Foot Surgery, Swelling & Systemic Enzymes

Foot Surgery, Swelling & Systemic Enzymes

 by Dr. Emily Splichal, DPM MS

Swelling, which is medically known as “edema”, is normal after surgery, especially when the surgical site is in the foot.  While some level of post-operative edema is expected,  too much swelling can interfere with recovery and increase pain levels. 

What causes post-operative swelling?

The most common cause of swelling after foot surgery is in response to the tissue disruption associated with the operation itself.  Even though the surgery is ultimately intended to help the foot, the body perceives it as an injury and goes through its normal post-injury inflammatory response.  

Immediately after foot surgery, thousands of cells called cytokines are sent to the surgical site as a response to the procedure.  The influx of these cytokines is initially to bring growth factors and nutrients to stimulate a healing response.  However, if not controlled, this initial inflammatory response can cause persistent elevation of cytokines, causing an increase in capillary permeability resulting in what’s called capillary leak.

And, because the foot is located in the lower most extreme part of the body, gravity naturally pulls down more fluid and makes it harder for the body to remove it.  This position of the foot (known as “dependent”), can exacerbate the already tenuous post-operative situation and cause even more fluid to back up in the feet and legs, which can lead to more swelling and, often, more pain.

Systemic Enzymes and Swelling

Systemic enzyme therapy is the therapeutic use of natural enzymes for their desired boost to the body’s natural healing mechanism.  One systemic enzyme in particular, Serrapeptase, specifically has shown promising efficacy in modulating the inflammatory process to reduce swelling and decrease capillary permeability.  In two separate studies on serrapeptase studying post-operative swelling, those taking serrapeptase experienced significantly less swelling than the placebo. [1][2]

When to start systemic enzymes post-operatively?

Since the inflammatory response begins immediately after surgery, it is recommended to begin a systemic enzyme regimen as soon as you are discharged from the hospital.  Like all medications and supplements, always consult with your physician before beginning, and ensure your physician continues to monitor your response to the supplement.


1. Esch PM, Gerngross H, Fabian A. Reduction of Postoperative Swelling. Objective Measurement of Swelling of the Upper Ankle Joint in Treatment with serrapeptase-- A Prospective Study. Fortschritte der Medizin. 1989; 107(4):67-8, 71-2
2. Tachibana M, Mizukoshi O, Harada Y, et al. A Multi-Centre, Double-Blind Study of Serrapeptase Versus Placebo in Post-Antrotomy Buccal Swelling. 1984. Pharmatherapeutica. 3(8):526-530

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