How can I reduce ankle and foot swelling (broken leg)

How can I reduce ankle and foot swelling (broken leg)

Post by star.. » Mon, 19 Mar 2007 05:51:45


Hello all.

47 y/o male, 6'1" 250. 11 days ago I broke my leg, a few inches above
the ankle. Fractured distal fibula; SE2 supination with external
rotation. Closed break, nothing major, minimal soft tissue damage. Had
a hard cast (fiberglass) put on. 1 week later saw the doc and he said
recovery is right on schedule, so he was able to take the cast off and
replace it a removable boot. With the boot I'm now able to put weight
on the leg and walk on it - still using crutches. I should be able to
gradually put more and more weight on it over the next few weeks,
eventually going from two crutches down to one, then to a cane, etc.

What I'm wondering is how to reduce the swelling in my ankle and foot?
I'm trying to keep the foot elevated throughout the day as much as
possible, but that's not always practical - I have to walk around
quite a bit. I'm also wearing Jobst 15-20mmHg Compression Support
Socks:
http://www.vermontcountrystore.com/jump.jsp?itemID=11161&itemType=PRO...

Is there anything else I can do to reduce the swelling?
Ice?
Deep heating rubs like Tiger Balm or Ben-Gay?
Exercising the ankle through range of motion - more or less
frequently?
Massage?
Tightly wrapped Ace bandage?

Any suggestions would be greatly appreciated. Thanks in advance.

- Dave

 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by D Stumpu » Mon, 19 Mar 2007 07:13:56


Quote:
> What I'm wondering is how to reduce the swelling in my ankle and foot?
> I'm trying to keep the foot elevated throughout the day as much as
> possible, but that's not always practical - I have to walk around
> quite a bit.

Standard disclaimer:  I'm not a doc, and check with yours before trying
anything I recommend...but I've had many injuries over 28 years of
running -- nearly all of them short duration and due to overtraining, so I
speak from my experience.

Swelling is common when bones heal.  I've had friends who've had bone
surgery and the swelling can take a year or so to fully resolve.

I imagine you want to promote rapid healing, I recommend using ice as
follows:

Use the freezer type ice packs.
Use on the area for 2 minutes or so, or until it starts to hurt.
Let the area warm up again (5+ minutes or so).
Repeat for 2-4 cycles.

Do this as many times a day as you can (morning, lunch, evening, night for
example).  I've found this regimen hastens healing big time over the range
of injuries I've had, although I've never broken a bone.

The theory is that areas without a lot of vascularization (tendons, bones)
need all the help they can to increase circulation in the area.  The shock
of the cold, coupled with the resumption of normal temperatures seems to
increase *** flow.  The better the *** flow, the more specialized cells
can be delivered to the injury site.  These various cell types do a lot of
the heavy lifting in the healing process.  Some clean up, some secrete
substances which stimulate the injured tissue to regrow rapidly, some
promote increased circulation, etc.

Check it out with your doc.

-- Dan

--
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How can I reduce ankle and foot swelling (broken leg)

Post by Howard McColliste » Mon, 19 Mar 2007 07:15:10


Quote:
> Hello all.

> 47 y/o male, 6'1" 250. 11 days ago I broke my leg, a few inches above
> the ankle. Fractured distal fibula; SE2 supination with external
> rotation. Closed break, nothing major, minimal soft tissue damage. Had
> a hard cast (fiberglass) put on. 1 week later saw the doc and he said
> recovery is right on schedule, so he was able to take the cast off and
> replace it a removable boot. With the boot I'm now able to put weight
> on the leg and walk on it - still using crutches. I should be able to
> gradually put more and more weight on it over the next few weeks,
> eventually going from two crutches down to one, then to a cane, etc.

> What I'm wondering is how to reduce the swelling in my ankle and foot?
> I'm trying to keep the foot elevated throughout the day as much as
> possible, but that's not always practical - I have to walk around
> quite a bit. I'm also wearing Jobst 15-20mmHg Compression Support
> Socks:
> http://www.vermontcountrystore.com/jump.jsp?itemID=11161&itemType=PRO...

> Is there anything else I can do to reduce the swelling?
> Ice?
> Deep heating rubs like Tiger Balm or Ben-Gay?
> Exercising the ankle through range of motion - more or less
> frequently?
> Massage?
> Tightly wrapped Ace bandage?

> Any suggestions would be greatly appreciated. Thanks in advance.

Elevation is the most important concept. An Ace bandage may be of some use,
but make sure you start at the toes and wrap continuously all the way to
just below the knee - no exposed flesh. Ice may be of some help. Otherwise,
the cure is mostly just time.

HMc

 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by star.. » Mon, 19 Mar 2007 07:25:24


Quote:


> > Hello all.

> > 47 y/o male, 6'1" 250. 11 days ago I broke my leg, a few inches above
> > the ankle. Fractured distal fibula; SE2 supination with external
> > rotation. Closed break, nothing major, minimal soft tissue damage. Had
> > a hard cast (fiberglass) put on. 1 week later saw the doc and he said
> > recovery is right on schedule, so he was able to take the cast off and
> > replace it a removable boot. With the boot I'm now able to put weight
> > on the leg and walk on it - still using crutches. I should be able to
> > gradually put more and more weight on it over the next few weeks,
> > eventually going from two crutches down to one, then to a cane, etc.

