My left foot looks inflated.

May 25, 2009 7:13 PM

For four years, I've been dealing with a really puffy foot. My doctor mentioned that it's likely edema. She didn't, however, tell me anything useful about eliminating the swelling.

Way back in 2005, i asked a question about this swelling, but at the time I assumed that it was related to an injury, and that it would likely be temporary. I was wrong. It's four years later, and the swelling is as bad as ever.

The swelling is worst in my left leg/foot, but also is slight on my right. It gets puffier throughout the day, and the degree of swelling is pretty variable from day to day, and between the morning and the end of the day. The picture of my foot shows a day when the swelling is pretty bad, which it is about 60% of the time. Days when my feet aren't swollen at all are about 5% of the time.

Compression socks help reduce the swelling for one day after wearing them, but in the heat of the summer this is really unappealing. It's also unreliable - sometimes they puff right back the next day, sometimes they don't. Exercise also deflates my feet, but the effect only lasts a few hours at most. I don't eat a lot of salt.

I want to be able to fit my foot into sandals. I want to wear skirts or shorts or capris without looking like i have a leg of a woman 150 pounds heavier than me. I want my ankle to be narrower than my knee. I will try almost anything might bring down the swelling reliably and regularly - so that i can maintain normal-sized appendages.

Any advice re: medication, alternative therapies, exercises, or other treatments would be very appreciated. (If there's any Toronto-specific advice for doctors or therapists or whatnot, that would be great too.)

posted by Kololo to health & fitness (26 comments total)

You really need to see another doctor. Edema can reflect a variety of underlying problems and a good physician will investigate or refer until it is explained.

Don't waste any time with "alternative therapies". Unfortunately, a few commenters always show up and suggest totally unproven remedies. Save your time and money and go see another physician so you can begin investigating.
posted by Inspector.Gadget at 7:20 PM on May 25 [2 favorites has favorites]

Agree on another medical consult. In the meantime, use "lymphedema" as a search word on Google, WebMD, Wikipedia, etc. and see if that provides some insight.
posted by megatherium at 7:43 PM on May 25

My mother had this problem after her kidney transplant. Doctors didn't really know what caused it. They speculated heart failure. Or it could have been complications from her medication. They told her to not eat salt, take her high blood pressure medicine and keep her feet up. This did not seem to work for her.

However, I solved her problem.

The doctors were right; all she had to do was keep her feet above her heart whenever she wasn't moving. Her own attempts at this failed because her bed was flat and she spent most of her day sitting in chairs; just raising her feet a few hours a day was not enough.

What I did was buy her an adjustable bed that raised her feet a little bit above her heart. She placed a TV on a dresser so she could watch TV comfortably in this positon.

Now for the secret sauce: I bought a special computer monitor arm that holds a computer screen over her bed up close to her face and got her a wireless mouse and keyboard. Now she could peruse the internet from bed.

The final secret was getting her to play online video games; in this case World of Warcraft. My family made a guild that plays with her online when we have time and she plays when she has nothing else to do. [Yup, over 70 and playing WoW even pvp arena, watch out she'll take you down!]

Keeping her feet raised above her heart almost all the time gradually reduced the swelling (which by the way was worse that the pictures you posted), it took a couple months. Her feet are finally 'normal' sized after being elephant sized for about several years.

Her doctors gave me a special personal thank-you for helping mom achieve this.
posted by Osmanthus at 7:45 PM on May 25 [5 favorites has favorites]

Kololo, if you do go to another doctor and get a remedy that works, I'd love to hear it.

In 2005, I had a really horrible tumble off of a horse (he fell, I jumped but landed on my hip and one of the stirrups hit my calf; fortunately, the horse wasn't injured). Since then, I've had swelling in both legs. At the worst point, about two years after the accident, my entire right leg would swell during the course of a day.

In 2008, though, the swellings stopped completely (well, almost). I'm not sure if I can attribute that to (1) starting birth control medication; (2) losing weight; (3) quitting my daily workouts; (4) changing my eating habits to include 20-30grams of fiber/day; or (5) lowering my blood pressure. Now my ankles don't swell anymore but my knees do every once in a while (I've had relatively recent injuries to both knees).

