Most of us are unaware that even when we sustain a small skin injury, the skin around the wound alters in many ways. After surgery it is not unusual to experience such colour changes. Bruising arises from escaped blood content which can migrate to the heel, arch, and may appear well away from the site of surgery. There is no need for concern, bruising will soon disappear. What may not disappear so quickly is the general redness, or even purple colours. This can vary during the day, after rest, or even after having a warm shower or bath. The healing process is complex as there is mass disturbance at all levels. The colour reflects the state of the small vessels (capillaries), the larger conducting blood vessels – arterioles or arteries, which change diameter through reflex controls. While cold makes the skin pale or blue, and heat makes the skin darker or red, after surgery the circulatory status is temporarily altered for months, not just weeks. It is a reflex because we have no control. The reason is associated with a need to carry nutrients (good) and waste products (bad) to and away from the surgical site.
Much can be done to improve the colour, which on occasion appears alarming. Drop the foot down and the colour will change dramatically. Elevate the limb, and ‘bingo!’ the foot colour improves. Rest and elevation are important during the first week after surgery, but as comfort returns, exercises in the form of muscle pumping are valuable, and not just to prevent a venous blood clot (DVT). Once the wound heals we can then start massaging the foot, compressing the soft tissue forcing the fluid back toward the ankle to be carried away by the lymphatics and veins. The use of regular (three times a day) massage with a suitable cream or Bio oil will help the scar and the foot return to normal faster. I had to become a patient to learn this trick from a good physiotherapy colleague. Massage and careful exercise following surgeries will not only improve the colour but discourage the unwanted reflex causing uncomfortable sensations after foot surgery.