The #1 Foot & Ankle Swelling Treatment Plan [The 95%+ BIG SECRET]

This is Dr. Tom Biernacki. And today we're talking about how to fix the swelling in your feet, your ankles, your legs. And we're starting now. So we had an earlier part one going over the causes of foot and ankle swelling, the top ten causes. And the big secret that almost every single person has. Now we're going to go over the treatments for those ten causes, but we're going to focus on that big secret because this is the real underlying issue that can fix almost everybody. And when I say fix, I see thousands of patients for this issue over the years, and I've come up with an algorithm that is practical. And most people, even with the worst health conditions, can get significant, if not complete resolution of their swelling. I feel really strongly about this, but the disclaimer always says if you have heart issues, your kidneys are failing anything like that. That's a different story. Check with your doctor. I can't extend life forever, as much as I would love to. This can be such a big problem. Look at the rates of heart issues. These are the more severe issues. But what comes first? Swelling vein issues that put pressure on the heart. In my opinion, this is one of the early things you can catch and see in a foot and ankle specialist is the key. We can start working on these things so that your heart doesn't have to work as hard. Now look at these statistics. This is from a study that was performed in Poland looking at the population. When you look at the age. Sure, when you're in 20, 30, 4050s, the percentage is not that high. But once you get into your sixties, you're 70 is your eighties. It starts to get to 50% of people that have extra pressure on their heart, making them more fatigued. Making them more tired. Decreasing the quality of their life. And if I'm missing any of these, tell me in the comments, you guys are so amazing in these videos. I get more views than a lot of these research papers, and the comments make such a difference to help me make better videos and you, the viewer, get better videos. So from the bottom of my heart, I appreciate you guys and keep letting me know what I'm missing and where I suck. So first, we talked about trauma. This is ankle sprains, stress fractures for injuries. If I were to do an MRI or an ultrasound, I actually look at the bones and there are bone bruises, soreness. And a lot of the times people don't realize how long this takes to get better. So even sometimes missing a curb, standing for 12 hours a day going to Disney World, your feet can get so sore injury on average, I tell people for a significant injury it can take six weeks for 50% of the swelling to go away. It can take three months for 75% of that swelling to go away. It can take six months for 90% of that swelling and go away and one year for 100%. Now, if you're 15 years old and you're healthy, you're going to heal a lot quicker than someone who's 80 years old on average. But these are rough guidelines for older adults, probably like age 40 or older. Now, swelling from more significant injuries like bone damage, knee hip replacement, back injury, stress fracture in your foot. This can take a long time. And the problem I see with people is it's not just a couple of weeks. It's not just a couple of months. You actually have to be supporting yourself properly. There is a scary statistic where if you're hospitalized for one week, you're muscle mass and your swelling will never go back to normal. That's crazy. So older people, if they sprain their ankle, break their ankle or their knee or their hip, statistically, they will never get back to their original strength or their swelling because they never go through the proper rehab. They don't do it properly. And that doesn't mean you have to spend a ton of money. There are simple, easy things you can do to get better, and we'll go over those at the end. But just keep in mind this is where the proper prosthetics, physical therapy and evaluation come in, because you have to set proper goals, proper diagnoses to get these problems fixed. When I see a patient who had a broken ankle or a sprained ankle or a twisted knee or a surgery in the past. Usually their healthy leg has good vein flow, good valve flow, but the injured leg tends to have more swelling, more damaged valves. And it's because, as they were healing and that bone or that ligament was healing, they were ignoring that leg. It was just thing swollen. It did not become flexible. Now it's tight, now it's swollen. And over the years, those valves just have to absorb more pressure. That leg has to work a little bit harder, and it's not flexible enough in the proper rehab. Flexibility is not done because it's hard. It's hard to get flexible and stretch and things like compression socks. After a while, just get tiring. So make sure you do the proper rehab, the proper orthotic shoes and braces. Pregnancy related problems. We talked earlier that your inferior vena cava. So on this side right here, I'm confused looking at the camera, it's like a double reflection here, but your inferior vena cava, when you lay on the opposite side, it's not going to put pressure on there with the baby pregnancy associated conditions. And there's a hormone