Sometimes it seems a minor leg injury simply won’t cool out no matter what you do. Odds are the overlying skin has been inflamed, and you must take steps to calm it before continuing the therapy.
When deeper tissues are “angry,” skin can become secondarily inflamed and more sensitive to anything, including topical medications and wraps. Clues that the skin is inflamed include:
• Swelling that won’t recede or worsens despite cold therapy, wraps and rest.
• Swelling that goes beyond the area of injury (e.g. if it’s a tendon, swelling extends over areas outside the tendon and its sheath).
• Heat worsens rather than recedes.
• Phenylbutazone doesn’t help.
Rapid control can be achieved by gently but thoroughly washing the leg (use bare hands, no sponges) with a tamed iodine surgical scrub or pHisoderm (not shampoo). This removes any surface medications or other irritants and treats any superficial infection.
Rinse the area thoroughly and blot it dry with a towel, allowing it to air dry completely. At this point, the leg may already begin to shrink and may show signs of flaking/scurfing.
Apply a thin coat of 1% hydrocortisone cream (an over-the-counter cream from a drug store) to all involved areas, rubbing it in well to get it down to skin level. Wrap the leg with a clean wrap (laundered in a hypoallergenic detergent, like Ivory Snow), using even, gentle pressure. Results are usually evident within eight to 12 hours, although the actual swelling may take a day or two to resolve. The skin flaking/scurfing, of course, takes a little longer but is virtually harmless.