had a total ankle replacement 6 months ago foot feels like it is totally asleep and numb

by Don
(Troy,Mo, USA)

Had a total ankle replacement 6 months ago 1st of August 2016. Since surgery my foot and big toe feel like they are asleep numb and the other 4 toes feel like they are half asleep tingle all the time and I feel like do not have much control over my toes. Been asking my surgeon about it since 3 days after surgery and all he keeps telling me is it might take 1yr or 2 yrs to get all my feeling back and this numbness and sleep feeling to leave. He has totally released me and when I call him he says their is nothing more he can do and say's you had a terrible ankle and it will just take time. I stumble and fall occasionally and loose my balance a lot on this foot. Walking on uneven terrain is almost impossible and walking up inclines or declines is so painful I can not do it, Stairs and steps are real pain to try to maneuver. Is all this normal for 6 months post ankle replacement?? Thank you

RESPONSE

Hi Don,

I will start off by stating that in any type of orthopedic surgery, patient's experiences will differ from person to person. So what might be "normal" for one person may be quite different for the next.
By your narrative, the two main complaints that you have is that your foot and toes are numb, and, you have difficulty ambulating particularly inclines, so let me address both.
All the nerves that control sensation and motor function in the foot come from the spinal column, down the leg, pass through the ankle and reach the foot.
It is not uncommon for nerves to be irritated or even damaged in ankle surgery. This will occur in fractured ankles that are repaired as well, so it is not limited to joint replacements.
There is a better then fair chance that during your surgery, some of the nerves passing through the ankle were either irritated or damaged. It is impossible to know which occurred.
Assuming you went for physical therapy after the surgery, to help reduce the postoperative swelling, at six months down the road, although I would not expect your sensation to be perfect, I would have assumed that you would have seen some degree of improvement in sensation to your foot, perhaps compared to three months earlier.
Nerve tissue is one of few tissues in the body that actually regenerates, albeit it at a slow pace.
From the surgeons standpoint there is nothing else he can do simply because he does not treat nerves. What he probably should have suggested is that you confer with a neurologist. If a neurologist could isolate which nerve(s) are affected there may some treatment that can be directed directly to the affected area, such as a cortisone injection, nerve stimulation or even different types of modalities available through physical therapy.
This is something you might want to consider, sooner rather then later, simply because the earlier you start on this, the better your chances of success.
Your other issue of an inability to walk normal and particularly of walking inclines is also going to be problematic.
You do not mention why you had the surgery in the first place. Was it because of severe trauma to the ankle that could not be repaired or was it from severe degeneration of the ankle joint, as seen in arthritis?
The purpose of implants in general is to relieve pain. The problem with many implants is that they also limit mobility. I am assuming your ankle does not move up and down as readily as your other ankle. This limitation of motion is what is causing you problems when you try to walk inclines; the ankle just doesn't move enough.
Ankle implants is a reasonably new area, I am guessing they have been doing them for around ten years. There is still much debate as to whether they are effective enough and of course as time goes on and surgical failures are reported, different types of implants are being devised.
There are things that can be done to help you ambulate better. This would include some type of brace as well as possibly a heel lift that would give you a bit more range of motion and might make inclines more tolerable.
Without actually examining you, I am only guessing here, as I would need to know how little or how much motion your new ankle actually has.
For this aspect of your problem, I would ask your surgeon if he can recommend someone who can work with you to better stabilize your foot and ankle and make walking more tolerable.

Marc Mitnick DPM
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