Walking Correctly After TKA
by Yvonne LaCrosse, PTA
Let’s talk about your gait after knee replacement, your walking pattern.
Listen to our podcast episode about Walking Correctly After TKA from The Bee’s Knees Podcast below.
One really important thing is to get that extension, the straightening of your knee. When your knee is completely straight it should be at zero degrees, and that’s what you want to strive for following a total knee replacement surgery. When we walk normally, our heel should hit the ground first, and then we should roll through our foot to the ball of our foot and our toes. And that’s what we push off with for the next phase of the walking pattern. Again, we hit with our heel, we roll through our foot and we push off with the ball of our foot and our toes. That first step, when the heel hits first, is called heel strike. Then once we roll through and we push off with the ball of our foot and our toes, that is called toe-off. Those are two of the phases that I’ll be talking about today in reference to getting that extension at zero.
0º Knee Extension
To walk properly you need that zero degrees so that your heel can hit the ground first. With your gait after knee replacement, sometimes what happens is your brain can start sending messages to the leg on how it should move and where it is in space. Your leg can sometimes have a delay on that message. It’s almost like your muscles have to relearn what their job is. Your leg has to relearn what it should be doing when you’re walking. Sometimes that can be part of the problem too. Sometimes you’ll have zero degrees of extension. You’ve been doing really well on your X10, but now you almost have to ‘reprogram your brain’ on how to walk again. Again, you’ll have to take a look at, “How am I walking? What am I doing with my feet when I step?”
You have to take a look at it, pay attention, start walking to what feels normal to you. Glance down, see what your feet are doing. You want to make sure that the heel hits first, you’re rolling through your toes.
The relationship between your brain and your leg, and with your foot hitting the ground is called proprioception. That relationship with your brain and your leg takes time to develop again after surgery. It’s important because your brain tells you where your foot is in space. Whether your foot hasn’t hit the floor yet, or if it’s just touching the floor if it’s about to touch a surface that may be uneven. These are all important things for your leg to get the message from your brain, and to do it in a timely manner.
For example, if you’re stepping onto grass or you’re walking on sand, your foot needs to know that before you step. You need a little bit more balance to walk on those types of surfaces. You need that good relationship so you don’t lose your balance and that you don’t start to waiver. If you were about to step up onto a curb, your brain needs to tell your foot how high should it lift so that you’d have good clearance.
A closely related concept is kinesthesia – which is a term that refers to behavioral movement and your sense of what your body’s movement is. This is the awareness of the position and movement of the parts of the body by means of sensory organs in the muscles and joints. The perception of the movement of one’s own body, its limbs, and muscles. The word kinesthesia or kinæsthesia (kinesthetic sense) strictly means movement sense.
Don’t Catch Your Toe (Avoid a Falling Risk)
Sometimes you’ll notice you almost lift too high because again you’re not quite sure what to do with your foot. Most importantly you want to make sure you lift high enough so that you don’t catch your toe.
Sometimes what happens before surgery is that arthritic pain that you are experiencing for so many years and for so long caused you to start walking differently. You’ll develop a pattern that is not how we’re meant to walk. For example, you are having a lot of pain on the inside of your knee, so it feels better if you walk on the outside of your foot to relieve that inside knee pain. After surgery, we’ve changed the way that our bones are aligned. We’ve changed the way we’re using our muscles, and we’ll start to develop this pattern to avoid pain. It becomes a problem, and it can cause hip pain, and it can cause knee pain, and it can cause ankle pain.
Re-Program Your Brain
After your problem is corrected and you’ve had this surgery and you don’t have that pain to avoid anymore. You really want to make sure that you have reprogrammed your brain on what is a normal way to walk. You might have a great range of motion, but your brain has accepted your old way of walking as normal. With your gait after knee replacement, you have to reprogram yourself. Don’t walk on the outside of your foot. Distribute your weight evenly through your foot and having good contact with the ground for your full foot, not just one side or the other.
You will need more than this blog to adjust your gait. You will need practice under the supervision of a good PT. By regaining your range of motion, arresting any muscle atrophy after surgery you can then focus your attention on your walking pattern. The sooner you can do this the better before you fall back on old, incorrect patterns that you developed prior to your surgery.