called relaxin for my wife. I make sure she has the proper slippers with the proper insoles, potentially compression socks as well. Potentially a back brace as well to help keep proper posture because you can throw it your back. This relaxin hormone just makes everything leak more, everything small more. Sometimes you just got to get through it, but you need proper support. Walking barefoot, for example, can lead to permanent varicose veins, stretched ligaments and flattened feet. That's something you do want to avoid and take the biomechanical precautions and I'll talk about those at the end. And I'm dealing with this with my fourth kid right now. Medications. There's a lot of different medications with a lot of different side effects. And what happens is this can cause foot swelling, ankle swelling. If you're starting new medications, check with your primary care doctor. If you're having side effects, there's always different options and different medications to take. Just make sure to have that discussion swelling due to infection. So this is very common cellulitis now where people confuse this as they think they need to be like vomiting and sick. When I see infections, there's people with scrapes, with dry skin, dry, cracked heels, athlete's foot, toenail fungus, infections. These are all infections that create inflammation in the body and make your feet swell more. So if you have thick, scaly nails, thick, itchy feet. This is all irritation. If if your skin's red and itchy, it will make your skin swell more. I have guides on all those foot leg conditions below. I could talk about that for hours. There's so many different causes. Check out my top 15 skin condition guide and all the solutions to them. But if you have cuts, wounds, ulcers, venous ulcers, diabetic ulcers, I have guides on all of those below as well. This is an area podiatrists can really help out with, but initially you can have some dry, thick skin with some bacterial colonization. It's not enough to cause an infection, but this is where preventative measures help. But at a certain point this is where the bacteria can get on the foot. It gets red, it gets itchy, it gets hot, potentially cracks or blisters wounds can develop. And then as that density of that bacteria increases, you can get systemic infection, blood infection. It can get into your body and you can get hospitalized. And that bacteria on your wound stimulates an inflammatory response that causes chronic, consistent swelling. This can give you fatigue, weakness and long term swollen legs. If your calf is sort if it's red hot tender, this could indicate a blood clot. Treatment involves blood thinners taking a daily aspirin, taking a blood thinner. But here's how you want to evaluate this. A simple screening home test is called the Holman's test. So essentially, if one leg's more swollen than the other, especially in the calf, you squeeze the calf or you bend the toes up. If it's really sore, that's a big indicator that you want to go get a venous Doppler. So that's done in a medical office or the emergency room. It's fairly quick. This test works really well. It's not dangerous. Highly recommend to get it checked out. Risk factors for this are diabetes, obesity, not moving, smoking, prior infections, health conditions, basically anything that causes inflammation, that's a very important one. If you think you have a blood clot, check out my video on the signs, symptoms and treatments. It's not always this easy, but usually it is for me when somebody comes in after an injury, a surgery with high risk factors, one leg is much more swollen than the other and what happens is you can bend that foot up and as that moves that calf, it's painful. I mean, really painful. You could squeeze that calf, you could push with your fingers on that clot area. And it's really painful. Not that that's 100%, but that's what makes you want to get a venous ultrasound test at that point. And you can go to any E.R.. They will squeeze you. And immediately, because this is considered something a little bit more urgent. Or you could go to a vein clinic. They will do this for you as well. And it just looks just like this. Venous insufficiency. This can be related due to weight, to age, to muscle soreness. I have a specific video that goes in-depth about venous insufficiency, but easy solutions are compression socks, elevation, wearing proper shoes, proper insoles. Do you need prescription compression stockings? Absolutely not. You do not. And what you do need is pre-made over-the-counter ones that are ten millimeters of mercury or 20 millimeters of mercury somewhere in that range. If they're more than that, the prescription ones are going to be too tight, too uncomfortable. You want some running compression socks to start with? You want good supportive orthotics, You want good shoes. Unbelievable. The difference it will make. And I'll go over that a little bit more at the end, because a lot of these are part of the big secret. I have a guide that goes over all the new products, all the home remedies. It's probably too long to go over here, but check that out on venous insufficiency. And on that note, if you have dry, scaly skin, if you have cuts, if you have a condition called lymphedema, where your