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Wednesday, June 24, 2020

Problems with Removable Boots and Swelling

Hi. Dr. Blake,

I wanted to get your take on my situation. I started having pain which turned to swelling at the end of Feb. 
I have very high arches (I have custom orthotics) but had not started wearing them yet. I went to a podiatrist who said that I needed to wear a boot. 
I wore the boot for about 4 weeks but still had some swelling. 
She suggested doing a MRI. During the time I was wearing the boot she said it was okay to walk around in the boot and so I was going for short walks with my son. 
I ended up seeing another podiatrist via tele med. He suggested Physical therapy. 
I did physical therapy for about 4-5 weeks. The PT hurt my foot and after the first visit I had swelling after I thought my foot was better from the boot. 
I continued the exercises and it felt like my foot was finally getting a little better but then he had me do some twisting balancing exercises that again really hurt my foot and made me think I re-injured it.
 He sent me back to the second podiatrist who did an MRI. 
He said I had a lot of inflammation and a small tear needed to wear the boot again, stop all PT and take  MEDROL or do a cortisone shot. 
I opted against cortisone, am wearing the boot but finding that my foot is swelling up again even though I am not walking and laying off it. 
I was also icing. I feel like the icing and the boot are hurting it. Is this possible? Maybe it's not getting blood flow.
 Before I got the MRI I was wearing my Dansko shoes at home and my sneakers and walking around an it felt better. I am really confused.
 Any sugggesitons?

Dr. Blake's comment: First of all, swelling can be inflammatory (typically painful), part of the healing/reparative process of an injury and chronic since it can last months and months after an injury (typically not painful), and related to venous insufficiency (veins having trouble removing fluid from feet and generally also not painful). 
So, when you say swelling, I need to know if this swelling hurts or not. 
Chronic symptoms, over 3 months, start to strain the venous return and swelling can get harder to drain out of your foot. You may need compressive socks or, at least, some period daily of elevation. Boots can begin to work against you and trap in the swelling due to the immobilization and Velcro strap restriction of the venous return. 
Icing controls inflammation, but usually does not get rid of it. Contrast bathing can be the best at removing inflammation and swelling produced by that inflammation. 
So, recommendations: Are we sure the tear needs to be protected? That is the million dollar question here. Inflammation is better served by contrast bathing not ice, no boot, some elevation, motion that does not cause more than 0-2 pain. I sure hope this rambling helps you. Rich 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.