Keeping an eye on your blood pressure and salt intake might be a key to controlling the swelling. Obviously, though, I'm not an expert on edema and the resolution of mine was more by pure chance than by anything I set out to do. Good luck with yours.
posted by LOLAttorney2009 at 7:45 PM on May 25

Are you overweight at all? My mother had a similar issue with one of her feet/legs. She was never significantly overweight, but since losing about 25 pounds (and no other treatment) the swelling has gone away completely.
posted by telegraph at 7:56 PM on May 25

Has your doctor figured out what is causing the swelling? Sometimes it can be idiopathic and there is no clear reason why the edema occurs. The edema itself doesn’t necessarily mean you have something seriously wrong with you, but left untreated you can get a severe infection and do severe damage to your legs. It’s extremely important to get the swelling down.

My mom has this condition and unfortunately, she has to wear compression hosiery all day, only taking them off at night. She has adapted by wearing cute tops and cute pants. Lymph edema can be really rough in that it restricts your choice in clothes.
When my mom was first diagnosed, she required daily leg/foot massages and wrapping for several weeks. Once the swelling went down, she was able to get custom hosiery that keeps the swelling down.

Wearing the hosiery is very important even though it’s uncomfortable. If the lymphatic fluid builds up too much, you can suffer a severe infection.

Again, I highly recommend you make sure the swelling isn’t caused by an underlying condition.
posted by parakeetdog at 8:00 PM on May 25

My wife has this problem and has had it for many years. She reduced salt in her diet, kept her legs elevated when she could and nothing worked well. She also used standard compression hose.

When being treated for a wound that would not heal the doctor said she should try a "multi-layer compression system." She is using that now and it has an under hose and and an outer hose. And it definitely provides greater compression. She has been using them for a year and her legs are back to normal size. Actually it is amazing at the success.

She got her hose from Carolon. www.carolon.com They are located in NC but take orders online. They do cost her $72 for a pair (that is two underhose and two outerhose). Maybe you can check their website and get enough information in order to make a decision.
posted by JayRwv at 8:06 PM on May 25

coming to you via my pda, so i'll be brief

1. another dr for a second opinion.

2. manual lymphatic drainage, plus compression hosiery/bandages & elevation.

there's a doco on extreme lymphodema called 'my big leg' which is very informative.

im waiting right now for a client who is coming to me for manual lymphatic drainage - i can send you some info if you'd like, but i wont have accessto a proper computer for about 6 hours
posted by goshling at 8:48 PM on May 25

Thanks for all the advice so far.

As for underlying conditions, my doctor seemed to think that it was "just" poor lymphatic and drainage and "one of those things that happen". If there is a specific type of specialist who might take it more seriously, i'd love to know what kind.

Osmanthus, you rock! What a great son you are! I'm going to see if there's anything i can use to keep my feet elevated above my heart while i sleep, without having to invest in an adjustable bed.

Lolaattorney, that is quite the list of changes! I am already on birth control, my workouts seem to improve the swelling (opposite of your result), and i already have a pretty healthy diet and low blood pressure. I suppose completely eliminating salt would probably help, but it seems like it would be pretty tough to reduce it more than my current levels.

Telegraph, I'm about 20 pounds overweight. (I'm 5'3 and 144lbs) I'm not sure that's enough to affect this, but i will ask my doctor. Any weight loss motivation is helpful!

Parakeetdog and JayRwv: I can try wearing the hosiery every day. Unfortunately though, my main goal is get my legs deflated so i can wear sandals and summery clothes, which makes the hosiery unappealing.