> > What I'm wondering is how to reduce the swelling in my ankle and foot?
> > I'm trying to keep the foot elevated throughout the day as much as
> > possible, but that's not always practical - I have to walk around
> > quite a bit. I'm also wearing Jobst 15-20mmHg Compression Support
> > Socks:
> >http://www.vermontcountrystore.com/jump.jsp?itemID=11161&itemType=PRO...

> > Is there anything else I can do to reduce the swelling?
> > Ice?
> > Deep heating rubs like Tiger Balm or Ben-Gay?
> > Exercising the ankle through range of motion - more or less
> > frequently?
> > Massage?
> > Tightly wrapped Ace bandage?

> > Any suggestions would be greatly appreciated. Thanks in advance.

> Elevation is the most important concept. An Ace bandage may be of some use,
> but make sure you start at the toes and wrap continuously all the way to
> just below the knee - no exposed flesh. Ice may be of some help. Otherwise,
> the cure is mostly just time.

> HMc- Hide quoted text -

> - Show quoted text -

Dan and HMc - thanks for the replies. I thought that the deal with ice
is that it's only to be used within the first 48 hours of an injury;
and that afterwards you use heat?
 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by Howard McColliste » Mon, 19 Mar 2007 08:13:26


Quote:

> Dan and HMc - thanks for the replies. I thought that the deal with ice
> is that it's only to be used within the first 48 hours of an injury;
> and that afterwards you use heat?

Generally correct IMHO. Dan's explanation of the concept of the mechanism of
the use of ice runs counter to my understanding of human physiology.
Increased *** flow to an injury does promote healing, but also increases
swelling. Ice application *decreases* *** flow by constricting capillaries
in the area of inflammation. After about 48 hours, the inflammation from the
acute injury begins to subside, ice becomes less useful and at that point
heat may be of some benefit by increasing *** flow with less risk of
increasing the swelling. Note, however, that swelling from fractures tends
to follow a more prolonged course because healing of bones is slower that
soft tissue injuries.

Elevation is key. Ice, heat, compression are secondary and are less useful.

HMc

 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by Pete » Mon, 19 Mar 2007 08:23:42

Quote:


>> What I'm wondering is how to reduce the swelling in my ankle and
>> foot? I'm trying to keep the foot elevated throughout the day as
>> much as possible, but that's not always practical - I have to walk
>> around quite a bit.

> Standard disclaimer:  I'm not a doc, and check with yours before
> trying anything I recommend...but I've had many injuries over 28
> years of running -- nearly all of them short duration and due to
> overtraining,
> so I speak from my experience.

> Swelling is common when bones heal.  I've had friends who've had bone
> surgery and the swelling can take a year or so to fully resolve.

> I imagine you want to promote rapid healing, I recommend using ice as
> follows:

> Use the freezer type ice packs.
> Use on the area for 2 minutes or so, or until it starts to hurt.
> Let the area warm up again (5+ minutes or so).
> Repeat for 2-4 cycles.

> Do this as many times a day as you can (morning, lunch, evening,
> night for example).  I've found this regimen hastens healing big time
> over the range of injuries I've had, although I've never broken a
> bone.
> The theory is that areas without a lot of vascularization (tendons,
> bones) need all the help they can to increase circulation in the
> area.  The shock of the cold, coupled with the resumption of normal
> temperatures seems to increase *** flow.

Heat is also supposed to increase *** flow, so I guess this still boils
down to the age old "hot versus cold" argument, and "alternate the hot and
cold", or "start and stop one only", etc. etc.  And of course don't forget
the "cold within 48 hours of injury", as Dave mentions in his follow post.

Pete :-)

The better the ***

- Show quoted text -

Quote:
> flow, the more specialized cells can be delivered to the injury site.
> These various cell types do a lot of the heavy lifting in the healing
> process.  Some clean up, some secrete substances which stimulate the
> injured tissue to regrow rapidly, some promote increased circulation,
> etc.
> Check it out with your doc.

> -- Dan

 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by D Stumpu » Mon, 19 Mar 2007 12:34:31


Quote:
> Generally correct IMHO. Dan's explanation of the concept of the mechanism
> of the use of ice runs counter to my understanding of human physiology.
> Increased *** flow to an injury does promote healing, but also increases
> swelling. Ice application *decreases* *** flow by constricting
> capillaries in the area of inflammation.

Cold does flush out the *** in the short term (a few minutes), and
thereafter as the temperature resumes, you get a new rush of fresh ***, at
least that is what I remember when studying this awhile back.

That's why you just apply cold for just a couple of minutes, creating a
tidal action of flushing out and refreshing with a new supply.  Heat can
have the same effect, as does the combination of cold/hot.

