Revision TKR Revision Complete, recovery continues

[Pumpkin]

I have been lurking here for a few weeks, Left TKA on Sept. 13, 2011, S & N Genesis II. Knee doing great, information here has been very helpful. 1970 left ankle sprain, 1973 left tibia fracture, healed crooked, 2000 Left partial menisectomy, notchplasty, microfracture to medial tibia, paste graft to left medial femur, 2008 large loose body removed from left knee.
I will put this in my signature when I have enough posts.
Have managed to tear all three peroneal muscles at their attachment on my left foot. MRI, shows partial tears on the two that attach to the bump on your foot below the little toe a couple inches, and a possible complete tear on the one that attaches underneath your foot on the other side. MD wants conservative treatment for 6 weeks, gave me an ankle brace, but it holds my foot up and stressed those tender tendons. Normally you would cast, but he does not want to interfere with the healing of my left TKA.
I am a PT specializes in geriatrics, and neurology, see people with knee replacements rarely, but always gently.
Has anyone had this happen, and what was the outcome?
Thanks, Chris

 

[Jamie]

Hi, Pumpkin.....welcome to BoneSmart. I'm glad you decided to join us officially on the forum.

You certainly have had your share of events here recently. I hope things settle down for you now. With all you've been through, I think our forum nurse, Josephine, is the best one to address your particular situation. I'll tag her so that she sees your post when she comes back online. @Josephine:

As a therapist, you will recognize the need to do gentle exercises and baby your new knee for a while. I'm glad.

 

[Pumpkin]

Thanks, called MD re brace, and asked about antibiotics used after TKA.

 

[Pumpkin]

No response today, must be the full moon.

 

[Josephine]

I'm here! Sorry it took me so long to get to you. Was working yesterday.

Those kinds of tears aren't uncommon in the foot and they do heal in time but can take some weeks. As I understand it, casting isn't actually for healing more for pain relief which is a bit academic in your case because of your knee. I hobbled around on a similar injury for about 6 weeks before I sought medical advice by which time it was too late to do anything! So I continued to hobble around on it for another few weeks and eventually it sorted itself out. I understand that these injuries rarely need fixation as they do pretty well on their own.

Painful though, isn't it? I remember it well!

 

[Minnie]

Hi Pumpkin!
I have had problems with my peroneal tendon in both ankles. On my right ankle I did not go to the doctor until it almost ruptured and I needed a surgery to repair it. My left ankle has many tears in the peroneal tendon, I think because I had so many problems with my right knee replacement that I really stressed my left ankle because for a long time I was only putting my weight on my left side.
I am still in the recovery process with my right knee but I am well enough that I can now distribute my weight evenly so the left ankle is not hurting as much as it was. I do wear a brace on it for any long walks and working out. I was told with PT the tears could heal themselves over time ( like Josephine said) and I am really hoping that is happening and it is hurting less so I am optimistic.
We really need patience with knee replacements sometimes and I continue to remind myself of that all the time because I have never been patient.. BUT I am now!!! Hang in there.. you are not alone
Minnie

 

[Pumpkin]

Thanks! Foot feels better today. Discouraging when MD recommends the brace making it worse. May modify it to allow my foot to move more freely pointing down. Using an ace wrap for walking, seems to be helping.
Hope we all heal soon!
Chris

 

[kneesrus]

Hi Pumpkin. My first question would be, what are your muscle grades? I have rehabed over 1,000 TKRs and I would want ankle stability. Not a cast for this condition, but some support while you work building your lower extremity. Our program entails strength ex from hip flexors to gastrocs. Most patients have lost a great deal of muscle strength in all planes while contemplating having a total knee replacement.
Best of luck,
David

 

[Pumpkin]

