Polio Place

Post-Polio Health, Volume 28, Number 4, Fall 2012
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: I have lower left leg PPS atrophy. Since hernia surgery recently, I haven’t been able to walk or bicycle as I regularly used to do. I’ve sometimes noticed worrisome foot edema that is more pronounced and sustained since the surgery. Other than trying not to sit for too long, cutting back on salt and elevating the leg more, is there anything else I should be thinking about or doing for this?

Answer: Hernia surgery could aggravate dependent edema in your polio-affected lower limb in several ways. Sometimes it is the result of salt/water imbalances that follow anesthesia, medications taken before and after surgery and the decreased activity surgery imposes.

Another problem is the swelling in the groin around the hernia repair site because one of the major veins that drains blood from the leg goes through that same area.
In addition, with more sitting and less walking, there is less normal pumping action from leg muscles to cause blood to flow back out of the legs. If any or all of these are the reasons for what you are experiencing, the swelling should largely be gone in the morning after having the leg elevated all night – it can be put on one pillow overnight.

You are doing the right thing by limiting salt, but wrapping the leg and/or elevating it when sitting can also minimize prolonged swelling. You can also wiggle toes and move your ankle muscles up and down while sitting.

There should also be no pain or redness in the leg. The one concern is whether during the surgery you had a new blockage of any veins in your leg. This is known as venous thrombosis. If the leg is red, warm and tender, it may be thrombophlebitis. The former can be silent and resolve with the above simple suggestions. If the latter, and occasionally with the former, there is a possibility that the blocking vein thrombosis (blood clot) can grow, and a piece may break off to cause a pulmonary embolism if a piece of clot travels to the lungs. This can be very serious and occasionally fatal. Generally, a blood clot in the leg will be diagnosed by tests, ultrasound and/or scans, and if found, then treated with anti-coagulants.

If you are concerned about having a thrombosis or phlebitis, you should see your doctor immediately or be seen in an urgent care/walk-in clinic.