my feet is really bad, I use crutches around the house. it would be nice to have them available when I have to walk somewhere outside of the house, BUT I generally doing shopping at the same time (food, it's the only thing I can't get delivered, so I need a wheeled cart to get that home) I can't wheel the cart and use crutches at the same time.......... so I don't know.
I couldn't wheel the cart and use a wheelchair at the same time either, so it would mean buying a very small amnt of groceries and taking multiple trips, something I have neither the time nor the energy for.

a cane or walker is utterly useless when the pain is in both feet.

I briefly considered roller skates but I wasn't good on those when I was a kid, there's no way I could use those now!! but it was a funny thing to think about

the sidewalks here aren't level enough, in those places we actually have side walks. so I could see some broken bones in my future with that idea


I may look into a rollator with a seat- again, this would limit me when it comes to food shopping but for other trips, it would at least give me a place to sit to rest my feet , but I love being able to cover distances without my feet touching the ground at all, the way that I am able to do that with crutches. (yes I know that's not the expected use but it's easier for me to do that than it is to put one foot on the ground- and since both feet hurt, it's a huge relief to swing like a monkey on the crutches)

 

[meecies]

the custom orthotics order is for:

custom accommodative orthotics

trilayer, multidensity, platizote topcover with offloading areas of pressure or prominence as deemed necessary
sub halux on right,
sub 5th metatarsal head on left
cork or other materials as deemed appropriate for durability

 

[mendogal]

Googled pes planovalgus and it came up flat foot
but reading further done there is another definition,
"Pes planus is a relatively common foot deformity that refers to the loss of the medial longitudinal arch of the foot, resulting in this region of the foot coming closer to the ground or making contact with the contacting the ground."

That is exactly what"flat feet"refers to! I have a high to normal arch at rest and the problem is losing the structure with each step I take. We are indeed - I, you, your podiatrist - talking about the same problem.
My podiatrist uses the term over or hyper pronation to describe the loss of the arch while walking.

 

[meecies]

My podiatrist uses the term over or hyper pronation to describe the loss of the arch while walking.

ok well this is very strange

for the vast majority of my life, I've been an over supinator!! with both feet/legs
my shoes were always worn down in just a few months on the outer edges of the heel (both feet)



Just a week or so ago I did a test with some brown packing paper and wetting my feet to test this pronation vs supination and........

my left foot shows the pattern I've had all along, supination
my right foot kind of made a blob pattern, hahaha BUT
you need to remember, my right leg is considerably longer than the left, and being barefoot, Of course I was not in the shoes with the lift in them

I think I'll try this again with the left shoe on and see what the pattern is for the right foot

I don't doubt that the arch may be compressed when I am walking, however I have fabric slippers and there is a series of holes where my foot has worn thru the bottom of these slipper
and it goes from the ball of my right foot (if that is what the area at the base of the big toe is called) and then there are 3 more holes that are arranged in slightly curved line at about a 45 degree angle, I'd guess? from that biggest stress point at the base of the big toe
I should take a photo of them but I don't know if you can add photos here, can you?

on the left foot, it is NOT the big toe, it's the little one.
my left knee is only worn down in the medial compartment with some burning pain from time to time on that inner aspect

but I've noticed lately that the left leg feels like it is bending BACKWARDS at the knee, which is quite disturbing. No idea what is causing that


I think I mis spoke earlier about the knee caps themselves- when I was in my 20s, my right knee cap was tracking to the outside and IIRFC they called that patella femoral syndrome

at that time they told me that the underside of both knee caps was rough (chondromalacia, perhaps??)


anyway, the orthotics for each foot will be very different, as the wear pattern is different

Until I got the shoe lifts - my little toe (5th metatarsal) was constantly blistered and bloody. The entire toe was extremely painful as most of my weight was concentrated on it, as I was walking on the outside of the foot, it being the shorter leg
I had akathisia at the time and could not stop walking, in spite of the pain.. so for at least 2 yrs I suffered with that til I found a podiatrist that recommended the shoe lifts

I need new shoes and once I get those, I will be sending them out to have a slightly higher lift put in them

this has all been very expensive.

and very very painful.

 

[meecies]

update:

sent the foot surgeon's notes to the podiatrist and now the podiatrist has walked back his diagnosis but tbh he's not clear in what he's saying, he's talking about my FOOT being valgus, but no where in this original notes does he mention a valgus foot
he mentions a severely valgus deformity of my r knee only

well in any case, he's done all he plans to do, and I'll get the orthotics and see if they help at all

In the meantime I found a different ortho practice (connected to a teaching hospital) with a LOT of online info
like this, about what recovery from TKR is like; emphasis is mine: THIS is the sort of information I've been looking for, yes of course some folks will be stronger and able to do more, some will have less pain, some will have more but this gives a very precise picture of what recovery can be like:


"After your knee replacement surgery, your doctor will give you specific instructions about how active you can be.

But here are some general guidelines.

For the first 1 to 2 weeks after surgery, it's easy to overdo it.

So try to balance rest and activity.

This will help reduce pain and swelling and promote healing and range of motion.

The time you spend up and about is called "up time."

Limit it to 20 minutes at a time.

Anything that involves sitting or standing counts as "up time."

That includes eating at the table, answering the door, getting the mail, even going to the bathroom.

Balance your 20 minutes of "up time" with 1 to 2 hours of "down time,"

which includes icing your knee for 20 minutes and elevating your leg.

You'll probably be given different exercises to do during "up time,"

things like walking and chair push-ups.

And you'll get others you can do during "down time," like ankle pumps and quad sets.

These exercises may seem simple, but they're really important for your recovery.

Three to four weeks after surgery, you'll start to walk more.

And you'll likely get new exercises to add to your routine-- to continue to build strength and range of motion.

