Swollen ankle 7 years after bunionectomy and fusion

by Charlene
(Brockway, PA)

I had bunion surgery and the next three toes fused straight 7 years ago. I had physical therapy afterward. Since that time, the only time that my foot and ankle don't swell is when I keep my feet propped up. Since I have a full-time job, it is not possible for me to continuously keep my feet up. My ankle swells more when I sit for long periods of time (I.e., traveling, visiting, sitting). My husband keeps telling me that it's a sign of a bad heart; however, both ankles don't swell (only the one from surgery). I have had tests done to check my heart. I am not overweight and I exercise 3-4 days a week. Also, when I do stretching and rotating exercises for my ankle, the pain is sometimes excruciating. Drinking more water and decreasing my salt intake seem to lessen the swelling a little. Does the swelling and pain seem to be normal this long after bunion surgery? Should I be doing more stretching exercises? Is this a circulation problem or a joint problem? What are you recommendations?

RESPONSE

Hi Charlene,

You are correct in that swelling in the feet and ankles when due to a heart problem or even a kidney problem are usually in both feet.

The swelling you have in one foot may be due to a couple of different issues, possibly the previous surgery on your foot.

Most cases of unilateral swelling is due to venous insufficiency, meaning the veins in the leg are no longer adequately pumping blood back up to the heart as efficiently as it once did. This will cause a "pooling" of blood in the foot and ankle.

This can occur even when seated as you may be cutting off the return circulation in your thigh.

Most people who suffer from venous insufficiency will notice that first thing in the morning upon rising their foot and ankle will appear fairly normal but as the day progresses the swelling will worsen.

So the question becomes why did this begin right after your foot surgery?

You do not mention any pain from the surgical sites so I will assume they healed properly and you do not limp or have otherwise changed your gait cycle in an effort to compensate for any residual pain. A compensated gait could cause swelling in the foot and ankle.

During foot surgery most of us use a tourniquet to control bleeding. If you had one it was either placed around your ankle or your thigh. A tourniquet that was applied too tightly, particularly around the ankle in theory, could have caused damage to the veins underneath and could adversely affect the ability of the veins to pump blood back up to the heart, thus causing swelling in the foot and ankle.

You also mention that when you exercise your experience a lot of pain in the ankle itself. Arthritis within the ankle joint can also cause swelling and this too will usually worsen as the day progresses.

Here are my recommendations.

See a vascular specialist and let he or she check for venous insufficiency. If that proves to be the problem there are things you can do to minimize the swelling.

If the vascular specialist fails to find any pathology with your venous system, then I would suggest you see a foot specialist and have your ankle joint x-rayed and examined for possible arthritic issues. As long as you are having x-rays you might also want your surgical site done as well to make sure everything is fine.

Marc Mitnick DPM
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