Managing Swelling and Discomfort in Patients with Leg Casts

Caring for Patients with Fractures 2

Hello Doctor, I previously inquired about an issue in #127757, and now I have another question to ask you.
My girlfriend has recently experienced swelling in both of her feet, especially noticeable when she is sitting in a wheelchair.
Even when lying in bed with her feet elevated on a pillow, there is still some swelling.
She has also been frequently telling me that her feet feel very uncomfortable and that moving them causes pain.
I would like to know if this is related to the casts she has on both legs, which extend from her ankles to her thighs, with only her toes visible and swollen.
What can we do to help alleviate her discomfort? It pains me to see her like this.
Additionally, when I drive her out, can she sit in the front passenger seat? Thank you for taking the time to respond.

Hengli, 10~19 year old female. Ask Date: 2017/09/09

Dr. Li Yongheng reply Orthopedics

Hello, generally speaking, swelling and pain in the affected limb after a fracture may persist for 2-3 months.
Therefore, when sitting in a wheelchair with the legs hanging down, this is more pronounced and should be considered a normal phenomenon.
It is recommended that the patient elevate their feet even while sitting in the wheelchair, for example, by placing them on a coffee table, and they should not let their feet hang down for too long.
Recently, if the patient reports discomfort in the feet and experiences pain with movement, it is important to check if the cast is too tight or if it is pinching the skin.
Regarding driving her to outings, as long as the travel time is less than half an hour, she can sit in the front passenger seat.
If there are any further questions, feel free to ask again.

Reply Date: 2017/09/09

More Info

Managing swelling and discomfort in patients with leg casts can be a challenging situation, especially when the patient is experiencing significant discomfort and swelling in their legs. In your girlfriend's case, the swelling in her legs, particularly when sitting in a wheelchair, is likely related to the immobilization caused by the casts. Here are some insights and recommendations based on medical knowledge regarding this issue.

Understanding Swelling and Discomfort
1. Causes of Swelling: When a limb is immobilized in a cast, blood circulation can be affected. The lack of movement can lead to fluid accumulation in the tissues, resulting in swelling (edema). This is particularly common in the lower extremities due to gravity, especially when sitting or standing for prolonged periods.

2. Pain and Discomfort: The discomfort your girlfriend is experiencing could be due to several factors, including pressure from the cast, restricted blood flow, or nerve compression. If the cast is too tight, it can lead to increased pressure, causing pain and discomfort.

Recommendations for Management
1. Elevation: Elevating the legs is one of the most effective ways to reduce swelling. While you mentioned that she is already using a pillow to elevate her legs while lying down, it’s important to ensure that her legs are elevated above the level of her heart. This can help facilitate venous return and reduce fluid accumulation.

2. Movement: Encourage her to perform gentle movements of her toes and foot (if permitted by her doctor) to promote circulation. If she is able to, moving her legs in a circular motion or flexing and extending her ankles can also help.

3. Compression: Depending on her specific situation and the advice of her healthcare provider, using a compression wrap or stocking may help reduce swelling. However, this should be done cautiously and under medical supervision to avoid restricting blood flow.

4. Monitoring the Cast: Regularly check the cast for any signs of tightness, such as increased pain, numbness, or tingling. If the cast feels too tight or if there are any concerning symptoms, it is crucial to contact her healthcare provider immediately. They may need to adjust or replace the cast.

5. Pain Management: Over-the-counter pain relief medications, such as acetaminophen or ibuprofen, may help alleviate discomfort. However, it is essential to consult with her doctor before administering any medication to ensure it is safe and appropriate for her condition.

6. Hydration: Encourage her to stay well-hydrated, as proper hydration can help reduce swelling. However, if she has any underlying health conditions that require fluid restrictions, this should be discussed with her healthcare provider.

Transportation Considerations
Regarding your question about transporting her in the car, she can sit in the front passenger seat if her condition allows it. However, there are a few considerations:
- Comfort: Ensure that she can comfortably position her legs without putting pressure on the cast. You may need to adjust the seat or use cushions for support.

- Safety: Make sure she wears a seatbelt properly, but be cautious about how the seatbelt interacts with her casts. You might need to place a soft cloth or padding over the cast to prevent discomfort from the seatbelt.

- Emergency Preparedness: Always have a plan in case she needs assistance getting in and out of the vehicle, especially if her mobility is limited.

Conclusion
In summary, managing swelling and discomfort in patients with leg casts involves a combination of elevation, gentle movement, monitoring the cast, and possibly using compression techniques. It’s essential to maintain open communication with her healthcare provider to ensure that her treatment plan is effective and safe. If her symptoms persist or worsen, seeking medical advice promptly is crucial. Your support and care during this time will undoubtedly make a significant difference in her recovery and comfort.

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