skin also is not just swollen but scaly, crusty, there are wraps that I do in the office with specific moisturizing bandages that can heal that skin while compressing it at the same time. It's something a little bit more difficult to do at home, but these bandages make such a difference. So if you're in the Michigan area, check me out. If you're not, check out a great foot doctor near you for that treatment for swelling from congestive heart failure. The bottom line is a lot of times heart issues, they just don't have the strength, especially if you're a bigger person who weighs more. The heart is not big enough to match your body's needs. The more you weigh, the exponentially harder your heart has to work. In a lot of cases, you need a cardiologist evaluation. You probably need to cut down on your body mass. You need to get assessed for atherosclerosis. So you need to make sure there's no blockages in your vessels that are preventing the flow. The bottom line is a heart issue is more difficult to control cause I work with vascular specialists, cardiologists for this issue. As a foot and ankle specialist. I checked the posterior tibial artery pulse, the anterior tibial artery pulse. This sets a good guideline. If those feel great, then you don't have to do much more. And the way you feel is bounding pulses up and down. And we also check the capillary full time. That means when you squeeze the toe, does it refill instantly? If it doesn't, if it's more than 3 seconds, we can use a computer to perform a test. We could perform what's called an ankle brachial index. So that's basically comparing your arms to your feet. Are there potential blockages somewhere? And if there are blockages, so for example, if one ankle is much worse, flow than the other or compared to your arms, then we might want to do more testing. You can check the toes and then you can order imaging. You can get what's called a CT angiogram. But what I do is I work with a vascular surgery team. So I work with great vascular surgeons essentially right away. They can do a test, which is an angiogram, where they can release dye. They can essentially check if anything's narrowed or blocked and then you can correct it. So this is one of the images where you could see, is there cholesterol buildup? Is there a plaque? Is there calcification? One of the most rewarding things in my career is how many people have been sent for vascular and cardiac testing, from what symptoms and how much better the quality of their life. Almost immediately got. Lymphedema. I mentioned this one earlier, but lymphedema is like venous insufficiency, but with more dry, scaly skin lymphedema is lymph vessels which can't reabsorb protein back into the blood flow. That protein then deposits into the skin. It gets thick, scaly, starts to crack. This requires specific lymphatic massage hoonah boot dressing. So I use a paste. It's like a moisturizing lotion called zinc oxide with soft wraps. I put these on for usually like two, three, four or five, even a week at a time if there is no drainage or sweat. And when people come back in a couple of weeks, those legs can be fully shrunken down those cracks. That dry skin looks a lot better and it heals up a lot more nicely. Lymphedema is the demolition of the lymph vessels. They can't reabsorb big proteins and thus they develop in the skin, whereas venous insufficiency is swelling in the skin, the proteins can still be reabsorbed. Kidney problems, fluid retention and ankle swelling due to kidney problems. Me as a podiatrist, I actually have a video about kidney problems because I'm one of the first people to diagnose it. For a lot of these patients, if you have foot and ankle swelling and you don't get these regular lab tests, you're in the early stages. A lot of the times, early stages of kidney disease can be improved or potentially even reversed. But as you get into more severe stages, you might need dialysis, you might need permanent medication or treatment. So it's great to catch these issues earlier. are so many causes now of kidney disease like diabetes, high blood pressure, using alcohol, frequent renal infections, smoking and overconsumption of certain medication and foods. And these are the symptoms. You can have dry, itchy skin, tired, bubly or foamy pee. As we're talking about. Swelling is very common. You can have puffy eyes trouble sleeping due to heavy needs, that bathroom loss of appetite, muscle cramps and need to go to the bathroom. But don't worry, a lot of this is improvable. But around the world, 843 million people right now as of 2017 have chronic kidney disease and most don't even know it. That's one out of ten adults in the world. And look at how much it's going up. It's going up like crazy. This is something that can be at the very least stopped, if not improved. There's a lot of stuff you can do. So if you're smiling, make sure you work with your primary care doctor or nephrologist to get the stuff checked out. Liver failure, getting a lab test to take a look at liver failure, specifically liver enzymes or your albumin levels. Albumin needs to be inside your blood vessels to attract the water. If it's not that water leaks into the blood flow At the same time, if you have liver issues, it can plug up the