TKR Thank Goodness I Only have Two Knees!

[mendogal]

That tightness preventing you from putting your heel down is likely a tight gastrocnemious - the calf muscle that runs from the femur to the Achilles tendon - I'm having problems that I thought were hamstrings and just today my PT identified the culprit as gastrocnemious; the two muscles cross each other behind the knee.

You can easily find gentle stretches on the internet.

 

[MSuki]

I like to stretch my calf on a step.

During my first TKR I slept for a short time with plantar fasciitis socks. They sort of pull your foot up toward your knee. This might be more extreme than you need and no idea if anyone would recommend it! But it helped me when my calf was so tight it was causing heel pain.

 

[mendogal]

I like to stretch my calf on a step.

During my first TKR I slept for a short time with plantar fasciitis socks. They sort of pull your foot up toward your knee. This might be more extreme than you need and no idea if anyone would recommend it! But it helped me when my calf was so tight it was causing heel pain.

I would caution against these if you don't have a diagnosis of plantar fasciitis. They pull on the calf by way of the Achilles tendon. I recommend looking for stretches that specifically target the gastrocnemius muscle; they will secondarily affect the Achilles tendon which would be the preferred way to stretch.

 

[selketine]

Thanks to you both for the suggestions. I don't have any foot/heel pain fortunately. However just in the past week when I get up from sleeping overnight I can't put my heel down on the surgical leg. It's hard to walk for a bit until it stretches out.

I wonder why it's bothering me all of a sudden and wasn't before - at all. Never had this issue. I'm wondering if that muscle is also somewhat tight during the day after sitting and it's one reason I'm off balance so much. After going somewhere to walk - I usually come home and have a really nice gait in the house and can use the cane. As the day wears on, I'm more and more unsteady. By night time I can barely walk with the cane.

I'll try keeping that muscle stretched - a wall stretch was the main "exercise" I found. The hardest part is bending my left knee to do it!

 

[sistersinhim]

I wonder why it's bothering me all of a sudden and wasn't before

Welcome to the yoyo of a joint replacement recovery. It seems like every muscle/tendon in our legs want their time to hurt. As you heal, you are walking in different ways, thus, the different muscle involvement and complaints. Did you get new shoes since your surgery. We recommend this, also.

 

[WFD]

I had exactly the same issue as @MSuki , and also used a plantar fascitis brace to keep the foot from pointing and the calf from shortening while I slept. It helped a lot and didn't cause any problems. If I didn't use it I would wake up with the calf contracted, my toes pointing, and in pain. One night I woke up, found the brace was bugging me instead of helping, and took it off never to put it back on again.

I also used the wall stretch multiple times a day and sometimes a step. I also found that (when I was recovered enough to do it) calf strengthening helped as well. Weak muscles are often tight and strengthening the calf muscles helped allow them to relax.

Of course your mileage may vary.

 

[MSuki]

Weak muscles are often tight and strengthening the calf muscles helped allow them to relax.

Oh I am inspired now! My calf muscle is still too tight.

Carol what is causing you to not be able to put your heel on the floor? Is it a tightness in a different muscle area? Difficulty bending first thing? I thought you meant heel pain but since you said not, I’m wondering what is going on.

 

[Layla]

I experienced some of the same. Basically my situation was a tight Achilles and it was suggested I try Calf Stretches, which helped. I am guessing that may be what you mean by the wall stretches? If the following is different than what you were doing, you may want to see if you're able to gently give this exercise a try...
Best Wishes for relief and a peaceful weekend! @selketine

Calf Stretch

1. Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.
2. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.
3. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times.

 

[selketine]

Did you get new shoes since your surgery

I haven't yet. Well I actually have a new pair of Hokas but I haven't worn them. I also have another new pair of shoes like the ones I've been wearing so I can try those. I can't tell shoes bother me when I'm out walking - I don't wear shoes in the house.

Carol what is causing you to not be able to put your heel on the floor?

When I wake up and stand up - I can straighten my leg (well at the knee) it seems but I can't put my heel down so I'm standing on my toes. It's like the muscle along the back is shortened up. It feels so weird and just started this week. Zero foot pain. I could walk better when I got out of bed right after surgery than I'm walking now - at least for the first 5 minutes. I'm barely able to walk because my left leg is really unhappy and painful. Thank goodness it goes away. However I do think that it's happening during the day after I sit. I get up often and walk but I can tell that my heel doesn't want to come down when I first stand up.

I am guessing that may be what you mean by the wall stretches?

That sounds like the ones I saw when I googled! I added those as best I can as the left leg doesn't like being bent like that. I also added back in the knee extension exercises I was doing (heel on a rolled up towel while sitting up in bed to try to get the knee flat). The PT said I could stop that because my extension seems flat already but maybe that was helping? It's the only exercise I've stopped. PT had added a new one but that seems more like an upper thigh one (lifting the leg while lying down).

