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 pushed upwards.
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. The circulation to the skin will be affected in time. The skin of the ankles and lower legs will be discolored (bronzing) and the skin fragile. Open sores called stasis ulcers develop. Because the blood flow to skin is poor, these ulcers are very difficult to heal.
There is no pill, procedure, or surgery that can prevent leg swelling when walking is limited. It has to be treated by the three words we hate to hear; Life Style Changes. Minimizing swelling is a do it yourself project!
Doctors aren't very good about helping with swelling. They will offer prescriptions for TED hose (somewhat helpful) and diuretics ("water pills" which should be used as a last resort). And 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!
Don't be fooled by an adjustable bed or hospital bed. The gizmo that lifts your legs may only lift your knees. Your feet may be left hanging down on the far side of your knees. That is actually worse for circulation to them than lying flat. Put pillows under the foot of the mattress to get the feet back up to the level of your heart.
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 minimally helpful 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 only when you lower the back rest. Rather than spending all your time sitting up with the foot rest up, you will probably have better results if you leave the footrest down but take several breaks during the day to recline as flat as possible with the footrests up as far as possible. This self-discipline is so easy to advise but such a nuisance to stick with!
What you need is a chair that can recline fully to what is called Trendelenberg position, feet slightly higher upper body. I found some at SpinLife, a website that specializes in equipment for wheelchair users, but has a large selection of recliners. This page has a comparison chart that shows which chairs have Trendelenberg. These chairs are all recliner/lift chairs and all the pictures show them in a lift position. None show the chair reclined so I can't tell if any have the type of footrest that supports the entire leg, not just propping up the calf. There is a reference to "full chase pad" on some models and that may differentiate the better type of leg rest. If I were buying, I would check that out first. I would also find out about returns if the chair doesn't fit you!
All too often I see PALS and other people in wheelchairs whose foot drop has been allowed to progress to the point where their feet cannot rest flat on the footrest. This guarantees that the feet and lower legs will swell badly and the valves will collapse like dominoes! Don't let this happen! As soon as foot drop droops its ugly head, start using a footrest or positioning boots in bed whenever you are on your back. A footrest can be as simple as a plywood or Plexiglas between the mattress and foot board and pillows in front of it to keep the ankles at a normal angle. While up during the day, wear your AFOs (Ankle Foot Orthotics. These below the knee braces the keep the foot at a right angle to the ankle to prevent tripping.).
Once you quit walking you don't need the AFOs but you do need to keep your feet flat on your footrests. People complain that the footrests are hard and cold. Slippers solve that but aren't as good as wearing shoes for correct positioning of your feet. All too often PALS quit wearing shoes because their toes curl under when they try to get them on. Unless your spasticity is bad, here is how to keep wearing shoes.
- Buy lace up shoes a full size larger than your normal and extra wide (W) or WW wide.
- Remove the lining of the shoes if it is spongy or soft. The inside has to allow your foot to slide in easily.
- Find socks that are thin and smooth for easy sliding. Compression hose work very well. (Don't buy the kind with open toes. They are for hospital use to check for circulation after leg surgery or a cast is first put on.)
- When putting the shoes on, pull the tongue forward to loosen the laces as wide as possible. The toes will still want to curl under but unless your spasticity is bad, they should relax after a minute and slide into place. Twisting the toe of the shoe side to side will help get the toes comfortably positioned.