Swollen or sausage feet can be uncomfortable, but also harmful. George Louw sheds some light on the causes of this condition and what people can do to manage or prevent it
A few days ago I was looking at my feet and I wondered when last I saw my toe joints. I recently needed a new pair of shoes, so I went from shop to shop trying for a fit, but my instep was too swollen for the shoes to fit.
Eventually, I went one size up, but it still is an effort to get them on. A while back, a sharp toenail cut into the adjacent toe. The wound was minor, but it took three weeks before it was fully healed.
From my dealings with other people with a spinal cord injury or afflication (SCI/A), I know that I am not the only person with sausage feet. In fact, as a “latecomer” to full-time wheelchair occupancy (my paralysis is progressive), sausage feet has only recently started to bother me.
With all of the above, I decided that, rather than spending an arm and a (fairly useless) leg on doctors’ fees, it was time to consult Dr Google. I knew that I was able to shift through the nonsense and find valuable information, which I did.
It is not recommended that you consult search engines for medical information unless you are a skilled and seasoned researcher. Rather consult your doctor.
In the 11 years that I have been writing articles for Rolling Inspiration, I cannot remember seeing anything on sausage feet, so I thought it a good idea to share a summary of my findings and the links to the two best sources of information. So, here goes…
What causes sausage feet?
Shawn Song, a SCI medicine fellow at the University of Washington Department of Rehabilitation Medicine in the United States (US), explains that sausage feet is caused by oedema – a build-up of fluid in the body, which leads to swelling. It is very common in feet, ankles and legs.
This form of oedema (known as dependent oedema) is common among people with a SCI/A as paralysed muscles can’t pump blood back to the heart effectively, which results in blood pooling in the legs with some blood leaking into the surrounding tissue.
How to sport an oedema
To detect an oedema, press a finger into the skin towards the bottom of the shin for several seconds. If the finger leaves an indentation, oedema is present. Also, if your socks leave an indentation, it can be an indicate oedema.
Swelling can also occur for other reasons. Therefore, if the swelling in your legs or feet don’t look symmetric, it could signify a more serious medical condition, for example, a blood clot. If you are unsure, seek immediate medical attention.
Dangers of sausage feet
Oedema mainly poses a risk to the skin. Long-standing oedema can cause the skin to thin, becoming more frail and vulnerable to breakdown. Shoes and clothing could fit poorly as a result of the swelling, which, in turn, can result in pressure ulcers.
Oedema can prevent or delay the healing of ulcers. In addition, dependent oedema increases the risk of cellulitis – an infection of the skin. Redness or warmth in the area where the oedema is present can be a sign of cellulitis.
Managing sausage feet
Flint Rehab, an organisation established by researchers in neurorehabilitation from the University of California in the US, states that swelling in the legs after a SCI can be caused by a combination of factors including dehydration, high sodium levels, physical inactivity and warm weather.
They note that it is essential for blood and fluid levels in your body to be balanced to enable the blood to travel more efficiently in the body, carrying more oxygen and nutrients to fuel cellular activity. They recommend eight techniques to reduce the swelling:
Move, move, move
A lack of movement can cause the pooling of blood. Passive exercise, the movement of limbs with assistance, is suggested for people with a SCI/A as it assist with blood circulation and prevents joint stiffness.
People with paraplegia, who still have upper body function, can use resistance bands, for example, to exercise their legs. For those with limited upper body function, it is best to see a physical therapist or ask a caregiver to assist.
No to salt
An excess of salt or sodium results in the body storing fluids. By limiting salt in food, the swelling of sausage feet can be reduced. Instead, people with a SCI/A are encouraged to eat more fruits and vegetables, which are low in sodium, but have high water content.
Put those feet up
Elevating your legs can assist in directing blood back to the heart. Whenever laying down or sleeping, place a few pillows below your calves with your heels hanging over the pillow to prevent pressure sores.
It might seem counterintuitive to drink more water as an excess of fluids can cause swelling, but dehydration causes the body to store fluids. Drinking enough water tells the body that it doesn’t need to store fluid for later.
Compression stockings or socks compact the legs, which increases blood pressure to assist the muscles in pumping blood back to the heart.
When wearing the stockings or socks, ensure it fits correctly. A too loose or tight fit can impact the effectiveness or result in complications. Make sure that the stockings or socks also don’t have any wrinkles as this can act as a tourniquet, aggravating the swelling.
People with high blood pressure, peripheral artery disease or cellulitis are discouraged from using this method. Individuals who are susceptible to autonomic dysreflexia are encouraged to speak to their doctor before using this method. It is generally a good idea to consult your doctor before using compression socks or stockings.
Massage your legs
Massaging the legs stimulates circulation, which will reduce the swelling. Use an upward motion when massaging to redirect the blood. Start at the feet, moving up the foot and leg.
Avoid hot temperatures
Warm temperatures cause the blood vessels to expand so that the blood can get closer to the surface to the skin, emit heat to cool you down. Cold temperatures do the opposite to conserve heat.
To prevent the blood vessels from expanding, consider the following:
- Carry around a spray bottle with water in it;
- Stay out of direct sunlight;
- Wear easy-to-remove layers; and
- Drink lots of water.
Inspect your body regularly
People with a SCI/A, commonly, don’t notice injured or irritated skin as their limbs lack sensation. Daily inspections of your body can help identify complications such as pressure ulcers, which can cause swelling, or even deep vein thrombosis, which causes blood clots due to physical inactivity. This could limit the blood flow to the heart.
Another complication to look for is heterotopic ossification, which is when bone growth occurs in soft tissue. These regular body inspections can help detect complication early or prevent them entirely.
When managing your sausage feet, there are a few other factors to note. The first is that, when the oedema resolves itself, the possibility of urine output increases. Therefore, it is important to be prepared to self-catheterise more frequently.
There are some medications that can be used to help the body shed water; however, this isn’t recommended as these medications can have unwanted side effects, especially for people with low blood pressure.
In conclusion, I hope that you found this information as useful as I did and that it will help you to relieve the unpleasantness of sausage feet.
Link to University of Washington Medicine: https://sci.washington.edu/info/newsletters/ articles/15_spr_edema.asp
Link to Flint Rehab: https://www.flintrehab.com/spinal-cord-injury- leg-swelling/
Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity. email: email@example.com