Anything else?
I've read about lymphatic drainage massage - has anyone tried that? Any successes?
posted by Kololo at 8:48 PM on May 25

goshling, i would love some info about manual lymphatic drainage!
posted by Kololo at 8:48 PM on May 25

Find a Registered/Licensed Massage Therapist or other practitioner who practices Manual Lymph Drainage (MLD). The most famous school is Dr. Vodder School (http://www.vodderschool.com/), where you can find a trained therapist... it's a really effective manual therapy that moves lymph through lymph vessels in specific drainage patterns.

I'm trained in basic MLD but I don't practice it often because I find it sort of boring as a therapist... but what can't be denied is that it really works-- fortunately, there's been loads and loads of research done which backs it up.

I've had some treatments myself, but none that were really indicated for me... I felt a bit woozy after and really had to pee. I've used it on post-mastectomy and post-reconstructive breast patients with a lot of success in dealing with their edema.

Try it!

If you're not into it, then elevate your leg a lot, contrast by dipping it in warm water for 2 minutes, then cold for 30 seconds a few times (always end in cold). These things will provide some temporary relief.

Tata
posted by nitor at 9:39 PM on May 25

Here's another thought entirely: Do you sit for extended periods of time? Particularly if the chair I am sitting in is perhaps a bit tall for me so the the front edge of the seat catches me in the back of the thighs, I find that when I've sat all day (or really just several hours) writing/researching/creating death roller coasters on roller coaster tycoon, my ankles, particularly the left one, swell up like balloons, with a tight, itchy feeling, and don't want to deflate. I've had this happen driving long distances, too, with not enough pit stops to get out and walk around. Regular exercise only partially prevents/alleviates this; I've just got to break up my sitting into shorter segments.

Just a thought.
posted by miss patrish at 9:48 PM on May 25

miss patrish... you're right!... but that's something different from chronic (read: 4 year-old) edema.

Part of what aids in venous return (bringing blood back to the heart after it's dropped off its oxygen) is the contraction of skeletal muscles. Veins have 1-way valves (the one way is back up to the heart)... they run between muscles, and when the muscles contract, the blood is pumped the only way it can go-- UP. So it stands to reason that if your muscles (particularly "calf" muscles) are not contracting enough, blood will start to pool in your calves and ankles and feet.

I don't, however, think this is the same problem that Kololo is experiencing.
posted by nitor at 9:57 PM on May 25

Let me re-emphasize that the bed alone was not sufficient. Her swelling only went down after I got her to stop sitting in chairs. The rule was, moving or have feet raised, no time in a chair.
posted by Osmanthus at 10:03 PM on May 25

I have on and off pitting edema (the kind where pressing a finger into the swelling results in an indentation) in the front of my lower legs. Not so much that other people would notice, but enough that my lower legs look a lot chunkier than they really are. No high blood pressure, no high cholesterol, and no doctor can tell me the cause. My brother gets it too. Diabetes and poor circulation run in our family, although neither my brother nor I have been diagnosed with diabetes. For me, it started when I gained a lot of weight (40 lbs) about 4 years ago so it makes sense to me that the weight is a factor. I'm slowly losing the weight now.

It comes and goes with me, making it hard to track what works and what doesn't. But here's what I can report: certain exercise -- walking, jogging, elliptical machine -- make it worse. Swimming makes it better, yoga makes it much better. It gets worse when I don't get enough sleep and when I sit for long periods of time, especially with my legs crossed. Elevating my legs/feet whenever I can works. Oddly enough, getting a ton of sleep makes it go away. I remember spending about 4 days sick in bed (without my legs propped up) about a year ago and the edema was gone. As soon as I got up and about, it came back.

In the meantime, I've started drinking lots of water and eating more foods with supposed diuretic effects (asparagus, onion family, garlic, leafy greens, pineapple, and grapes). I also take vitamin B. I can't say I've noticed a big difference yet, but I haven't been doing this for very long. I also tried reducing my sodium intake including processed foods and that didn't change a thing. I ate a ton of high-sodium food this weekend and the swelling actually went down, so go figure.