I've also been trying to walk with the cane in the house some - it's hard! I tried walking without it (holding it - holding one in each hand actually in case my knee gives out) - and my husband said I was walking like Tim Conway in one of those old skits - haha! I can barely shuffle my feet - it is quite comical!

 

[mendogal]

Oh! Tell your PT about it! If he thinks its appropriate he can have you stand on a slant board: both legs straight, heels lower than toes. Not necessarily as extreme as this pic I grabbed.

 

[kneeper]

Carol what is causing you to not be able to put your heel on the floor?

When I wake up and stand up - I can straighten my leg (well at the knee) it seems but I can't put my heel down so I'm standing on my toes. It's like the muscle along the back is shortened up. It feels so weird and just started this week. Zero foot pain. I could walk better when I got out of bed right after surgery than I'm walking now - at least for the first 5 minutes. I'm barely able to walk because my left leg is really unhappy and painful. Thank goodness it goes away. However I do think that it's happening during the day after I sit. I get up often and walk but I can tell that my heel doesn't want to come down when I first stand up.

I had that at one point. It is tight muscles. I agree with @mendogal that your PT can help with this.

 

[selketine]

The wall stretches seem to have worked a bit - it was not quite as bad this morning. Hopefully that continues.

I went to the mall for the first time and walked more than I have since surgery. I stopped a few times to sit. I also realized the mall floor is fine for walking but very slippery when trying to stand up. My husband was with me and had to let me use his foot as a stop so my foot wouldn't just keep slipping. Very exciting to think I could just sit down somewhere and not be able to get up!

 

[MSuki]

Are you still sleeping on your back? When I was on my back for the first surgery, I had a problem where my foot would end up being too extended -I guess gravity was pulling it down? So that my heel was on the pillow and my foot was sort of in the pointed position. Do you think that might be what’s happening?

 

[benne68]

I went to the mall for the first time and walked more than I have since surgery. I stopped a few times to sit.

Good for you!

How are feeling today? Hope you aren't on the ODIC bench after all that extra walking.

 

[selketine]

How are feeling today? Hope you aren't on the ODIC bench after all that extra walking.

You know yesterday (Sunday) I felt pretty good but decided not to go out walking anywhere and just practiced at home with the cane - in fact used the canes most of the day (sometimes two canes cause my knee still can buckle). Today though my knee was sore - the front and back of it. Maybe walking with a cane uses different muscles? No idea! I did go for a short walk at the grocery with the cane. I've sitting here icing and elevating - and I don't like to ice so you know it's bothering me if I'm doing that- haha! My knee itself hasn't been sore right in the center like that for awhile.

I've asked for my surgeon to write me a "return to work" letter saying I could go back "as tolerated" and back full time by April 2nd. I haven't actually seen him since the surgery so I don't know how he could make that evaluation. I had to send the request through the HMO's medical records department which is what they wanted me to do. I am hoping to go back a few hours a week but not full time to start. My workplace is very flexible and happy to accommodate me.

 

[benne68]

@selketine. I'm sorry your knee is complaining today, but it's completely normal to go through these ups and downs as we recover. I'm a few weeks ahead of you and still have days where it feels like I'm doing the "2 steps forward, 1 step backwards" dance!

Hope that soreness resolves for you soon.

 

[Susie-Q]

see if I can go a few hours a day to start.

I think this is wise. I worked part-time in 4 hours shifts at my former workplace and when I went back at 2-3 months post-op, I started at 90 min to 2 hrs and worked up to the full 4 hour shift. My work was on my feet the whole time on a cement floor.

I hope this week is going well for you, @selketine , and that your calf muscles are stretching out a bit better. I also wanted to mention I had to get new shoes and new orthotics after my second TKR.

 

[selketine]

I had PT today after being away from it for 2 weeks. I think the therapist seemed worried I'd go backwards - she kept calling me this week trying to find a time I could come in (all her openings were last minute and I had plans plus I'm working from home so I can't just drop stuff and go).

So the great news is that 3 weeks ago I was at 90 for ROM and she measured me at 105 today! So I'm super happy about that. My right knee is bending about equal to my left now -so that's probably pretty much where it would go pre-surgery. I'm hoping it will get to a better bend eventually but I can really tell a difference.

I'm also pretty much using the cane all the time except in the mornings when I get up. Tomorrow I am going to visit my work and just see people, and next week I'll start going into the office - maybe 2-3 hours for a couple of days. I'm looking forward to it!

 

[benne68]

the great news is that 3 weeks ago I was at 90 for ROM and she measured me at 105 today! So I'm super happy about that. My right knee is bending about equal to my left now

What wonderful news! Maybe now she will understand the value of giving the knee time to recover and not pushing it for ROM.

You're doing great.

 

[Susie-Q]

What awesome progress!! When you give the knee a chance to rest, heal and reduce swelling, this is what you get, better ROM!! Not by pushing it aggressively but by letting it gradually show improvement through ADLs.

Congrats!!