after any procedure casting or internal fixation of fracture ankle and foot there is always chronic edema what is the management
A good multilayered Jones dressing combined with elevation and ice behind the knee does a good job if the patient is compliant.
In certain cases, the soft tissue and ligamentous injuries take longer to heal or our preference to address bony injuries makes their management less adequate resulting in chronic swelling during ambulation may be due to element of instabilities.
Firstly, one must rule out reflex sympathetic dystrophy/complex regional pain syndrome which is requires an entirely different spectrum of management.
If that is ruled out, the management is relatively simple and depends on the facilities as well as patient compliance.
Easiest to use is intermittent compression bandaging- one can explore this modality further at http://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2010.15.Sup3.47362?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
One may even use newly developed cryotherapy compression wraps, if available.
In addition to mimimal foot elevation while at rest, the most essential part of the management is active foot and ankle mobilization which improves both lymphatic and venous drainage of the swollen foot & ankle.
Associated soft tissues damage during injuries, operative technique, quality of soft tissues, age, chronic diseases etc. maybe a causes of chronic oedema.
Compression, ice and elevation help to menage postoperative or injuries oedema and have a purpose to move the build-up of lymph fluid, to reduce swelling and to enhance muscle pump effect..
The Algodystrophy (CPRS) represents a difficult disease to diagnose and treat. Budapes clinical criteria represent the most accepted diagnostic approach. CPRS required multidisciplinary approach.
P.R.I.C.E. Protection, Rest, Ice, Compression, Elevation is the main treatment
The double insult of the initial injury and the subsequent operative procedure had as result the "inflammation" in the area and concentration of blood. This is a common reaction of the body to any insult. The above mentioned treatment is fundamental despite it sounds controversial (as it is mentioning Rest but in the same time we know that Mobilisation can reduce swelling due to the activity of the muscles). The meaning of Rest has to be understood as Rest to avoid prolonged irritation in the area. Prolonged swelling in the area according to some opinions is the reason of pressure on the local nerves and due to pain there is reduction of movement and so further swelling (so we end in a vicious circle) resulting to the Complex Regional Pain Syndrome, which is difficult to treat due to the chronic presentation and effects.
In addition to what have been mentioned, I think we should give it some time to go.