I don't completely agree with the "no alternative therapies" approach. I'm not super crystally or New Age-y at all, and I'm not saying it should replace Western medicine, but why not look into it as a supplement to a "regular" medical consult? For example, I suffered for years with mystery sinus pain. I saw many doctors and specialists, including dentists thinking it could be mouth-related, took rounds of increasingly strong antibiotics, had x-rays, a CT scan, an MRI, etc. I was never diagnosed, nothing helped, and I was in near constant pain. What finally worked? Yoga and acupuncture.

Good luck!
posted by Majorita at 11:27 PM on May 25 [1 favorite has favorites]

I've had ankle edema, both feet (idiopathic according to the doc). Sporadic over several years. It seemed to come on when I was exercising a lot (stationary bike), but that may have been coincidence. Goes away on its own after a few months. Then it's back again in another few months.

I did everything I could think of to get rid of the edema. I have no known risk factors (I'm not overweight, no kidney, heart of vascular problems, low-to-normal BP etc.). I'm a male, in my 40's. First happened approx. 5 years ago. My diet is excellent. I exercise. Relevant blood tests are normal, with normal electrolytes. I take little salt, good amount of potassium, magnesium, calcium, phosphorus.

One note of caution. You say you want to eliminate salt from your diet. First, that's very difficult, if not impossible (there's salt even in fruits and vegetables, mineral water etc.). Second, you are already on a low salt diet, right? Well, I found if I went too low on my salt, I had a lot of undesirable side effects, especially if I consumed a lot of liquids (and it is easy to consume a lot of liquids just from eating fruits and veggies). I started getting muscle cramps in my legs and feet, and eventually my arms and hands. They would get so bad that I'd wake up in agony in the middle of the night. Further, studies have shown that going too low on salt is not good for your cardiovascular health. Don't overdo the salt restriction especially in combination with a lot of rapid liquid consumption (you can even get hyponatraemia).

The last year the swelling has gone completely, and so far has not come back. What may have made a difference, is that I upped my protein intake to 2gm/kg of body weight, based on the recommendation of one dietitian (vegetarian source protein, pea protein powder). So far so good. We shall see.
posted by VikingSword at 11:58 PM on May 25

I have had lymphedema in my right foot for about 5.5 years. I believe it came on after skiing for a weekend, but I am notoriously bad at noticing things, and so it's possible that it had been there for a while, and only noticed after skiing. It doesn't look as bad as yours, but the same sort of deal.

I went to quite a few doctors, and the consensus was that this is something that just happens. just about every doctor

Others have said this but I wear a prescription compression sock (30-40mmhg, to the knee) every day. I wear it all the time except when I am sleeping, in the shower, or swimming. I have the kind that has the toes cut out, so I can still wear flipflops. If I have to forgo a compression sock for a day, I notice a difference in comfort immediately, especially in the summer. I am at work right now, wearing a knee-length skirt, and I have the sock on, because otherwise it is just too uncomfortable.

My foot hurts most when I wear heels, it is hot outside, I am on my feet for a while, or I run for a long period of time. I am unwilling to give up those activities entirely, and so the sock it is!

I hope you can make some progress. I will continue to monitor this question, to see if there's anything I can find useful! Good luck.
posted by teragram at 4:38 AM on May 26

Regarding the idea about the bed: My husband put blocks of wood under the legs at the foot of the bed when I was pregnant. Raised the foot of the bed just 3-4 inches. It helped with the swelling in my legs and feet and we didn't have to invest in a fancy adjustable bed. YMMV. Good luck.
posted by jeanmari at 7:57 AM on May 26 [1 favorite has favorites]

I developed this after sustaining a serious knee injury in a road traffic accident.

I elevate my feet all the time. I am short, so at a normal heigh desk with a properly adjusted, normal-height chair, my feet do not rest squarely on the floor in a way that bears weight. Instead, they almost dangle, and all the weight is on my thighs. This restricts blood flow and causes my feet to swell almost instantly.

I sit with a box under my desk, and rest my feet on that. My knees are elevated higher than my hips and my weight is balanced between my bum and my feet. It makes a BIG difference. We also got foot cusions for our coffee table and I always sit with my legs extended, resting on the cushion, and never on the floor.

