Prevention of Swollen Feet & Legs During Travel

Early this year, before anyone had heard of Covid-19, my husband and I traveled abroad to India.  We flew across oceans for nearly 16 hours.  During that time, I remained quite active, especially with my feet.  To adjacent passengers, it probably seemed like I was a high maintenance traveler, as I often stretched out, took frequent walks about the cabin, changed out compression stockings, frequently removed shoes, and even extended my legs for massages (begrudgingly provided by my husband).  What the passengers didn’t know, and what my loving husband did, was that, as a Podiatrist, I acted to avoid swollen feet amidst prolonged air travel.        

Today, in our new Covid world, when traveling in limited spaces, it’s important to consider the effects of these spaces on leg swelling and resulting complications.  The low cabin pressure in airplanes often leads to thicker blood and poor circulation.  If airline passengers are not careful, they could be dealing with swollen feet and legs that can be exacerbated, possibly leading to complications. 

There are many causes of leg and feet swelling.  The most common cause of leg edema in older adults is chronic venous insufficiency. Other causes include pulmonary edema, deep vein thrombosis (DVT), heart failure, liver and kidney disease, thyroid disease, malignancy, infections, standing for long periods, pregnancy, obesity, sleep apnea, and excess salt intake. Lymphedema, accumulation of protein rich interstitial fluid, and lipedema, fat maldistribution, can also cause leg edema. In some cases, certain medications like antihypertensives, steroids, and hormone therapy can contribute to swelling.   

Not withstanding these numerous causes, the exacerbation of leg edema during travel can be controlled and limited.  Thankfully, there are many tips to avoid the swelling and complications that result from air travel:

  • You can sit in an aisle seat; it can help to stretch out your legs. The emergency row, although it comes with more responsibility, will provide maximum space for your legs. This row will also allow you to stand without blocking people from bypassing you. Avoid crossing your legs if possible.
  • You can place your feet on your bag to elevate your legs at night; this can reduce pooling of fluid.  You can also remove your shoes to allow any excess fluid from building up.   
  • You can stand and walk around the aircraft to increase circulation. The contraction of the calf muscle pushes the blood out of your calf when walking. This blood travels from the superficial veins to the deep veins, and then to the communicating perforator veins.
  • You can wear compression stockings, which help pump blood back to the heart. Check with your doctor about wearing compression stockings, and have your doctor advise you on the appropriate amount of pressure to use. Some people cannot tolerate high pressure, so it is important to know the differences in various pressures. The stockings are available in both open and closed toes. There are also velcro strap options for patients with difficulty bending or pulling the stockings up their lower legs.
  •  You can massage your feet and calves.  This can increase circulation and have some similar effects to walking around. Extending and flexing your knees/ankles can also increase circulation.
  • Some doctors have advised patients to take a baby aspirin to thin the blood and improve circulation.
  • You can also avoid caffeine, alcohol, sedatives, and salty snacks and increase your water intake. Some doctors have suggested taking a magnesium supplement to your daily diet; this could help limit water retention. However, it should be avoided with any kidney or heart condition. Check with your doctor regarding consumption of any diet supplements.

During my trip early this year, I made sure to take a pair of compression stockings and got up frequently to walk around on the flight. I also made sure to stand in an area where I was not blocking any flight attendants or passengers from bypassing me. I also massaged my calves to increase blood flow. And even asked my husband to massage my calves. I also elevated my legs up onto the seat and rested them on my carry-on bag and husband occasionally (he comes in handy). As soon as I landed, I made sure to walk around as much as possible. Personally, I feel your body will recover faster if you stay hydrated. Once you exit the plane, being outside in warm temperatures or taking a warm shower if possible, will increase circulation in your legs and get the blood to flow more freely. It is important to find activities that will reenergize and rejuvenate your body after a flight.

Although these tips may help with leg edema, you must still consider certain risk factors before proceeding with air travel.  If you are pregnant or just underwent a major surgery, discuss with your doctor if flying is even appropriate. Taking birth control can also contribute to blood clots. Being overweight, having cancer or a blood clotting disorder, heart failure, being over 60 years of age, and sitting for long periods of time are also risk factors to consider. The signs and symptoms of a blood clot, or DVT, in the leg may include swelling, bruising, discoloration, warmth, tenderness, or pain in your leg. A pulmonary embolism can also occur when a blood vessel in your lung becomes obstructed from a blood clot that travels from another part of your body, usually your leg. The signs and symptoms of a pulmonary embolism include sudden shortness of breath, feeling light headed, rapid pulse, coughing up blood, or chest pain that worsens with deep breaths and coughing.

When looking at the big picture, people should focus on prevention measures, such as exercise and making appropriate lifestyle changes to promote good health. Consulting with a doctor before your flight can provide guidance that is tailored to your health, especially if you have preexisting conditions. With busy lives, it is easy to overlook these measures, but it is still important to follow them. Even if you are very healthy, following basic guidelines to prevent swelling and possible complications goes a long way.  




Dr. Reema Dua practices in Rockville, MD (North Bethesda). She enjoys sports medicine and treating athletes. She has been in practice for 9 years. Dr. Reema Dua is a trained specialist in podiatric medicine and surgery.  She received her DPM from the Temple University School of Podiatric Medicine through a 7-year accelerated program, and then completed a 3-year surgical residency at Staten Island University Hospital in New York.  









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