Sunday, June 28, 2009


Not a pretty sight, and certainly not one you want to see below your knee on a trans-Atlantic flight. On average, it's a bad thing that airplane seats on such journeys are so close together that you can hardly reach your feet to pull off your shoes, but a good thing insofar as inspecting your ankles is difficult. But when I finally got my lower leg into viewing range on the leg of the trip from Madrid to Philadelphia, it was strictly Exhibit B for me!

This would be a good time to review venous return from the lower leg and all that might interfere with it during a summer flight. Consider blood and its journey from toe back to heart after its load of oxygen has been delivered to these nether regions. Each heartbeat sends a surge of blood through the elastic arteries which expand as the blood pushes by and then contract in a springy sort of way to amplify its forward progress. By the time the blood passes through the teeny weeny capillary bed back to the leg veins, however, it's a different story.

The veins which carry blood back to the heart are neither elastic nor springy. When the blood arrives in the venous system, that pulsing kick from the heart's action is much diminished. In the upright or seated position, gravity is tugging that old deoxygenated blood downwards. The veins have valves on their inner walls that open to partially prevent this gravitational backwash, and activation of the leg muscles helps to further squeeze venous blood in its upward course.

Think for a moment, then, about a middle-aged lady(MAL) stuck in a seat for 9 hours watching "Bride Wars" and "Marley and Me" and eating salty airline meals. Actually, the movie choices have nothing to do with our cankle tale here, but believe me, these were dismal ways to pass time. So the MAL has already walked too much through the hot Spanish sun with her venous system dilated from the heat and saggy with age. She's retaining water from the high salt food. Furthermore, as she sits motionless in steerage, two 90 degree turns in her leg veins (at the knees and the hips) further slow the flow.

Oh gad, methought, those are NOT my ankles (or more precisely, where are my ankles?). For those of you wondering when your ankle bones will re-emerge from the inflight edema, mine took two days and I've seen it take up to two weeks in some of my patients.


Reality Man said...

Well, that sucks. I have already written you about the advantages of avoiding steerage. One question is: Is it merely unsightly, or is it actually dangerous? A sidenote: I have noticed something similar as a MAM, not when flying but simply motoring around, when I wear (well known squishy shoe) rather than something that laces up.

kenju said...

Thanks for the visit and for looking through my European photos. It was a hard trip!! My daughter planned the whole thing (she had been all those places before) and since she is never still a minute, our whole nine day trip was planned to the nth degree. Did you ever see the old movie "If it's Tuesday, This Must Be Belgium" ? That's what this trip felt like - and cankles? Mine were huge during both transatlantic flights, even though I wore compression socks. My doc says I have "pendant" edema, but it bothers me, nonetheless.

kenju said...

P.S. How did you like France and Barcelona? I have always wanted to go there; my daughter went to Barcelona for the Olympics and loved it there. She wants to rent a villa in Tuscany some summer and take us there, and take us to France again. She has been to Nice and and Cannes - I sure would love that!! I hope you'll write about your trip and show photos.

Mauigirl said...

That happened to me, and it was the day after I got home from Ireland before I noticed them. I was sitting at an Irish bar (trying to recreate what I'd just returned from I guess) and looked down at my ankles and there they were - all swollen. I finally realized it was probably from the airline flight. First time it ever happened to me. I guess it was the first time I was truly a MAL.

Naturegirl said...

Oh how I can indentify with this!! In fact even travelling by car for a long distance can cause this for me!Always one leg more than the other!Now I wear my "old lady" pressure socks! Seems to work!
I love your blog! So glad that I happened on it! I will take time to review your other blogs.
A pleasure to meet you!! :)NG

femail doc said...

RM: Just couldn't bear to pay lots extra for business or first class. A certain some number of long-distance fliers do get blood clots, and they are probably a subset of the becankled. Those well-known squishy shoe have zero support and are a major source of foot pain for the MALs in my practice.

KJ: I'm speechless. I did south of France and Barcelona in eight days and assumed your trip was at least 2 weeks. You must have been exhausted. I think your doc said 'dependent' edema as in swelling due to the force of gravity on dependent parts of your body. Lovely--compression stockings, the newest fashion statement by aging ladies.

France was fabulous as was Barcelona. The latter, however, lost some appeal due to the big cityness of it all--I don't think I'd go back there but would revisit France any day. Tuscany sounds great!

MG: The thought of you sitting at a bar and gazing at swollen ankles is a perfect visual of the modern MAL.

NG: We should start a blog with candid pictures of aging baby boomers who have lost their beads, bell bottoms, and (shapely) butts in favor of orthotics, sensible shoes, compression stockings etc. We could get Mauigirl to contribute the bar/cankle spectacle. Again, nice to have you here!