TKR Thank Goodness I Only have Two Knees!

[MSuki]

I’m glad you got to take that break from PT and sounds like your work situation is flexible. Be careful and start slow on going to the office - I think it’s a good idea to limit hours/days at first especially since work from home is an option.

 

[selketine]

Well... now my foot is acting up. I'm getting pain on the top of my foot on the surgical leg - near where the toes connect to the foot so it's not the arch or heel. I am wondering if it's connected somehow to that tightness I have in the back of my leg when I get up (especially out of bed in the morning). I've been stretching almost every time I get up to walk but I always go back to square one. The foot pain keeps me walking flat footed. This has been about 2 weeks now.

Any ideas on if the calf stretch issue is connected? Is this a podiatrist issue? I have an HMO so I'll need to start with my primary care doc. Doesn't seem like an issue for the surgeon to me since it's not really the knee.

I mentioned it a couple of times to the PT on Friday and she didn't offer any advice or comment - but she did say the stretch I'm doing should help the calf tightness.

 

[MSuki]

Don’t know about yours but I have had top of foot pain initially and again after over-walking and I think it might be related to the readjustment of tendons and ligaments. Is yours worse after walking or worse after sleeping?

 

[benne68]

am wondering if it's connected somehow to that tightness I have in the back of my leg when I get up

Probably. It's amazing how everything in our legs is connected. It always surprises when my massage therapist works in a different place on my leg than the spot where it hurts!

Which calf stretch/stretches are you doing? In addition to the standard wall stretches, my therapist had me do heel lifts and lowers standing on the edge of a step.

 

[selketine]

Is yours worse after walking or worse after sleeping?

Oooh...definitely worse after sleeping - that is by far the worst. Otherwise it seems like it is worse after inactivity. Sometimes I can get it to stop and other times not so much. Doesn't hurt when I'm just sitting but I can push on the top of my foot and it's sort of sore.

Which calf stretch/stretches are you doing?

Just the wall one. I googled "heel lifts and lowers on the edge of a step" and found a video. She does have me do heel lifts just standing on the floor and holding on to the counter. I've sort of stopped doing them cause she took them off my list but maybe I should try the ones you mentioned.

Clearly it's not a 911 issue thank goodness! I'd rather not go to the doctor with it - was really hoping the PT could help me but she didn't have much to say.

 

[benne68]

I thought of another one that my PT had me doing, @selketine.

Ankle rolls: from seated position, extend the leg and do circles with your ankle -- 10 in one direction, then 10 in the other. I would do them a few times a day.

 

[mendogal]

It sure wouldn't hurt to get a podiatry referral.

 

[Layla]

Happy Two Month Anniversary, Carol!
I hope the foot pain and calf tightness is easing. With any luck you made progress in the right direction as the days went on and now you're enjoying the weekend. Take care!
@selketine

 

[selketine]

Happy Two Month Anniversary, Carol!
I hope the foot pain and calf tightness is easing. With any luck you made progress in the right direction as the days went on and now you're enjoying the weekend. Take care!
@selketine

Hard to believe it's two months! I celebrated by...going to a mall - haha! It's one a bit farther away, that the last time I went (November) I was barely able to walk 1/3 of the distance around it (it's shaped like a racetrack oval). I made it halfway down and all the way back where I started with some breaks in between including lunch. I'm not feeling too bad today either - left knee is worse than the right this morning. 3500 steps yesterday. My pre-surgery normal was 1200-2000.

My foot issue is still there but doesn't seem as bad. Maybe my left knee is competing for attention haha!

I started back to work part-time last week (6 hours) and will do more hours this week. It all went well but it oddly tired me out way more than walking at the mall. I came home and had to nap after working which is unusual for me. It's an office job so not much walking - in fact I have to get up and walk so as not to get stiff.

 

[benne68]

What a great update, @selketine! I'm glad to read that you are feeling real progress. Slow and steady!

 

[MSuki]

Congrats on going back to the office but taking it slow! Lifting your heels is the opposite of stretching your calves if I’m picturing this right. Lowering heels off a step stretches it, or you can do a calf stretch standing against a wall, I’m sure there would be pics if you look it up. Interestingly my PT combined both - so I was supposed to stand on the slant board heels lower for 30 seconds, then do the heel lifts 10 times, then repeat twice more. I haven’t been doing this lately and when I tried this morning my calves were much tighter than the last time so I need to be more consistent with it.

