Management of a swollen limb (case experience of n=1)


Recently, this winter following an intrepid nosedive from two-meter height I was left with a dodgy right knee and an inability to walk unaided. The advice was to rest up and take pain killers, and then more painkillers just in case.

Let’s face it I’m no spring chicken and the mind-numbing inactivity that follows would only be tolerable in cadaver. Whoever said doctors make the worst patients knew what they were talking about.

Picture: my poor right leg! No plastic chairs were injured in the process.

What followed was annoying to say the least, it took three days before my shoe size went from a six to an eight with digits that resembled small sausages – and no it was not a DVT for the clever ducks reading this.

I realised a few things as a result (experience of n=1 but hopefully an informed one; keep reading) that clinically has been bugging me for a while about the management of a swollen limb. This as you know happens a lot in MS, particularly when the disability increases.

  • Gravity leads to leg swelling very quickly and you don’t have to have a neurological disorder for this to happen. This is because of inactivity of the calf muscles which normally pump blood back to your heart occurs less frequently (see diagram below). Walking is the best way to get the calf muscles working stimulating venous return.
Diagram: Calf muscles squeeze blood back to the heart in the deep veins (image from

This is not to say that you cannot fake it until you make it. A way to fool the system relies on simple physics and a bit of medical knowledge.

Firstly, you have to take the gravitational effect out of the equation. That is elevate the leg. This doesn’t require you to be performing a high kick manoeuvre on a highchair where the leg is at level higher than your heart, a simple bean bag would do. But you do need to commit to doing this at least a few hours per day. Secondly, pointing your toes (a movement called plantar flexion in medical lingo, see top figure below) and then bring it beyond neutral position (dorsiflexion) automatically activates your calf muscles (gastrocnemius, and the deeper soleus muscles; see bottom figure below) mimicking the activity of walking. And hey presto, the swelling gradually recedes.

Figure: Flexing and extending the foot at the ankle (image uploaded AC de Pina Filho on
Figure: muscles involved in plantar flexion (image from slideshare, Prof SA Makarem)

I also tried putting on an ankle brace to see if I could lessen the swelling from a compression point of view. Bad idea, resulting in significant pain in the ankle joint from a secondary torniquet effect. I know that serial bandaging is used in lymphoedema and works well here, but this is in fact graded compression and is preformed over several weeks. Short term rapid compressions do more harm than good.

Figure: serial bandaging in lymphoedema (image from physical therapy partners)
  • The leg that has minimal movement will become cold almost to freezing proportions. This is normal and occurs even in the absence of swelling or a peripheral nerve disorder. Sadly, moving the foot about does little to discourage this from developing, particularly at night times. The solution I found was to sneak up to the heat emanating from another warm friendly foot! This process is called conduction which is one of the most effective ways of heat transfer between solid objects according to the laws of thermodynamics. A hot water bottle wrapped in a towel (to prevent burns) and placed at the end of the bed also worked well.

I hope this helps a fair number of you in dealing with your own annoying leg swelling. Much of what I’ve mentioned here is common sense but worked well for me. Nothing like first-hand experience to solve a problem.

About the author

Neuro Doc Gnanapavan


  • “this winter following an intrepid nosedive from two-meter height”

    I am genuinely interested to know how you fell 2 meters on a slope? Did you fall from the lift? or were you knocked out over a roller at high speed? Or a snow park perhaps?

  • Thank you for sharing your experience. Very useful, helpful knowledge about reducing swelling. Another good motivation to walk more.

    • Thanks, and I will definitely be passing on this to my patients. Another point is that this is also probably what a physiotherapist would advice but it’s good to do it early!

  • That’s quite a traumatic way to subsccribe to a physics/biology lesson! From one who broke their ankle windsurfing :-0

    Glad you are on the road to recovery, look after yourself and thanks for the swelling and heating tips. From new proud owner of cashmere ankle warmers and electric heating foot pad (being used cautiously!)

  • This is a case of when activity does to you instead of what it does for you!
    Sorry this accident has hit you so hard and hope you get better soon.
    Thanks for the info, some of which is valuable for looking to achieve more general well-being – I already stick my feet on the coffee table and do eversion exercises whilst watching the tv and now I can add dorsal and plantar flexion whilst I’m sofa surfing.

  • Clear enough, but if you have to sit because you can’t walk, you can’t do dorsiflexion because there isn’t a connection, you daren’t lie down because when you try to get up you’re suddenly desperate to piss and getting to your feet can take 20 minutes, so you can’t raise your feet above your heart till you are finally in bed and lying on your back, but then you start snoring.
    — Sounds like an exaggeration but isn’t!



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