Quote:
>After about 48 hours, the inflammation from the acute injury begins to
>subside, ice becomes less useful and at that point heat may be of some
>benefit by increasing *** flow with less risk of increasing the swelling.

IMO, it's not about decreasing the swelling -- that's a sign that the body
is focusing resources on the injury -- the primary goal is promoting the
most rapid healing.  I've read several studies which show that
anti-inflammatories slow some types of healing, so I avoid them unless the
pain is severe enough to cause stress (which introduces cortisol and other
hormones which can impair healing).  IMO, ice, by flushing out the area
(maybe removing the phagocytes filled to the brim with detritus), and
letting a fresh supply come back in, helps the body heal faster.

I have not noticed that it ice stops working after 48 hours.  Although most
injuries I've had have been healed pretty much within 2-7 days, with the
exception of a tear near the upper tendon of a hamstring -- that took a few
weeks.  Ultrasound and heat worked well for that.

I strained my ankle on Thursday's run (a mild sprain, with swelling).  I
could hardly walk on Friday morning, and there was noticable swelling and
yellowish discoloration in the area.  I took Friday off from running.  I
iced many times, and was able to run an easy 10 miles today (Saturday), and
my ankle feels fine walking around the house and going up and down stairs as
I write this.  And I'm no spring chicken at age 55.

Quote:
> Note, however, that swelling from fractures tends to follow a more
> prolonged course because healing of bones is slower that soft tissue
> injuries.
> Elevation is key. Ice, heat, compression are secondary and are less
> useful.

Elevation is another way to promote good circulation.  I would use Ice,
heat, and elevation if I had a healing fracture.

Good healing,

Dan

--
Posted via a free Usenet account from http://SportToday.org/

 
 
 

How can I reduce ankle and foot swelling (broken leg)

Post by Danie » Wed, 21 Mar 2007 00:49:33


Quote:
>Hello all.

>47 y/o male, 6'1" 250. 11 days ago I broke my leg, a few inches above
>the ankle. Fractured distal fibula; SE2 supination with external
>rotation. Closed break, nothing major, minimal soft tissue damage. Had
>a hard cast (fiberglass) put on. 1 week later saw the doc and he said
>recovery is right on schedule, so he was able to take the cast off and
>replace it a removable boot. With the boot I'm now able to put weight
>on the leg and walk on it - still using crutches. I should be able to
>gradually put more and more weight on it over the next few weeks,
>eventually going from two crutches down to one, then to a cane, etc.

>What I'm wondering is how to reduce the swelling in my ankle and foot?
>I'm trying to keep the foot elevated throughout the day as much as
>possible, but that's not always practical - I have to walk around
>quite a bit. I'm also wearing Jobst 15-20mmHg Compression Support
>Socks:
>http://SportToday.org/

>Is there anything else I can do to reduce the swelling?
>Ice?
>Deep heating rubs like Tiger Balm or Ben-Gay?
>Exercising the ankle through range of motion - more or less
>frequently?
>Massage?
>Tightly wrapped Ace bandage?

>Any suggestions would be greatly appreciated. Thanks in advance.

>- Dave

As Ozzie would say, here's my folklore:

I broke my left fibula at the malleolus on October 8. When there is
a fracture, the first step toward healing is internal bleeding.  The
hematoma clots around the break and new bone forms as new ***
vessels grow through the hematoma.  I was truly amazed at the extent
of the dark purple "bruising" along the top of my foot to the base of
the toes, and along both sides of the heel -- basically all the
interstices filled up with a puddle of ***.

The increase in size of your ankle is due to the "clot" and the callus
on the bone, first of all.  Plus, the circulation through that area is
diminished by the hematoma etc. -- so until new *** vessels grow
through the mass and move fluids through there efficiently, you're
going to experience secondary swelling: a.) any time the injury is
below heart level; b.) any time you use / over-use muscles in that
leg; c.) maybe even with certain foods.  Only this "secondary"
swelling (as I call it) responds to ice and elevation.  

Lots of thoughts:  Make sure the boot is not too tight.  Use
improvised footstools -- pull out a desk drawer near your desk, or use
inverted wast basket, etc.  Massage? -- only the muscles that connect
to the tendons that go through the ankle, NOT the ankle itself.  Have
the boot off when you can safely elevate the leg at home -- and wiggle
your toes, gently move the ankle (not to full range of motion) just to
get the juices flowing.  

So to a great extent, the swelling is the healing process.  My
understanding is that anything that impairs circulation (compression
bandage, smoking cigarettes...) is going against the healing process
at this point.  

What an orthopedic surgeon means when he says minimal soft tissue
damage is, "Damn, no chance to wield my surgical tools on *this* guy!"
Face it, even when the bone is knit, what's left is a bad sprain.  The
worst thing for a sprain is immobilization.  But you have to
immobilize this one so the bone can knit.  So you're basically screwed
whether they open you up and put a physical***in the bone or not.

Forget the "one crutch" method.  Crutches suck and get in the way.  As
soon as they will let you, move to an adjustable cane, in the hand
opposite the injured leg.

Good luck!  
--

--
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