 

[Layla]

Sounds like you're moving right along, making decent progress. I wish you all the best as you ease back into work. Thankfully you're able to rest at home afterward if you're feeling exhausted. Thanks for the update, Carol.
I hope you have a great week!
@selketine

 

[mendogal]

Wow! You're walking waaaay further than I could at two months!!! Great update.

 

[selketine]

There was an interesting post on another TKR group I follow (not sure you want them mentioned here). The overall posts there lean heavily towards the "no pain no gain" variety. Someone posted however that their doctor at Duke in North Carolina has an approach to recovery very much what is advocated here. Not doing much the first weeks, not doing strengthening exercises, getting ROM and flex is more important in the first months so focus more on the gentle stretches bringing those back, doing things that minimize swelling, etc. A few other people posted their docs had the same approach - not encouraging that much walking the first 6 weeks (well like under 3500 steps a day which seems a lot to me haha!). One doc keeps his patients on a walker for 6 weeks. Also mentioned was that "current research" shows this to be more effective than all the PT. I wish they had cited the research but it was mentioned to them by their doctor I guess. It was an interesting thread because I think the people who follow a more BoneSmart approach rarely post there (like me) because it's considered bad advice.

Reminds me of parenting newborns - what parents were told to do 10 or 20 years ago is probably considered bad advice now.

 

[kayakker]

@selketine ...How's the foot? I have the exact same thing and, while it is painful, it is more an anxiety issue for me.. I've had both hips and one knee replaced and am so afraid osteoarthritis is going to take over every bone in my body. I touch the top of my foot right where my toes attach and it is painful and seems like my bones are more pronounced than the non-operative foot. I'm scared I have developed bone spurs or arthritis in my foot! What on earth do they do about that?? I'm a hard "no" on foot replacement...lol. I'm wearing Copper Fit arch supports and they seem to relieve the pressure on that part of my foot. I'm hoping it will resolve with time....as everything else with this journey seems to do.

 

[benne68]

that "current research" shows this to be more effective than all the PT.

Yes, it is interesting that the latest studies are supporting this more gentle approach to recovery. There was an article on the American Physical Therapy Association website recently on this topic that said PT sessions should be focused on "achievement of mobility milestones, education and assessment" instead of "traditional range of motion or strength exercise -- which we're finding patients don't need as much of."

 

[Jockette]

It was an interesting thread because I think the people who follow a more BoneSmart approach rarely post there (like me) because it's considered bad advice.

When I first found Bonesmart, at 4 weeks post op, after a very aggressive pool PT session (50 minutes!) that took me 3 days to recover from, it only took me seconds to agree with the gentle rehab approach mentioned here, rather than what my PTs were doing with me! When I tried to tell others about it they looked at me like I had 3 heads. Even after 7 years on Bonesmart, I still get very few people in person who think our gentle approach is a good idea. It’s very frustrating. Joint Replacement patients are suffering needlessly because of the aggressive rehab they are doing, and some have actually been harmed enough to need more surgery because of it. And yet, we are the odd ones.

 

[selketine]

How's the foot?

I'm sorry to hear you're having some similar. I'd say mine has gotten better somewhat. I've been doing the stretches people here suggested which seems to have helped. It's most sore in the morning when I get up. I wouldn't think it is arthritis (for either of us) - maybe just some weirdness that will resolve in time because our gaits are different after surgery? That's what I'm hoping!

 

[MSuki]

It does remind me of the scene in Die Hard though where Bruce Willis is doing little circles…..

There can be a lot of weirdness post this surgery. And no real explanations for most of it other than realignment. I had to go to my GP this week for clearance for my cataract surgery and told him about my foot pain, which came back after my ordeal at the airport. His only reaction was basically yeah that’s weird.

 

[selketine]

Another week down. My foot is better and usually just sore now first thing in the morning. I'm back in the office 3 days a week and will be back full time starting April 2nd.

Interestingly, a coworker knows someone getting Bilateral TKR - and the person was telling my coworker that she expects to be back at work in the office in 2 weeks. Just really not sure whether to laugh or cry but really her doctor needs to set some realistic expectations. I think people who go into this surgery thinking they're going to be mostly good in 2 weeks are the ones who are really blindsided by the difficulty of it and it only makes it harder.

Not sure if I'll go back to PT - I haven't been in a couple of weeks. My TKR leg can definitely bend as far as it could pre-surgery - and it bends farther than my left knee now. Still is stiff and sore but I figure that will fade eventually. At this point, more bend is just gravy!