Swelling in the feet, known as peripheral edema, is a frequent complication for individuals recovering from a stroke. This condition involves the accumulation of excess fluid in the tissues, usually affecting the foot and ankle on the side of the body weakened by the stroke. Post-stroke edema can interfere with mobility and increase the risk of skin complications, making its management an important part of rehabilitation.
Why Swelling Occurs After a Stroke
The primary reason for foot swelling after a stroke is the failure of the “muscle pump” mechanism. When the stroke causes hemiparesis or paralysis, the calf muscles on the affected side lose their ability to contract effectively. These contractions normally squeeze the deep veins, acting as a pump to push venous blood and lymphatic fluid upward against gravity.
Without this action, blood and lymph fluid pool in the lower extremities, known as venous and lymph stasis. Prolonged sitting or standing with the foot in a dependent position significantly worsens this pooling. Changes in the autonomic nervous system caused by the stroke may also affect the tone and function of peripheral blood vessels, contributing to poor circulation.
Home-Based Techniques for Reducing Edema
Simple, consistent actions performed at home can significantly help manage and reduce foot edema. The most immediate and straightforward technique is elevation of the affected limb. The foot should be positioned above the level of the heart for 15 to 20 minutes at a time, repeated several times daily, using pillows or a footrest to maintain the height.
Movement is essential because it directly addresses the muscle pump failure. Patients or caregivers should perform gentle ankle exercises, such as ankle circles, ankle pumps (pointing the foot up and down), and toe wiggles, even if the movement is passive or assisted. These small movements stimulate the remaining muscle function and help propel fluid back toward the trunk of the body.
Maintaining proper skin integrity is important since swollen tissue is vulnerable to injury and infection. The skin on the affected foot should be kept clean, moisturized daily, and thoroughly checked for any cuts or blisters. Caregivers must ensure the patient avoids prolonged pressure points and that shoes or slippers are not tight, which could worsen swelling or restrict circulation.
Dietary adjustments and hydration play a supportive role in overall fluid balance. Paradoxically, the body may retain fluid when dehydrated, so drinking at least eight glasses of water daily helps maintain a healthy fluid balance. Reducing the intake of high-sodium foods is also recommended, as excess sodium causes the body to hold onto water, directly contributing to fluid volume and swelling.
Professional Therapies and Compression
For more persistent or severe edema, several professional and prescribed therapies are available. Physical therapists can create a tailored plan that focuses on strengthening and activating the muscles needed for venous return, including specific “muscle pump” exercises and gait training. They may also teach specialized techniques for passive range of motion that are most effective for an individual’s level of impairment.
Compression garments are effective, working by applying external pressure to the limb to prevent fluid re-accumulation and assist circulation. Compression stockings must be professionally fitted to ensure the pressure gradient is correct, with the tightest pressure at the ankle decreasing gradually up the leg. For patients with severely limited mobility, a Sequential Compression Device (SCD) may be prescribed, which uses inflatable cuffs to mechanically squeeze the leg in a wave-like sequence, mimicking the natural muscle pump action.
A specialized technique called Manual Lymphatic Drainage (MLD) is used for swelling primarily caused by lymphatic impairment. MLD is a gentle, rhythmic massage performed by a certified therapist to lightly stretch the skin and redirect fluid away from the swollen area toward functioning lymph nodes. In some cases of moderate to severe edema that is unresponsive to conservative measures, a physician may prescribe a loop diuretic, such as Furosemide, to increase the excretion of sodium and water through the kidneys.
Warning Signs and When to Contact a Healthcare Provider
While some degree of foot swelling is expected after a stroke, sudden changes can indicate a serious complication requiring immediate medical attention. A deep vein thrombosis (DVT), a blood clot in a deep vein, is a significant risk for immobile stroke survivors. Signs of a DVT include sudden, severe swelling, pain or tenderness in only one leg (often described as a cramp), and skin that is unusually warm or red.
An infection, such as cellulitis, can also occur if the compromised skin barrier is breached. Symptoms of cellulitis include localized heat, pain, and tenderness, with the skin appearing red, glossy, or discolored. If these symptoms are accompanied by a fever, it suggests the infection is spreading and requires urgent antibiotic treatment.
Note if the swelling is present in both feet, rather than just the paretic side. Bilateral swelling may suggest a systemic issue unrelated to the stroke paralysis, such as heart failure or kidney dysfunction. Any dramatic increase in swelling despite home management, or any signs of chest pain or shortness of breath, should prompt an immediate call to a healthcare professional.