Conversely, sitting in a regular chair with my feet unelevated, even in a waiting room for 15 minutes, causes my feet to swell. (I sit on the floor instead; I don't care if I look like a hippy freak.)
posted by DarlingBri at 12:02 PM on May 26

Edema runs in my family. Family members with this problem just take a prescription diuretic for it (one is hydrochlorothiazide, which I believe diminishes potassium, so they also have a vitamin and/or a banana) when the swelling gets bad. Regular cardio exercise and keeping the feet elevated also help a great deal. They've managed their problem this way for decades with no increase in severity or affected areas. It's definitely a good idea to be under the supervision of a doctor who'll fully evaluate you for edema-related problems, but overall I've seen this as a very easy thing to manage that only in small ways (primarily vanity!) affects quality of life.
posted by tyrantkitty at 12:30 PM on May 26

Sixteen years ago when I was pregnant, my son laid on my left side exclusively so my left foot would always swell way more than the right. After he was born, the swelling disappeared from my right ankle/foot but remains on the left. About a year after his birth I was referred to a vascular specialist who said he could find nothing wrong.

In the heat of summer, my foot will swell to where I cannot bend my toes. I've since asked several other general medical doctors and they all say not to worry about it, keep my foot up, try compression stockings, etc.
posted by justlisa at 4:33 PM on May 26

Some really good advice above.

Manual Lymphatic Drainage (MLD) is a form of Body Work/massage that focuses on the lymphatic system. There are quite a few schools of MLD, the most well known is the highly regarded Vodder Method but there are others. Bruno Chikly is also very highly regarded, he teaches MLD through the Upledger Insitute. Many schools teach MLD as part of their massage programs or as post grad courses, so even though as therapist isn't trained by one of the better known schools doesn't mean they aren't knowledgable or effective.

MLD is actually becoming a bit a trend, esp in the spa & beauty therapy world. I have a few clients that come for MLD specifically for cellulite. Some of the spas offer lymphatic therapy with fancy expensive machines. I know a couple of places in my area have them, but I'v never tried one. I'm biased, but I'd prefer a hands on approach from a qualified therapist instead of just haveing things strapped on & a button being pushed. There are cheaper machines available for home use - again, I have no personal experience with any, but I once treated someone who has one - she came to see me when her machine was in for repair. She sounded quite happy with it and couldn't afford regular sessions with a therapist - I think she was using the machine several times a week?

MLD is used a lot pre & post surgically. Pre-surgically, it boosts the immune system & surgeons have reported that MLD actually changes the quality of the tissue, making it easier for them to work with. Post-surgically MLD has been shown to decrease recovery time quite substantially and to reduce swelling and bruising and pain. Being such a gentle technique, it can be performed very soon after surgery, even the next day.

It's a very gentle, slow, methodical type of therapy. There are styles that are quite firm, but I'm not familiar with them or anyone who practices them. MLD is performed with no oil, but instead uses cornstarch which takes away any "stickiness" and provides "glide".

A session usually lasts 90 minutes. You should be naked (properly draped, of course) as your knickers actually act as a tourniquet restricting movement of the fluid thru the inguinal region. Treatment always starts & ends at "terminus" (sternum) and works outwards away from the heart but always directed towards the heart. To clear edema in your foot, the therapist must first start your chest, then clear the way for the fluid in the foot to travel.

It may take 2 sessions to start to notice a difference, but dramatic results are often experienced after one session. You will (hopefully) notice increased urine output and reduction of swelling. Many people feel quite light or a bit woozy afterwards. Many people fall asleep during treatment.

IIRC, participants in a recent study on MLD for women having surgery for endometriosis lost up to 3 kilos in excess fluid over the course of the study.

