Undergoing knee surgery is a significant journey, often filled with anticipation, hope, and a commitment to improved mobility and quality of life. However, the postoperative period can bring unexpected challenges for some individuals, such as burning calf pain.
This comprehensive guide will explore the reasons behind calf pain after knee surgery, explore various contributing factors, and provide ten practical strategies for managing and overcoming this discomfort.
What is a Total Knee Replacement?

A total knee replacement, or total knee arthroplasty, is a surgical procedure in which a damaged or arthritic knee joint is replaced with an artificial joint, a prosthesis.
This procedure is commonly performed to relieve pain and restore function in individuals with severe knee joint degeneration due to conditions such as osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis.
According to the Healthcare Costs and Utilization Project, more than 678,000 total knee replacement surgeries are performed yearly in the United States1. The high obesity rate in America is a significant contributor.
Understanding the Surgery
To understand the post-operation pain, we must first examine the surgery procedure.
- Incision:
- A midline cut is made at the knee.
- Muscles that are cut: knee extensors or quadricep muscles
- Ligaments that are cut: anterior cruciate ligament (ACL), posterior cruciate ligament PCL (if posterior cruciate-substituting approach)
- Resection of Damaged Tissue: The damaged or arthritic surfaces of the knee joint, including the ends of the femur (thigh bone) and tibia (shin bone), are removed.
- Implantation of Prosthesis: The artificial joint components, typically metal and plastic, are implanted. The features include a metal femoral component, a metal tibial component, and a plastic spacer that serves as the artificial cartilage.
- Closure: The incision is closed, and the new knee is carefully examined for proper alignment and range of motion.

What are the Causes of Calf Pain After Knee Surgery?
I’ve had numerous Knee Replacement cases within my five years of experience as a Physical Therapy Assistant. From my experience, about 50% of my patients complained of a burning sensation in the back of the leg. It leads people to ask: What is causing this pain? Is it normal? How do you fix it?

What Kind of Pain is Normal?
After a total knee replacement surgery, it is expected to have a fair amount of inflammation and swelling. The patient may experience a considerable amount of pain as well.
The burning sensation behind the knee is believed to be due to nerve damage.2 While the surgical procedure does not directly cut or damage nerves, there are several ways in which nerves in and around the knee can be affected. Some affected nerves are the peroneal or branch and the saphenous nerve.
When the nerves are repairing, you may experience lower leg pain, often described as sharp pain, tingling, burning, or pins and needles. It’s important to note that individual experiences may vary, and nerve-related issues are typically temporary.
What Kind of Pain is ABNORMAL?
If you are experiencing:
- Significant swelling in the affected leg that will not decrease
- Severe pain or tenderness, often starting in the calf.
- Red or discolored skin.
- Warmth over the affected area.
These symptoms indicate Deep Vein Thrombosis (DVT) or deep venous thrombosis. It is a medical condition characterized by the formation of blood clots (thrombi) in the deep veins of the body, commonly in the legs. DVT occurs when blood clots form in the large veins deep within the muscles, typically in the lower limbs.
Risk Factors contributing to the development of DVT, include:
- Prolonged Immobility: Extended periods of inactivity, such as during long flights or bed rest, can increase the risk of DVT.
- Surgery or Trauma: Individuals undergoing surgery, especially orthopedic procedures like knee or hip replacement, are at an increased risk of developing blood clots. Trauma or injury to the veins can also contribute.
- Medical Conditions: Certain medical conditions, such as cancer, obesity, and diseases affecting blood clotting, can elevate the risk of DVT.
- Age and Gender: Older age and being female are factors that can increase the likelihood of developing DVT.
- Smoking and Obesity: Lifestyle factors, such as smoking and obesity, can contribute to the risk of DVT.
The danger of DVT lies in the potential for the blood clot to break loose and travel through the bloodstream. If a clot travels to the lungs, it can cause a potentially life-threatening condition known as a pulmonary embolism (PE).
It’s important to note that not everyone with DVT will experience symptoms, and the condition can sometimes go unnoticed. If you suspect DVT or experience symptoms, seek medical attention promptly. Diagnosis may involve imaging tests such as ultrasound.
Ten Best Ways to Relieve Calf Pain After a Knee Surgery

