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Why Am I Still Swelling?

Posted Mar 25 2013 9:30am

We hear this question after almost every post op patient or any patient who has had a moderate to severe injury.  And as I tell my patients preop, expect swelling.  And I’m really not kidding when I say it will take 6-8 months or more to stop swelling after bunion surgery ; at least a year for any major reconstructive surgery.  But the question remains, why does the foot swell?

During surgery the soft tissues (and bone depending on the type of surgery) are injured in a controlled manor.  We cannot due surgery without cutting your skin and the soft tissues directly under it.  We also have to move tendons, vessels and nerves out of the way to get to what we are working on.  This involves holding these tissues to each side of the incision with instruments.  All of this is done very carefully, but it is still an injury.  The body has to heal this injury and brings in certain cells to the area to make this happen. This healing process makes you swell.
We repair incisions in layers from deepest to most superficial (skin).  This is done purposefully to help improve incision healing and reduce swelling. The sutures or stitches we put in the deep layers are absorbable.  Your body slowly breaks them down into water and CO2.  This process makes you swell.
Remember that your foot is the body part closest to the ground and gravity.  And it is the only part of your body that you walk on, thus applying at minimum your entire body weight with each step.  Gravity pulls fluid downward causing increased swelling and walking increases pressure thus increasing swelling.
Do you have spider veins or varicose veins?  These occur from your leg veins’ inability to pump blood efficiently back up the leg which forces more blood into your vessels.  This causes fluid retention in the legs, thus causing swelling even without surgery.  So add a controlled injury and guess what....LOTS of swelling.
There must be a healing time.  How long that healing time is is very individual.  If you follow your post op instructions of keep the foot elevated and iced as much as possible, this reduces your swelling.  Staying off the foot as much as possible helps as well.  Compression is great at controlling swelling.  That is why you will have a compressive dressing on your foot or ankle and be placed in some type of shoe, boot, cast or splint.  All of these devices help control your swelling.
The hard part is estimating how long the swelling will be there.  We can give you averages, but everyone is different.  If you are noncompliant with your post op care, it is very hard to control swelling once it gets started.  If you have varicose or spider veins, expect your swelling to be present 3-5x longer than normal depending on the surgery you are having.  If you have varicose veins with swelling to start off with, you may develop severe swelling requiring chronic therapy to control the swelling.  This could take a good year to improve.
Swelling is totally normal in all surgeries.  And no matter how quickly you recovered from surgeries or injury to other body parts, the foot and ankle is totally different.  You can’t just “push through” the swelling and expect it to go away when you decide you want it gone.  Will you still be swollen at 3 weeks post op bunion betcha!  How about 3 months?  Yep.  But each week you should notice improvements in swelling until one day you realize that it disappeared without you evening knowing it.
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