Hi David, Strength in all leg mm are around 4+/5, started strengthening program in June, and did well post surgery with all mobility. Except now my ankle mm are weakened by this episode. Plantar flexors are 3/5 and painful, Dorsi flexors are 3/5, painful at end range with pulling on peroneal mm attachments. I would not anyone to strength testing at this time. Before and after surgery I was unable to to a full single limb toe raise on the left. Of course now I would not attempt it. I continue with floor exercises to keep leg and hip mm strong, and warm water pool for Left knee ROM and strengthening against resistance of water. Just prior to this episode I had a mild ankle twisting episode, that I assume started all of this.
PT I was seeing did not believe me that my foot hurt, and thought it was an ankle sprain, he did rapid PF/DF to loosen my ankle and that is when the acute phase started. (I have quit this PT, now seeing PT I trust). Took about 6 days for initial episode to settle down, then was flared up by ankle brace MD gave me, foot is better, but flares more easily now. I am using an ace wrap,not too tight, with heel locks medial and lateral. Ace wrap provides sensory input to facilitate stability. If I wrap too tight my foot is unhappy. I use a cane or crutches, when it is sore. Elevation, ice and heat applied as needed.
MRI shows possible grade 2 tears in brevis and longus tendons, with radiologist questioning if there is more extensive tearing, and possible complete tear of longus. I can move in all ROM, so MD wants to wait 6 weeks to see if it will heal on its own. Ankle unstable secondary to varus healing of tibial fx 1974, partial tear of ACL 1993, and loss of medial compartment starting in late 90's. I noted last week that my pronation moment on the left has increased. Prior to knee surgery I was using a 1 to 2 degree lateral wedge. I have a hard time finding shoes that do not have a mfg defect that feeds into inversion moment, cost and presumed quality does not seem to matter. All of this falls into the category of not fun at all. Any suggestion would be greatly appreciated. Hurts like the dickens.
Chris

 

[kneesrus]

WOW! OK, here is something you may try. Take an old fashion Koosie and cut out a horse shoe shape. Place the horse shoe around the lateral malleous and moderately wrap with your ace bandage. This will give direct support to peroneals. Obviously if it hurts, d/c. This is not a no pain, no gain situation as you know.
The other question I would have is, have you been on antibiotics for a long time? There has been a connection between this medicine and tendon damage.
Hope you get well soon. You have been through a great deal, you need a break.
David

 

[Pumpkin]

Thanks, I'll try the horseshoe tomorrow, and report back.
Took keflex in June for a tooth infection, and am still trying to find out what they gave me post TKA. Otherwise no antibiotics for two years prior.
Chris

 

[kneesrus]

There has been some evidence that long term antibiotics weakens tendons. Key word, long term. I have been looking at evidence base studies on peroneal tendon tears related to TKR without a match so far. I will keep searching for you.
Have a good week,
David

 

[Pumpkin]

Thanks David!
Used the horse shoe on my ankle, gave some light compression over the tendons. No problem with it so far. Cut one out of half inch hapad felt, was comfortable in my skin.
Thanks for looking into antibiotics, seems most tears are the Achilles tendon. I suspect this is the result if chronic ankle instability over the last ten years, and my high arch.
Chris

 

[kneesrus]

That is certainly an explaination. That is what the studies suggest, nothing on TKR being a factor.
Best to you,
David

 

[Pumpkin]

Good news, started using a heel lock yesterday, on the inside ankle, it stops the ankle twisting, and my heel bone feels better. Using Kendall wet Pruf tape, stays on in water. Foot still sore where the peroneal mm attach, I expect it will continue until they heal. Using a cane outside.
Had my ROM measured today, up to -5 extension, and 117 flexion. At last I feel like I am getting somewhere.

 

[kneesrus]

Great to hear good news. Rock on!
David

 

[Pumpkin]

I am grateful the huge fire near my house is moving in the other direction. 60 MPH winds are pushing the fire towards neighborhoods.
Can't imagine having to evacuate at this time.
A little off topic, but having limited mobility makes this very scary.

 

[Pumpkin]

Fire danger past, snowing and windy. Stress levels are way down and my knee feels much better now that I can relax.
Foot feeling better, just need the patience to give the tendons time to heal.

 

[Mountain Kat]

Pumpkin, glad the fire danger has passed and you are feeling better! I worried about the same thing when I was scheduling my surgery. I didn't want to postpone the surgery just because it was the middle of fire season though, but it did cross my mind.

 

[Pumpkin]

Been hobbling along on the painful left foot for weeks, finally searched under peroneal tendinitis vs peroneal tendon tears. With the information I located, I modified my shoes with a heel lift and lateral wedge, and a recess for my big toe. Took care of the mini ankle strain I had with each step and decreased the stress on my sore tendons. And my knee in 90% better.
I am so relieved to have less pain, and feel like I can go out and have some fun finally. Going to a potluck at work tomorrow, and am looking forward to having a great time. I return to work in January, think I my be able to now.
Thanks for all the wonderful support on this forum, I appreciate everyone here,