Why do I get 'cankles' every time I fly?

Holiday prep comes with its fair share of stress - last minute packing, booking in for your shots, getting insurance... all in the hope that your much-needed two weeks’ away go as smoothly as possible and that you’re able to switch into relaxed mode as soon as you get there. However, this can be significantly delayed if your legs are heavy and swollen for the first few days as a result of a long-haul flight.

Sitting for long periods on a flight can cause blood to pool in your legs and ankles, resulting in fluids moving from the blood into the surrounding tissues and causing you to puff up (cankles, swollen toes...we’ve all been there). While for some, the discomfort and swelling may pass after just a few days, for others, it might be something more dangerous such as deep vein thrombosis (DVT), i.e. a clot in the legs’ veins.

As consultant venous surgeon Professor Mark Whiteley tells us, the underlying reasons for both are similar and making precautionary steps part of your holiday prep and the journey itself will help. The more you’re able to boost blood flow, the lower the risk you’ll balloon up at your end destination.

From pre-trip planning to circulation-boosting skincare, here’s how to plane-proof your legs.

What you can do before a flight

1. Check your flight duration

The greater the air-time, the greater the health risks. “Research seems to point to flights of two hours or less having very little risk, flights of two to four hours having a questionable risk, and flights over four hours carrying significant risk,” says Professor Whiteley. “If your flight is going to be more than four hours in length, then you should think carefully about anything you can do to reduce risks of getting a problem in your legs.”

2. Buy some flight socks

Compression socks are a hand luggage essential for helping keep DVT and swelling at bay and work by applying pressure to the lower legs to boost blood circulation and reduce the risk of clotting. “A very useful secondary mechanism is that by pressing on the skin and subcutaneous tissue, they reduce the amount of swelling in the lower leg by reducing the amount of fluid leaving the venous blood during a flight,” says Professor Whiteley.

Over-the-counter options are available and come in a variety of different sizes and lengths. Advice regarding sizing and proper fitting is well worth seeking from a pharmacist or another health professional though as the better the fit, the greater the protection they’ll provide. Professor Whiteley recommends checking out daylong.co.uk for stockings and helpful advice too.

Strength-wise, the NHS recommends class 1 stockings that exert a pressure of 14 to 17 mmHg at the ankle as being generally sufficient for a flight lasting four hours or more. Scholl Flight Socks , £15.99, are a good option in this regard.

2. Up your step count

If you’ve got a long flight on the horizon, get as much walking into your week in the lead up to it to reduce your risk of DVT and swelling - especially if you’re stuck behind a desk for the majority of the day. “There is increasing evidence from research departments that people in sedentary jobs start accumulating clumps of blood cells on the valves in their leg veins,” explains Professor Whiteley.

“The more walking someone does, the more these little clumps disappear. What isn't known at the moment, is what relevance these little clumps of blood cells have - if they may start the destruction of the valves and be a cause of varicose veins, or the beginning of a clot in the veins. However, what is certain is that walking causes the blood to be pumped up the superficial and deep veins and reduces the number of these clumps. Therefore, it cannot be a bad thing to increase walking particularly before a long flight.” A quick stroll around the airport before your flight will also stand you in good stead too.

4. Book an aisle seat

This will ensure you’re in a better position to get some movement in during your flight. “Recent research has suggested that people who are stuck in a window seat are more likely to get DVT than those in an aisle seat,” cautions Professor Whiteley. “This is probably due to people in window seats being less likely to get up and walk, as they do not want to disturb others.” Window seats also tend to have less legroom, which makes stretching your legs at regular intervals particularly tricky to do too.

What you can do during a flight

1. Stay hydrated

This is an essential step before, during and after a flight for reducing your risk of DVT and swelling as you’re more likely to develop a clot if you’re dehydrated. But opt for straight water rather than alcoholic and caffeinated drinks as these can cause you to become more dehydrated by increasing the frequency you need the loo.

Drinking more water will also help mobilise fluids around your body, reducing retention and therefore preventing swelling.

2. Keep moving

For many of us, a flight is a great excuse to pop your headphones on and catch up on books, films and sleep. As a result, it’s all too easy to stay still for the duration which can significantly increase your risk of post-flight complications. “Periodically moving the legs, particularly walking up and down the aisle, causes the blood to be pumped up the veins, reducing the risk of DVT and superficial venous thrombosis considerably,” says Professor Whiteley. “In addition to walking, you can also do exercises either by your seat or in spaces such as by the toilets. Many airlines give advice on this but simple exercises that are useful mimic walking - such as standing on tiptoe or squatting down and standing up.”

3. Apply a circulation-boosting leg cream

After taking your seat, slip off your shoes and apply an invigorating body lotion such as Elemis’ Instant Refreshing Gel , £32.40, to give your compression socks a helping hand. “The active menthol provides a cooling sensation to help boost circulation,” Noella Gabriel, co-founder of Elemis tells us. Well worth taking the time to dispense into a 100ml bottle if you ask us.

We’re also big fans of Legology Air-Lite Daily Lift for Legs , £48, a lemon-scented wake-up-call for tired limbs that’s great for tackling plane-related puffiness and tightness.

What you can do after a flight

1. Go for a walk (even if you’re tired)

We know, we know, after a long-haul flight the dream is to crash onto the nearest sun lounger/bed. However, a little light movement can help stop potential swelling in its tracks. “Do some gentle exercise, such as going for a swim or a walk and then follow with a shower using a product like Sharp Shower Body Wash , £21.60, as the wild mint and peppermint are really energising and uplifting,” advises Noella.

This is also advisable when it comes to reducing your risk of DVT too. “Clots in veins develop in a progressive manner rather than just suddenly ‘appearing’ so even if you are starting to develop a small clot in the vein, it may disappear naturally or be very limited if you go for a walk after the flight,” says Professor Whiteley. “Conversely, if you are developing a clot in the veins, going straight to bed, particularly if dehydrated and in a hot environment, increases the risk of the clot getting bigger.”

2. Keep drinking…

...water that is. “Just as with the advice for going for a walk, it is just as important to keep hydrated in the first few hours after a flight,” says Professor Whiteley. “When you’re tired, likely to be less mobile, in a hotter country and may have already started developing a small subclinical clot in the veins, keeping hydrated reduces the risks of a clot forming or increasing in size if it has already developed.”

3. And if the swelling persists...

...seek professional help, particularly if your legs become increasingly swollen and tender. “The only real way of telling what is going on in the leg is a venous duplex ultrasound scan performed by an experienced professional who scans veins all of the time,” says Professor Whiteley. “If you seek medical advice and are not offered a venous duplex ultrasound scan, you have to be very certain that you are confident in the advice given.”

The earlier clots are spotted, the less damage will be caused. “A clot that is not treated quickly and that becomes established is much more likely to lead to scarring of the vein and a long-term problem called post thrombotic syndrome,” warns Professor Whiteley. “This can lead to long-term health problems in the leg, leg ulcers and the increased risk of deep vein thrombosis in the future. Therefore a venous duplex ultrasound scan performed early in people who are worried about the possibility of a blood clot can be well worth the effort.”

Follow Ayesha on Twitter and Instagram .