Sock It To Me

One of my childhood memories that seemed so tragic at the time and so humorous in retrospect recalls my 7th grade trip to Washington, D.C. with the Safety Patrols from Guy Webb Elementary School. We left Atlanta by train early one evening and were scheduled to arrive in Washington the following day. Like most of my classmates, I had been taken shopping by my parents to purchase appropriate touring attire. Included in my purchases were a sturdy pair of black leather, lace up walking shoes. .. with corrugated rubber heels, and good ankle and arch support. I was proud of those shoes but kicked them off for the comfort of stocking feet somewhere around Charlotte, N.C. Foregoing the cost of a Sleeper Car, we remained in our seats for the duration of the trip.

After a fitful hour or two of light sleep, we were summoned awake by our teachers who demanded a hasty disembarkment at the Washington train station. I grabbed my new shoes. .. .only to discover that they had shrunk two full sizes overnight. With considerable effort and consternation, I wedged my swollen feet into the tops of them. . .leaving the laces gaping widely open and my shoe strings dangling. I hobbled off the train, truly concerned that I was doomed to wear too-small shoes for my entire 5 day Capital City experience. Mercifully, the edema in my feet eased dramatically within the next 60 minutes and my shoes miraculously returned to their normal, foot-fitting size in the process. And, I learned a valuable lesson. . .I’ve never removed my shoes on a long plane or car trip since.

If the above scenario is familiar to any of you, I empathize, and I also offer suggestions to minimize your foot swelling during future trips. We’re in the shank of travel season as I write this Insight, so you might even use this information to good advantage before Labor Day rolls around again.

Normal bulk flow in our smallest blood vessels (our capillaries) is based on the difference between the blood flow pressures inside the capillary walls and the pressure that tissues outside the capillaries exert on the external blood vessel walls. Edema is a sign, not a disease. When the pressure differences create excessive exodus (filtration) of fluid/substances inside the capillaries across the capillary walls, the volume of the interstitial fluid (the fluid in the tissues outside the capillaries) increases abnormally, and edema appears.

Dependent edema occurs as a natural consequence when any of us have our feet dangling and inactive for long periods of time. The mechanism of this swelling (technically termed edema) is a combination of gravity’s effect on our circulation and stagnation of the natural “massage” of our leg, ankle, and foot muscles, veins, and arteries that occurs when we’re up and active. Heated environments and/or the hot, muggy summer weather further aggravate this phenomenon by dilating the blood vessels and allowing more blood to settle in the lower extremities. Extended air travel to exotic far-away destinations compounds this phenomenon because the air pressure in planes is lower, making pooling of blood and fluid in our legs and feet that much easier. But, with a few simple measures, you can combat this tendency for swelling and avoid the agonies of puffy feet and tight shoes at the end of your journey.

A day or two before your journey, and certainly during your journey, low calorie, low salt, low starch diets will decrease your body’s tendency to hold fluid and subsequently help to minimize edema. Drink plenty of water, it helps to dilute the concentration of substances in our bloodstreams and allows blood to flow more efficiently. Move during your journey! If you’re on a plane or a train, get up and walk the aisles with regularity. If you’re in a car, beg for pit stops on an hourly basis. Elevate your legs and feet if you can. And, in between, exercise your feet, legs, and ankles in your seat with ankle rolls, flexing your feet and calves, and bending your knees up and down. All of these activities stimulate movement of blood and lymphatic fluid because the active muscles massage all the soft tissues. . .including the blood vessels.

I have “discovered” Light Weight, Knee High Support Socks at a local medical supply store. They provide 12–18 mm of external pressure and are ideal compression support for healthy legs during long trips. They come in a variety of colors and sizes, are a blend of cotton and elastic, and can be washed and dried normally with the rest of your clothes. Support stockings for women are also made in this same pressure support range from knee highs, to thigh highs, to panty hose. And, I know from experience, it doesn’t take a crow bar to don them–though a little effort is needed to manuever them from toes over the heel. When I have worn my support socks on long trips, I’ve had NO edema in my feet and legs. In fact, they’ve really become a staple in my wardrobe, and I wear them frequently on office days just because they make my legs and feet “feel good.”

So, be aware that the agony of swollen ankles and feet doesn’t have to be an expected hazard of long trips. There are steps each of us can take to minimize this phenomenon, so we’ll put our best foot forward when we finally reach that glorious destination.

Stephen L. Hines, M.D.
July 2002

  1. This is a very interesting article. There was one sentence that made me stand up and take notice! “Edema is a sign not a disease.”

    A couple of years ago, my father was admitted to our local, small hospital for observation after a fall. When I asked them why they had not started him on IVs, their response was that the labs weren’t back yet. I told them he was obviously dehydrated. They wanted to know what made me think he was dehydrated? Signs and symptoms! Seems these nurses were clueless!! Based on the fact that the hospitalist would not treat until labs were back. I wondered if doctors were not trained in signs and symptoms anymore? I encouraged him to at least order a TKO for the time being, which he did.

    Dad died after 4 months divided between the hospital and the nursing home. He was 91 years old and Mom had been gone for a number of years. There’s tons more to his story, but suffice it to say that this pharmacist spent 4 months teaching the nurses the the value of signs and symptoms!

    • Thanks, Ellen.