It’s not always easy to find inspiration for these most inspired and inspirational blogs, although sometimes the inspiration just surrounds, as it does now, at 36,000 feet. As it’s a common question in our NYC podiatry practice, thought it might be high time – pun intended – we talked a bit about flying and your feet.

Let’s get a few things out of the way for those who may be avoiding it for other reasons. Flying is safe, so safe you could fly for around 63,000 years and not experience a catastrophic mishap. It’s not so much fun with the TSA land grabs, delays, lines, and let’s not get started about the cleanliness of your seat (word to the wise – use some Purell after grabbing your stuff from the seat pocket). However, it can still be a trip, so to speak, and here are a few things to remember.

We have discussed swelling many times before, and air travel is a great way to experience it at its most squishy. Modern aircraft cabins are pressurized, as we all know by now, but only to a level of about 8,000 feet in most cases. And sitting for long periods of time with the knees bent obstructs the venous outflow that drains the fluid from the legs, and robs our legs of the calf pump action by which leg muscles move fluid out of the legs. This means that the atmospheric pressure causes the legs to swell, and the body is then unable to drain the fluid properly. Those who are prone to leg swelling will find their condition is exacerbated, and patients whose legs or feet are swollen due to recent lower extremity trauma – including surgery – can expect the swelling to increase between takeoff and landing. A rarer and more dangerous complication is the increased risk of blood clots in the leg which can potentially travel to the lungs and prove fatal.

But remain calm, my dear patient, and don’t cancel those reservations just yet, as I’m all about solutions, not just problems. For my surgical patients, it’s ok to travel, albeit preferably not within the first two weeks after surgery. Not only is swelling an issue, but there is a lot of ground to cover in most modern airports (ugh). If you must fly, inform the airline and take advantage of inter terminal transport of any means other than walking. And to all who are prone to swelling, compression hose can be your friend, as are the extra room seats that allow for a bit of elevation. It’s also a good idea to get up and stretch the legs at least once an hour, and walk the line, or aisle, as it were. However, no matter what precautions are taken, the legs and feet will be a bit swollen on arrival, which will resolve within a few hours after landing.   And blood clots in the leg generally first present as a painful swollen area behind the knee, so if you’re unsure, seek immediate medical attention.

As with anything else, it’s always better to be prepared. I can’t do much about the indignities of travel, unnecessary fees, and terrible food with such small portions.   I can, however, offer these few tips as well as my own itinerary, because Heaven help those who sit next to us and our 7 kids when flying. Oh and do drop a postcard.

See you in the office.

Ernest Isaacson