Calf pain after knee surgery can be a common and discomforting issue. While it’s essential to consult with your healthcare provider or orthopedic surgeon for personalized advice, here are some general strategies that may help alleviate calf pain post-knee surgery:
- Physical Therapy or Rehabilitation Program:
- Adhere to the rehabilitation program prescribed by your surgeon or physical therapist.
- Consistent exercise and movement are crucial for recovery.
- Perform prescribed exercises to improve strength, flexibility, and range of motion in the affected knee and calf muscles.
- Manage Swelling:
- Use ice packs on the affected knee to reduce swelling.
- Apply ice pack for about 15-20 minutes every 2-3 hours during the initial days after surgery.
- Consider compression stockings or bandages to reduce swelling in the calf.
- Elevate Your Leg:
- Keep your leg elevated whenever possible, especially in the initial days after surgery.
- This helps reduce fluid buildup and minimizes calf pain.
- Pain Management:
- Take pain medications as prescribed by your healthcare provider.
- Over-the-counter nonsteroidal anti-inflammatory medicines or drugs (NSAIDs) can help manage pain and inflammation.
- Follow your healthcare provider’s recommendations regarding pain medication use and consult them if you experience any adverse effects.
- Calf Stretches:
- Perform gentle calf stretches to prevent stiffness and promote flexibility.
- Consult your physical therapist for specific safe exercises for your recovery stage.
- Monitor for Signs of Complications:
- Be vigilant for signs of complications such as increased pain, persistent swelling, redness, or warmth in the calf.
- Notify your healthcare provider promptly if you notice any concerning symptoms.
- Hydration and Nutrition:
- Ensure you stay well-hydrated, drinking plenty of water, as dehydration can exacerbate muscle cramps and discomfort.
- Maintain a balanced diet rich in nutrients to support the healing process.
- Gradual Weight-Bearing:
- Follow your surgeon’s guidelines regarding weight-bearing on the affected leg.
- Gradual progression from non-weight-bearing to partial and then full weight-bearing is often recommended.
- Massage and Gentle Mobilization:
- Gentle massage of the calf muscles may help alleviate tension and promote blood circulation.
- Consult with your physical therapist for appropriate manual techniques and mobilization exercises.
- Use Supportive Devices:
- Consider using assistive devices such as crutches or a walker, as your healthcare provider recommends.
- These devices can help reduce the load on your affected leg and calf.
Remember, individual recovery experiences can vary, and it’s crucial to communicate openly with your healthcare team. If you have concerns about calf pain or any other postoperative symptoms, seek guidance from your surgeon or physical therapist to ensure you’re on the right track for a successful recovery.
The Takeaway
Navigating calf pain after knee surgery requires understanding the underlying causes, implementing practical strategies for management, and knowing when to seek professional help. By adopting a proactive approach to recovery, individuals can optimize their postoperative experience and work towards restored mobility and improved quality of life.
Remember, each recovery journey is unique, and with the proper knowledge and support, overcoming calf pain can be a crucial step toward a successful rehabilitation process.
Quick Summary
- A total knee surgery can cause burning calf pain.
- The leading cause of the burning sensation is due to nerve damage.
- Don’t get confused between a normal burning sensation from nerve damage and excessive warmth from a DVT.
- 3 Top Tips to Relieve Calf Pain: Reduce Swelling, Stay Active, and Drink Water.
References
- Manske, R.C. (2016) Fundamental Orthopedic management for the physical therapist assistant. St. Louis , MO: Elsevier. ↩︎
- OSC, O. (2022, November 8). Nerve pain after knee replacement surgery is common. Orthopaedic and Spine Center of Newport News. https://www.osc-ortho.com/blog/nerve-pain-after-knee-replacement-surgery/#:~:text=Feelings%20of%20tingling%2C%20electric%20zings,though%20there%20is%20nothing%20there.
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