Why Are My Feet Swelling?

Q: Is it normal for your feet and ankles to swell, and can anything be done to stop it? I've noticed I begin to swell three days ago. The swelling does go down a little at night when I prop my feet up.

— Angela, Wichita
A:
Fluid retention is very common and the easiest way to diminish the swelling is by lowering your intake of salty foods (chips, fries, olives, fast-food items, etc.) and drinking plenty of water. You could also try wearing elastic stockings (also known as support or compression stockings), which can help stimulate circulation in your legs and stop swelling. If you spend all day on your feet, the stockings are probably your best bet for long-lasting relief.

Another option: Try elevating your feet even a few inches off the ground when you're sitting down. For example, keeping a small ottoman or stepstool under your desk at work and using it to prop your feet up can help reduce the swelling a lot. Finally, mild diuretics can help ease swelling in severe cases, but these are medications that your doctor will need to prescribe. The best idea is to discuss all of these options with your doctor, so the two of you can devise a plan together.

How Should a Diabetic Foot Ulcer Be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Prevention of infection.
Taking the pressure off the area, called "off-loading."
Removing dead skin and tissue, called "debridement."
Applying medication or dressings to the ulcer.
Managing blood glucose and other health problems.
Not all ulcers are infected; however if the physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

Keep blood glucose levels under tight control.
Keep the ulcer clean and bandaged.
Cleanse the wound daily, using a wound dressing or bandage.
Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be "off-loaded." Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of "let the air get at it" is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. The physician can determine circulation levels with noninvasive tests.