Post-ACL Surgery: Why Is My Foot Numb and Painful? - Orthopedics

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After undergoing ACL (anterior cruciate ligament) reconstruction surgery, experiencing numbness and pain in the foot, particularly in the toes and the front of the foot, can be concerning. While some discomfort and pain are expected post-surgery, especially in the initial weeks, the symptoms you describe warrant further investigation.

Firstly, it's important to understand that during ACL surgery, various structures around the knee, including nerves, can be affected. The most common nerve that might be impacted is the common peroneal nerve, which runs down the leg and can lead to symptoms such as numbness, tingling, or pain in the foot and toes. This nerve can be compressed or irritated due to swelling, hematoma (a localized collection of blood outside of blood vessels), or even from the positioning during surgery.

The timeline of three weeks post-surgery is significant. While some numbness and pain can be normal, especially if there was significant swelling or if the surgery was extensive, persistent or worsening symptoms should not be ignored. Here are some potential causes and recommendations for your situation:
1. Nerve Compression or Injury: As mentioned, the common peroneal nerve can be affected during surgery. If there is swelling or hematoma, it may compress the nerve, leading to the symptoms you're experiencing. If this is the case, the symptoms may improve as the swelling decreases over time.

2. Scar Tissue Formation: Post-surgical scar tissue can develop and may lead to nerve irritation or compression. This can cause pain and numbness in areas that are not directly adjacent to the surgical site.

3. Circulation Issues: Sometimes, post-operative swelling can impede blood flow to the lower extremities, leading to numbness and pain. Elevating the leg and using ice can help reduce swelling and improve circulation.

4. Physical Therapy: Engaging in a structured rehabilitation program is crucial after ACL surgery. A physical therapist can provide exercises that promote circulation, reduce swelling, and improve mobility. They can also assess your symptoms and determine if they are related to nerve issues or other complications.

5. Medication: Over-the-counter pain relievers, such as NSAIDs (non-steroidal anti-inflammatory drugs), can help manage pain and reduce inflammation. If the pain is severe, your doctor may prescribe stronger medications or nerve pain medications like gabapentin or pregabalin.

6. Follow-Up with Your Surgeon: It is essential to communicate your symptoms to your orthopedic surgeon. They may recommend imaging studies, such as an MRI or ultrasound, to assess for any complications, such as nerve entrapment or significant swelling.

7. Avoiding Strain: While it is important to engage in rehabilitation exercises, avoid putting too much strain on your knee and foot until you have a clearer understanding of the cause of your symptoms.
In summary, while some pain and numbness can be expected after ACL surgery, persistent or worsening symptoms should be evaluated by your healthcare provider. Early intervention can help prevent long-term complications and ensure a smoother recovery process. Always prioritize open communication with your medical team regarding any concerns you have during your recovery.