 

[mendogal]

My ortho team was firm that in the first weeks Less Is Better.

 

[meecies]

My ortho team was firm that in the first weeks Less Is Better

you're very lucky

 

[meecies]

oxford knee score has improved

I'm now at 48
keeping my knee lubricated (very simple to do with exercise) I now have no knee pain at all, not during the day nor at night

the other score Tegner Lysholm Knee Scoring Scale is now 97 out of 100


my most recent xray was graded at OA stage 4
that's in one compartment only (possibly it's a bit in the middle now, too- I forget)

~~~~~~~~~~
last winter, I had knee pain at night, that kept me awake. I was taking celebrex twice a day, for a total of 400mgs daily and still couldn't sleep at night

so for all you folks who think OA pain only gets worse, you might want to reconsider that

I found an article (and then lost it, grrr)
that had a graph that showed that with each increasing level of OA in the knee from grade 0 to 4 (best to worst) pain was only correlated with radiographic evidence up to grade 3, but then the correlation went DOWN- in grade 4
There was also some mention of a biomarker that also went down as the OA grade went from 3 to 4
I've heard something similar in other places- one study where they took random people off the street and xray their knees and then had drs try to determine which patients had pain, based solely on the xrays- and there was only weak correlation.

Not really surprising, they do the same thing with the spine- there's a lot of ppl with spinal deformities, disc issues, etc with no pain whatsoever.
And some without any radiographic evidence of a problem who do have pain.



what I need it a similar scoring for foot, toe, and SI joint pain, shoulder pain and back pain



I tried on some very expensive shoes at a local store, but they only had black so I ordered a pair of the color I wanted off amazon
and they are too small

I'm starting to think that amazon does sell counterfeits
So I gotta return those

was so hopeful for those, as they felt kind of like walking on clouds, the pair I tried on at the store
My size is very hard to find in stores and many places won't order them for you.

so I'll have to keep looking

my left hip is giving me a lot of trouble lately...
sigh

I re joined an exercise class at the Sr Center that I used to do, but now I do over zoom

I have to modify at lot of the exercises because of several hypermobile joints (esp shoulders)
but I just want to try to stay in shape as best I can

very discouraged that the Pain clinic doesn't think a referral to them is "appropriate"... don't really understand their reasoning and they were not willing to tell me

 

[meecies]

was just re reading the podiatrist's response when I asked about the supposed flat right foot


he made a comment that really irked me and I wanted to find it and see what his exact words were

this is the reason he gave for misdiagnosing me with a flat right foot: "Given my limited physical exam, it did appear that she had a slight valgus foot deformity/flatfoot deformity"


what?

his after visit notes mention his "lengthy discussion"....
but he only did a "limited physical exam"????

why was that?

I think I know why, he took one look at my obviously valgus knee deformity, decided that was the problem and then decided to back that up with what would usually happen

well I've got the bottoms of 2 pairs of slippers that prove that I still have high arches in both feet, it's only if I turn the right foot out in an exaggerated way (which I sometimes will do to take pressure off different parts of my foot) that it looks like maybe the arch is a bit lower... but it's not at all flat, not even close

I'm really getting fed up with these half assed assessments and the unwillingness to do things that might actually benefit ME

If it weren't for my crappy insurance, I'd message him and ask him what was the reason he only did a limited exam, but I can't afford to burn any bridges

still waiting to find out why Pain Management thinks they are not the appropriate place for me to be seen

I wonder if it's because the podiatrist's notes say pain level "3"
they always ask for your pain score, 0 to 10 and I always tell them, it depends..

it depends on how much I've been doing, how active I've been, how much time I've spent on my feet.
for that particular day, I told him I'd walked 3 miles a few days previously and spent the last couple of days OFF MY FEET doing not much of anything, so right then at that moment, the pain level was about a 3


I don't know if that's the reason Pain Management isn't willing to see me but it surely could be


I wish I could afford some sort of advocate........
this is BS

 

[Layla]

this is the reason he gave for misdiagnosing me with a flat right foot: "Given my limited physical exam, it did appear that she had a slight valgus foot deformity/flatfoot deformity"
what? his after visit notes mention his "lengthy discussion"....
but he only did a "limited physical exam"????

If it weren't for my crappy insurance, I'd message him and ask him what was the reason he only did a limited exam, but I can't afford to burn any bridges

I don't see any reason why you can't inquire about this.
You can certainly call and politely ask what determines a patient receiving "a limited physical exam"
Hopefully it will satisfy your curiosity, giving you a better understanding and peace of mind regarding this appointment / and physician.
I wish you luck if you choose to contact them. A great week to you, meecies!

 

[meecies]

:P

 

[meecies]

update:
got fitted for the orthotics, now to wait for them to come in

my 10 weeks of PT are done but boy did I get my money's worth with this guy!

he helped me avoid surgery that will, at BEST, just swap my current issues for other ones, which may or may not be worse- IMPOSSIBLE to predict ahead of time. The odds of getting any net benefit are essentially zero

I am going to see the spine specialist because it turns out that there's a very good chance that the burning pain in my feet, esp the big toes, is coming from compression on my spine at L4 and L5
I've got stenosis there (as well as cervically) and there's been an uptick in symptoms that reminded me that, oh yes I have spinal issues (multiple issues)
After looking at the dermatomes and checking symptoms of spinal stenosis, and talking it over with the PT, it may very well be that the issues I've been having with balance (for over 2yrs now) may be from the spine!!

It didn't make sense that it was from my legs/hips because we've worked on those as well as core strength and now I can even do planks!!
but still have issues rather randomly where I'll lose my balance!

So I'll be checking that out.

so glad I cancelled the knee surgery. What an absolute disaster that would have been, when there's so many different things that can be done that are not invasive or risky or irreversible like surgery.