This is the doco I mentioned above. Fascinating & I wish I had recorded it. It profiled an EXTREME case, but used some amazing animations & described the function of the lymphatic system and what can go wrong really clearly & succinctly, and showed the remarkable results possible with lymphatic therapy (MLD/compression bandages/elevation)

Finding a therapist - word of mouth is best. Maybe your Dr can refer you to someone? If there is a local breast cancer support network, I expect they would know therapists you could try. With all due respect to the therapist above, you want someone who doesn't find the work boring. I can see why they might not like doing it, as it is very repetitive and slow, but I am truly fascinated by the lymphatic system and I love working with it and feeling it working underneath my touch.

I could ramble on for ages, but must get back to work. If you have any questions or want me ramble on randomly about MLD any more, please mefi mail me. I've been meaning to write an article on MLD for my website for well over a year, so am more than happy to use opportunity this info as a basis for doing something productive!
posted by goshling at 11:00 PM on May 27 [1 favorite has favorites]

Oh, quite often the movement of lymph is restricted not only by a sluggish or compromised lymphatic system, but fascial restrictions can have a impact also. Every client is different, by often lymphatic treatment can have a huge boost when MLD is performed in conjuction with myofascial work. I've seen classes advertised that teach a method using both MLD & fascial techniques - can't recall what it's called off the top of my head but can find the ad later when I am at home.
posted by goshling at 11:06 PM on May 27

I'm back again!

Just wanted to add that you sound like you already aware of some things that work for you (exercise, compression socks) and as brilliant as I think MLD is, it's not likely it will help the underlying problem that's causing the edema (Myofascial release MIGHT give you some longer term improvement, tho) so you'll have an ongoing routine of doing what works for you for the best short term relief. eg elevate as much as possible, compression as much as possible, exercise, MLD then hopefully be able to wear sandals for a few days.

After an MLD session, the lymphatic system tends to ramp up a bit for about three days, then goes back to it's normal (whatever that is for you) over the next 3 weeks (on average), so that's an average for suggested duration between treatments. Of course, YMMV.

You might try 1 treatment a week for 3 weeks, then you might be fine with a maintenance routine of once a month. Hopefully you'll be able to clear what's currently there, then work on not having so much build up in future. You'll probably find certain things will trigger a build up - stress, illness, lack of movement, too much activity, hot weather, hormones, etc. Personally I don't think diet is going to have a huge impact, but it'd probably be worth keeping track of your diet and the size of your foot.

I also don't see why you couldn't pick up a few techniques for treating yourself with MLD techniques, it's not rocket science after all, and while it's best to perform the full body routine in sequence, you could probably manage some benefit just by working the pathway of the effected limb - clear terminus, then the sub claviclar nodes, axillary, abdominal, inguinal popliteal, then work your ankle & foot. The upper right quandrant of the torso drains into the right venous angle, everything else from the diaphragm down & the left upper quadrant drains into the left venous angle.

Here's a page from a cancer group that includes some info on self treatment.

Again, I suggest calling a cancer support group in your area as they are likely to have lots of info on lymphedema management & resources in your area as cancer survivors frequently have compromised lymphatic systems, esp those who have nodes removed.

The lymphatic/fascial technique I was trying to recall is called Lympho-Fascia Release and is developed by Bruno Chikly and claims permanent results
Article from Dec 2008 Massage Mag here
posted by goshling at 5:32 AM on May 28

Ditto on what everyone else said about the compression stockings. They can be quite expensive however, depending on your health insurance carrier, they might be covered as a "medical device". You would need to visit a medical supply store and you would also need a prescription from your doctor. My doc wrote a script for me for compression pantyhose while pregnant because I would get edema so bad I couldn't bend my knees. The $170 maternity pantyhose cost me $20 with my insurance. You can buy compression pantyhose at many pharmacies but I've found the ones supplied by a medical supply store are better quality and last longer. You might also be able to find compression pantyhose that are made out of lighter material and won't appear as obvious to others.

Also, make sure that you aren't wearing anything tight/constricting around the waist line. Any compression around your waist will affect circulation below that level (although you would most likely see edema in both legs).
posted by cdg7707 at 5:33 AM on May 28

Followup on my own condition
posted by justlisa at 4:17 PM on October 8