Swelling of feet and legs
Note: Although the information here is useful
for anyone with swollen feet, it is intended for people with an ongoing problem
with swelling of feet and legs due to being unable to walk.
If this is not your situation, please consult your doctor to
determine the cause and treatment of your swelling. If there is swelling
or puffiness of your fingers or around your eyes, see your doctor promptly.
The Cause of the Swelling
The heart pumps blood through the arteries under high pressure. As the arteries
branch out into smaller arteries and then into tiny capillaries, pressure
decreases. Oxygen is removed from the blood in the capillaries and then the
"used" blood flows into veins for the trip back to the lungs for another
load of oxygen. Unfortunately, the pressure generated by the heartbeat has
been lost by then and the blood relies on simple back pressure to move back
up to the heart. This is aided by muscle activity. Ordinary muscle movement
"squeezes" the veins and pushes the blood along. The veins have little one-way
valves all along the way that keep blood from draining backward as it is
When muscle movement is lost, it becomes much harder to get the blood back
up from the legs. It pools in the veins and causes them to get distended.
Water seeps from distended veins out into the surrounding tissue and your
legs and feet swell (edema). With repeated episodes of swelling, the little
veins become damaged and leaky so that water seeps into the tissues even more
easily. At the same time, the valves are collapsing under the heavy weight
of all that blood that is pooled on top of them. That damage to the valves
is permanent. Without the valves, the blood pools in the feet
even worse than before and remaining valves are under even more pressure
and more likely to fail.
Doctors aren't very good about helping with swelling. The first thing they
will say is to put your legs up to minimize the swelling but they don't tell
you how to do that effectively. They will offer prescriptions for TED hose
(somewhat helpful) and "water pills" (which should be used as a last resort
The first thing to look at is
the chairs you sit in. A recliner may seem like the ideal way
to keep your feet up and swelling down but it is NOT! There are two
big problems with most recliners. First, the foot rest section is made in
such a way that all the weight of your legs rests on the calves. That is
really bad for circulation. Second, putting your feet up - even way, way
up - without "unfolding" at the hips is very minimally helpful, possibly
even detrimental, as that bend interferes with the already difficult job of
moving blood upward to your heart. Lift chairs are wonderful and most of
them are recliners, but if you spend most of your time in a recliner, I strongly
recommend that you bring the foot rest up onlywhen
you lower the back rest.
Whether you sit in a regular chair, recliner, or a wheel chair, it must be
properly fitted to you. You need to make sure that your leg to floor/foot rest
distance is short enough that there is minimal pressure at the back of the
lower thigh and knee. Having your feet "dangle" is a sure-fire way to cause
swelling! Put a box/platform under your feet (an old hard side suitcase
worked great for me - lightweight and had a handle) or raise your foot rest
an inch or so. The objective is to make certain there is
minimal pressure on the back of your knees/thighs. If you
add a ROHO or other cushion you need to adjust your platform/foot rest
upward to make up for the height of the cushion.
The best treatment for leg swelling
that I have found is something that I discovered entirely by accident:
More time in bed.When my husband
was working, I spent about seven hours in bed at night and then would lie
back in my recliner for another two or three hours in the afternoon. Even
with that, my legs were swollen by noon, miserably uncomfortable by evening
and absolutely painful by bedtime. When my husband retired, I was
able to go to bed at the usual time, listen to books on tape for an hour
or two, and then sleep late in the morning. Instead of spending 10 hours
lying with my feet up in two separate sessions, I began spending 10 hours
or more in bed all at one stretch. Within a matter of days after starting
this routine, I noticed that the swelling was minimal. Now I don't even have
to lie down in the afternoon in order to be comfortable in the evening! I
don't know if this is due to spending more time lying down at one stretch,
spending all my lying down time in a bed rather than a recliner, getting
more sleep, or some combination of the three. All I know is that in this
has made an incredible difference for me. Not only has it made my problems
with swelling minimal, I feel better in general.
Another thing that helps is
muscle activity. Granny's old
rocking chair served a real purpose beside putting babies to sleep! I find
that the swelling is minimized on days when I am most active. (Interpret that as days when I am frequently
hauled in and out of my chair and forced to stagger a few steps, whining
all the way!) I guess I have some muscles left
in my legs, even though I sure can't feel 'em! Even passive range of
motion exercises help.
Keep cool. A few minutes of being
too warm, toasting my feet by the fire,or just sitting in the summer
sun is all it takes to turn my feet into balloons. (Blood vessels dilate
when we are warm.) Simply keeping my legs in the shade makes
a difference, but I have also been known to pour cold water over my
feet on hot days when I need to be outside. Wet socks and tennis
shoes are still more comfortable than that miserable burning sensation of
Sometimes I also have problems with a burning sensation in my feet in bed
at night. It doesn't start until my feet began to warm up. It can get really
bad in the middle of the night if I have the electric blanket on and my feet
get really warm. That is a real nuisance because the rest of my body gets
really chilled and I can't move at all if I pile on extra blankets. So, in
cold weather I end up sleeping with the electric blanket on, but my feet
For some people, this burning
pain becomes severe and doesn't seem to be relieved by getting the swelling
down. This might be the end result of long term or severe swelling.
Some people find that aspirin (not tylenol) helps. Do not take aspirin
if you are on anticoagulants (medications to thin the blood). If burning
pain is felt when swelling has not been a problem, discuss it with your
Limiting salt intake used to
be high on the list of things to do to minimize swelling, and your doctor
may suggest it, but the need for that is questioned these days. I guess it
is enough to say don't over-indulge with salty foods.
Hospitals often use
devices to improve blood flowto the feet of patients who are going to be stuck in bed for a while in order
to reduce the risk of blood clots. TED (elastic or compression) stockings
are by far the most common. By simply squeezing the legs and feet a
little, they help keep the veins from getting distended. You can ask
your doctor for a prescription for these stockings, but unless you have strong
hands and arms, you will need help getting them on.
Hospitals also use types of "boots" that inflate and deflate to help pump
the blood along. One study showed that simple alternating pressure
on the soles of the feet greatly improves flow, so some brands of boots simply
apply waves of pressure to the bottom of the foot. With help from your doctor
you may be able to get your insurance to cover the cost of this equipment.
It is not complicated to use, but you must be very careful to make sure that
it is not rubbing anywhere and causing breakdown of the skin.
If you complain about swollen
ankles and feet to your doctor, odds are he will whip out the old prescription
pad and put you on
diuretics. I have real reservations
about this because many of us are borderline dehydrated half the time anyway.
(Another contributing factor for the development of blood clots.) It gets
hard to reach a drink, or hard to swallow, or it is simply too hard to get
to the bathroom so we don't drink as much as we should.
Diuretics cause your kidneys to remove more water from your blood stream.
The "thicker" blood is then able to "sponge up" more water on its travels
through the body so it does reduce the edema. It does nothing about the cause
of the edema -- poor blood flow – however. Using diuretics for swollen
legs is kind of like taking a diuretic to lose weight - sure it "works",
but it doesn't really solve the problem.
I certainly won't say diuretics should never be used -- if nothing else works
well enough to keep the swelling under control, they need to be used because
the swelling further damages the veins and valves and the situation just
gets worse. But all the things described above should be implemented first
before diuretics are even considered.