inferior vena cava and create leg swelling. You need to get that diagnosed through imaging or a lab test. In a healthy liver. It produces enough albumin to be inside your blood vessels that attracts blood flow back into your vessels and out of the tissues. But what happens is if your albumin leaks into the tissue or if you're not making enough of it, the fluid is free to go into the tissues. Now, what gets worse is if your lymph vessels are not working because you have lymphedema, a lot of that fluid just stays in your tissues. It's not pulled back in. There are some therapies like to replace IV albumin, so if your liver can't make it, there are some IV albumin that can soak up that fluid. So there's hospital treatments. But that's a sign potentially that you need to go see your doctor and get checked out. Now, the big secret is this I promised you a big secret. Almost every single patient that comes in to see me, I use an ultrasound and imaging they have swollen ligaments on the bottom of their foot. Their muscles are swollen. There's fluid. All this type of muscle irritation and overload stimulates the body to send inflammatory cells to these areas and it swells the skin. Most people that have foot and ankle swelling don't know what it's like to not be sore anymore. They have a hard time walking the distances like when they were teenagers. They can't work out. They're not strong enough. The big secret is you have to support your body until your muscles can heal. A lot of the times this means proper supportive shoes. Even inside the house. Even outside the house, it means proper, supportive, cushioned insoles. It potentially means compression socks combined with all that weren't ankle brace or a knee brace. What I do is I do a biomechanical exam. I see what's overloaded, what's overworked, and we stabilize those as a couple of weeks go by, that muscle calms down and that swelling melts away. Now that patient can start moving and walking. In the most cases, even if it's the heart, the kidneys, in a really sick patient with a lot of health issues and a lot of medications, as they start doing better, their muscles get stronger, their swelling and inflammation decrease and you can get stronger, you can get more condition. A good plan is to start slow that five, six, seven weeks. Don't start with an unsupportive shoe. Start with a good shoe. Otherwise you're going to get bone soreness, muscle soreness, fascist soreness right off the bat. Start with a cushioned shoe with a soft, gentle orthotic. You don't need a hard, restrictive orthotic. Get used to it. You can see as ten weeks, 20 weeks go by your shot, your muscles are adjusting, the orthotic is preventing you from rotator, compressing, stretching, and then you could potentially go to a more supportive orthotic as your ligaments, your tendons in your cartilage get used to it. If that's still not getting used to it. If you're having a hard time adjusting, there's absolutely nothing wrong with using a walker. a cane ankle, braces, knee braces, massage sticks, massage back braces or back massagers? I use them too. It warms me up in the morning. It's a great start. If six weeks go by and you still have severe aching or pain and you can't really get past that 5 minutes, that's when you want to see a podiatrist or a specialist, get that joint, get that ligament evaluated. Maybe something's torn, maybe something's injured. But there's a great orthopedic surgeon that I work with. And essentially he told me one thing knees and hips and feet and ankle. I stand by this by my joints that I work with as well. They only have one way to communicate by getting sore. It doesn't mean something's damaged. It doesn't mean something's ruptured. It could just mean the muscles are weak, they're overworked, they're swollen. And I would say 90 plus percent of the time, in my experience, there's nothing wrong. You just need to condition yourself a little bit better. 10% of the time something could be damaged and that's usually sharp pain, gripping pain, pain that just does not get better with more activity over a period of time. I just worked with a lady with significantly swollen legs that needed a cane. She just started doing basic exercise, basic shoes, basic insoles, her legs swelling dramatically, went down and she doesn't need the cane anymore. Her nerve pain disappeared. I have stories like this every single day. What's too tight? What's too weak? What's too overwhelmed? Support it, stabilize it, compress it, make sure it heals up. And then when you're healthy, start strength training, start exercising, starts sleeping better, start eating better. And then if those things don't work, I do have a specific video with the compression socks, the exercises, the devices, exactly how to wear shoes, orthotic braces. Click on that. It's just going to make too long of a video if I do it here. that's when we can go to the most advanced treatments like medications and things along those guys and guys tell me what help. Tell me what didn't help. Tell me if you have some tips that are missing. Like I said, I really appreciate you in these videos make such a big difference when you comment down below. It really helps out other people in the comments and me to make better videos. Thank you.