Leg Swelling

By Professor Elizabeth Dean
Professor Dean is head of the Post Polio Clinic at the University of British Columbia

Swelling in the legs is a common complaint of polio survivors. Muscles act like a pump. When they contract, blood returns to the heart after being pulled downwards by gravity. Legs with muscle weakness or paralysis have less capacity to perform this pumping action, either when you are walking or when you contract these muscles in the sitting position. Swelling in the legs can be a serious problem for several reasons. First, engorgement of tissue with fluid can be uncomfortable, making clothing fit difficult; it can become chronic and it is important to bring it to your doctor’s attention. Here are some things to try to reduce leg swelling after your doctor has ruled out other causes.

If you are able, move your ankles up and down when you are sitting, and bring your knee up towards your chest. These movements will be helpful.

If you are unable to actively move your leg, a family member or friend can passively move the leg for you, so your hip and knee bends; this is best down when you are lying down so the fluid can move towards your chest cavity more easily. The leg should be moved in a rhythmic fashion.

Put your feet up whenever you are sitting down. Don’t be proud – just ask for a stool or another chair. Before long, people will be anticipating your request and have one waiting for you when you sit down. When you lie down for a rest or sleep, put pillows under the leg so that it is higher then your heart.

Have a family member massage your leg so the fluid moved up towards your heart. Again, this is best done when you are in a lying position so the fluid can move towards your chest. This massage should not be vigorous, as tight swollen skin is more at risk of abrasion, breaking down, inflammation and cellulitis. The leg should not be massaged if skin breakdown or redness is present.

Avoid restrictive clothing, including corsets, tight underwear, tight socks and shoes. Consider support stockings (for both men and women) that extend up over your knee. If you have extensive swelling, the stocking will have to go up to your groin; otherwise “ballooning” of the fluid will occur where the stocking ends. These stockings must be properly fitted by a physiotherapist to ensure that they are an appropriate fit, that they are not too loose or too tight, and to teach you how to apply it so it does its job properly, when to wear it and how to take care of it. It is important that you wear it for a period of time, then take it off for a period of time and then reapply it.

Passive mobilizers of the legs are available as well as what is called an intermittent pneumatic stocking. These, however, are not typically available to the public, but may be used by a therapist if your swelling is extensive or does not resolve the problem with suggestions above.

If you are a diabetic or have glucose intolerance, your skin is even more at risk of breakdown and infection. Your doctor should be following your closely. Both your doctor and physiotherapist should make recommendations regarding foot care.