TKR Orthotics

[Buttercup52]

Hi,
Just looking for advice. I have had both knees replaced. The first one was done in 2015 and although I would say it was successful occasionally I experience slight discomfort in the soft tissues on the outside of my knee. I can usually remedy this by riding a bike to strengthen quads and I have a few exercises from a physio which seem to help. I have checked with surgeon and he tells me the knee is fine and to go back to physio. The right knee was done in 2020 and I would say it is 100% successful. Same surgeon did both knees.
I now have a problem with my right foot and I know I have advanced arthritus in it. I am awaiting results from MRI to see if there are other issues. I am continually advised to wear orthotics and I have tried them several times without success.
Recently I went to someone who was highly recommended and he has made me another pair of orthotics. I have broken them in and they seem to be helping myvfoot problems quite a bit. The problem is that they seem to make the muscles around my left knee very sore and uncomfortable so I get rid of one pain and then end up with a painful knee which takes a few days to settle down. Just wondering whether anyone else has similar problems or has any words of wisdomof how to solve this problem.

 

[benne68]

Sorry to read that you are struggling with knee pain after getting new orthotics, @Buttercup52.

While I don't have any experience with orthotics, we have other staff members who can share theirs.

In the meantime, would you please give us the months or your TKRs so we can make sure your signature is accurate.

 

[mendogal]

Hi!!!
I have a history that directly applies. Short answer: yes, orthotics WILL affect knees, HOWEVER in the long run properly fitted orthotics will preserve knee function.

I knew I had "flat feet" back in the 1980s as a new nurse, when it led to painful bilateral plantar fasciitis and my feet being strapped for months before I was given custom orthotics. Sadly, I wasn't warned that abandoning them might lead to knee problems. I happily used drugstore inserts for years alternating with minimalist shoes. My feet seemed happy.

My R knee arthritis was a result of a martial arts injury/ACL graft and medial meniscus partial removal.

In autumn of 2021 an acute L meniscus tear based solely on shifting my weight in my dining room never responded to conservative treatment or even arthroscopy, so that was my first TKA a year ago January. My second followed quickly as I had anticipated because of added strain on it.

Fast forward to earlier this year. I finally decide to see a podiatrist about bunions. He was appalled at my flat feet and showed me how the pronation of the foot with each step led to a skewing of my tibia and maltracking of my patella. He honestly believes it was this skewing that created wear and tear on my menisci, precipitating the first TKA. And I believe him.

Well, I got my excellent custom orthotics and it took me a while for my feet to adapt - I added an hour at a time of wearing them every few days. And yes, once I could wear them for a few hours a day, my knees started to bother me... I had anticipated this because I saw how in the podiatrist office how walking without the orthotics my post op tibia and patella were already showing poor mechanics! It's about 5 weeks in the orthotics and my knees are improving again.

So .... Let's back up to you and your query now. As we develop bone on bone knee arthritis, it throws off our weight transfers and subtly over time our entire structure (mal)adapts. Muscles and tendons constrict and shortenwhile others loosen... this affects the hips, and moving upward, the pelvis skews in one or two planes, and that affects the back.

We go into surgery for a knee replacement and (besides the healing that needs to happen) all at once our entire structure is changed again!

You've been walking without orthotics for a few years post op, so your structure has had ample time to (mal)adjust to that foot problem. It makes sense that correcting your weight shifts and gait with the orthotics will throw off your structure temporarily.

I recommend going very slowly with the orthotics - in the house an hour a day, then if tolerated two hours, etc. Give your whole body a chance to really adjust to them. Ice and elevated your knees if necessary. Also ice your arches and do some gentle calf stretches if your feet complain!

 

[Buttercup52]

Thanks very much for your reply. It is good to know that I am not alone with this issue. I did break in wearing the insoles but will probably need to do it at a slower rate. I think my left knee was in quite a bad state when I had the replacement so I think the tendons and ligaments are easily upset by change.

 

[EalingGran]

I wonder if you have a good physio/ PT, or in my case it would be my pilates teacher, that you trust?
If so, I would ask them to watch ( and ideally video) you walking both in bare feet and then with the new orthotics. Then ask for their comments and views on how you are using the muscles of the legs and feet and are there any obvious problems or imbalances. This way you would get a second opinion on whether the orthotics will be helpful in the longer term or may be causing some new issues.

 

[Susie-Q]

I also experienced the need for new orthotics after my second TKR, about a year post-op. I'd had a pair for about 20 years that I'd gotten after a bought of plantar fasciitis. About a year ago I ended up with plantar fasciitis again, possibly due to the new realignment of my two new knees. Got fitted for new ones and during that adjustment period, everything was thrown off course, from my knees all the way up through my hips into my back. All is well now, just know that it takes time to get adjusted and there will be aches and pains as things resettle.

 

[Buttercup52]

Thanks very much for feedback.