Why Am I Still Swelling?

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 surgery...you 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.

Shoe Gear After Bunion Surgery

You have gotten your bunions surgically corrected and have grand expectations of wearing any shoe you want, when you want, for as long as you want.  Sound familiar?  Let’s talk about realistic expectations after you have bunion surgery.

First, your shoe selection immediately after bunion surgery will be dictated by the amount of swelling you have.  When you are allowed to transition to regular shoe gear from your post op shoe or boot, we always suggest a thick soled athletic shoe.  Often a mess style is better than a full leather upper.  This allows you to continue to control your swelling, but is the most accommodating type shoe.  You want one with great support as you will have considerable arch strain if attempting to wear shoes without arch support.  In the beginning, you may not be able to wear an insert inside your athletic shoe, mainly due to swelling.  But as this subsides, put your custom orthotic or Healthy Steps insert in your shoes to improve your recovery process.

Once you are allowed to wear different types of shoe, please don’t expect to return immediately into your 4 inch heels or ballet flats or Cole Hahn loafers.  Your foot is going to retaliate and give you a lot of unwanted pain.  So be patient.  Want to wear a dress shoe or sandals?  That’s ok, but think supportive, thicker soled shoe, not thin, flat and flexible.  The stiffer the sole of the shoe, the more comfortable it will be.

What about flip flops?  You can wear them only if you want to go through the surgery process all over again!  No joke, not kidding.  The only way you keep a flip flop on is to grip the small strap between your toes with your first 2 toes.  This causes your big toe to move outward or lateral.  This is the same direction it was going before surgery and causing increased pressure on the metatarsal head inward or medial.  If worn immediately after surgery, you risk the chance of causing an immediate recurrence of your deformity.  Sooooo not worth it!  Now in many cases, I will often let my patients wear flip flops occassionally after the first year.  But there are some cases when they are just not ever an option.  But same holds true for the type of flip flops you wear.  Think thicker soled and not Old Navy throw backs!

Ok, what about those heels? If you are a lover of high heels, they will feel comfortable in 6-8 months after surgery.  But don’t expect to be able to wear them all day long in the beginning.  Again, be patient.  When in heels, you walk directly on the area where surgery was performed, so that bone has to be ready for the increased pressure.  Otherwise, you’ll have pain.  And as always, we love for you to keep heels to a minimum.  But for some, they are a dress code requirement.  In this case, think wider heel, not narrow and thicker support under the ball of the foot.  34 Minutes shoes are a great example of supportive heels that maintain great style.

Now for you gentlemen, the options are a little easier.  You will still start with your athletic shoes, but your next step if you are needing dress shoes is a lace up or full upper shoe.  Avoid loafers or slip on style shoes where the tongue of the shoe stops just passed your toes.  When wearing these shoes, there is a forced toe gripping effect that must happen to keep your shoes on, which in turn causes pain.  Make sure your shoe fully covers the top of your foot.  And you are no different than the women when it comes to the sole of the shoe...think thick and rigid.

Everyone is different in their healing process and we help you through shoe transitions based on what we see during your recovery.  Just be patient with your foot and don’t force it into a shoe that it’s not ready to be in.