Edema and Related Medical Conditions

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Wednesday, November 23, 2005

Foot Edema

Alternative names Return to top

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral, Peripheral edema

Definition Return to top

Abnormal buildup of fluid in the ankles, feet, and legs is called peripheral edema.

Considerations Return to top

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in these locations.

Common Causes Return to top

Foot, leg, and ankle swelling is common with the following situations:

Prolonged standing
Long airplane flights or automobile rides
Menstrual periods (for some women)
Pregnancy -- excessive swelling may be a sign of pre-eclampsia, a serious condition sometimes called toxemia, that includes high blood pressure and swelling
Being overweight
Increased age
Injury or trauma to your ankle or foot

Swollen legs may be a sign of heart failure, kidney failure, or liver failure.

In these conditions, there is too much fluid in the body.

Other conditions that can cause swelling to one or both legs include:

Blood clot Leg infection Venous insufficiency (when the veins in your legs are unable to adequately pump blood back to the heart)
Varicose veins
Burns (including sunburn)
Insect bite or sting
Starvation or malnutrition
Surgery to your leg or foot

Certain medications may also cause your feet to swell:

Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone
A group of blood pressure lowering drugs called calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil)
Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)

Home Care Return to top

Elevate your legs above your heart while lying down.

Exercise your legs. This helps pump fluid from your legs back to your heart.
Wear support stockings (sold at most drug and medical supply stores).
Try to follow a low-salt diet, which may reduce fluid retention and swelling.

Call your health care provider if Return to top

Call 911 if:

You feel short of breath.
You have chest pain, especially if it feels like pressure or tightness.

Call your doctor right away if:

You have decreased urine output.
You have a history of liver disease and now have swelling in your legs or abdomen.
Your swollen foot or leg is red or warm to the touch.
You have a fever.
You are pregnant and have more than just mild swelling or have a sudden increase in swelling.

Also call your doctor if self care measures do not help or swelling worsens.

What to expect at your health care provider's office Return to top

Your doctor will take a medical history and conduct a thorough physical examination, with special attention to your heart, lungs, abdomen, legs, and feet.

Your doctor will ask questions like the following:

What specific body parts swell? Your ankles, feet, legs?
Above the knee or below?
Do you have swelling at all times or is it worse in the morning or the evening?
What makes your swelling better?
What makes your swelling worse? Does the swelling get better when you elevate your legs?
What other symptoms do you have?

Diagnostic tests that may be performed include the following:

Blood tests such as a CBC or blood chemistry
Chest x-ray or extremity x-ray

The specific treatment will be directed at whatever underlying cause is found. Diuretics may be prescribed. These are effective in reducing the swelling but have some side effects.

Home treatment for benign causes of leg swelling should be tried before drug therapy under medical supervision.

Prevention Return to top

Avoid sitting or standing without moving for prolonged periods of time.
When flying, stretch your legs often and get up to walk when possible.
When driving, stop to stretch and walk every hour or so.
Avoid wearing restrictive clothing or garters around your thighs.
Exercise regularly.
Lose weight if you need to.

References Return to top

Cho S. Peripheral edema. Am J Med. 2002; 113(7): 580-586.Schroeder BM. ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Am Fam Physician. 2002; 66(2): 330-331.Update Date: 6/3/2005

Updated by: Thomas A. Owens, M.D., Departments of Internal Medicine and Pediatrics, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare


Foot Edema

Why You Have Foot Swelling

You may hear your doctor refer to leg and foot swelling as edema, the term used to describe an abundance of fluid found between tissue cells. Edema typically causes lower leg, ankle and foot swelling, but can really impact any area of the body.

Many factors contribute to your likeliness to develop foot swelling. Some causes of foot swelling can be quite serious, so please take note of any body or foot swelling and talk to your doctor about it.

The causes of foot swelling, according to The Podiatry Institute, include:

Serious conditions of the kidney, heart, liver or blood vessels can contribute to foot swelling and edema in other parts of the body.
Eating a poor diet high in salt and carbohydrates can cause foot swelling.
Abusing laxatives can contribute to foot swelling. Abusing diuretics may cause you to develop foot swelling.
Abusing drugs can lead to foot swelling.
Taking birth control or hormone replacement therapy pills may cause foot swelling.
Pregnancy and PMS can lead to foot swelling.
Sodium retention may contribute to foot swelling.
Varicose veins and a history of phlebitis (inflammation of a vein’s wall) can lead to foot swelling.
Allergic reactions may cause foot swelling.
Neuromuscular disorders could lead to the development of foot swelling.
Any kind of trauma may contribute to foot swelling.

How to Determine If You Have Foot Swelling or Edema

If you have foot swelling or edema, your may first notice that your foot is swelling up more and more as the day goes on. But after a period of time, the foot swelling will set in first thing in the morning and continue to worsen throughout the day.

Long-term foot swelling or edema causes pitting:
When you press on the swollen area for a few seconds, you will notice an indentation in that area. Continued foot swelling or swelling in other parts of the body can also cause skin ulcerations (sores on the skin).

Over time, other symptoms of foot swelling and edema will develop:

High blood pressure is a symptom of edema/ foot swelling.
Headaches can go along with edema/ foot swelling.
Increased urination is a symptom of edema/ foot swelling.
Palpitations can go along with edema/ foot swelling. Puffy eyes can go along with edema/ foot swelling.
Weight gain is a symptom of edema/ foot swelling.
Swollen hands and/or wrists can go along with edema/ foot swelling.

Tips on How to Relieve Your Foot Swelling and Related Symptoms

The best way to reduce leg and foot swelling is to elevate your legs above the level of the heart, which puts minimal pressure on knees, thighs and lower back. Just sitting in a reclining chair in front of the TV is a great way to elevate your legs to reduce foot swelling. Many products, for use at home or at work, can also help reduce leg and foot swelling.

Other aids to ease leg and foot swelling include:

Leg cushions , including leg and bed wedges and leg elevators, raise the feet while sleeping and/or resting to help ease foot swelling.
Support socks and graduated compression hosiery – which come in various gradients (light, moderate, firm) depending on the pressure you need, and various lengths depending on the level of the edema – can help ease your foot swelling.
Proper fitting shoes and socks can help relieve foot swelling.

Shopping Tip: Remember to buy new shoes in the afternoon to get the best fit, since foot swelling can get worse as the day continues. If you buy new shoes in the morning, and your foot is swelling by the afternoon, your shoes will feel too tight.

The Podiatry Institute recommends the following techniques to help decrease foot swelling and other symptoms of edema:

Increase muscle activity with walking to help reduce foot swelling and other symptoms of edema.
Avoid standing in place for long period of time to ease foot swelling and other symptoms of edema.
Avoid sitting with the feet dependent to relieve foot swelling and other symptoms of edema.
Limit salt intake to help alleviate foot swelling and other symptoms of edema.
Do not abuse diuretics, but a short-term course may be helpful to help reduce foot swelling and other symptoms of edema.
Do not abuse laxatives if you want to reduce foot swelling and other symptoms of edema.
Drink plenty of water to alleviate foot swelling and other symptoms of edema.
Avoid contraceptive pills and hormone replacement therapy – if possible – if you want to help reduce foot swelling and other symptoms of edema.
Use a compression pump to help fluid return to the blood vessels to help ease foot swelling and other symptoms of edema.

If foot swelling or other swelling continues to worsen, please consult your doctor. You may need more specific treatment for your case of edema/ foot swelling.

Information on foot, leg and lower body health conditions like foot swelling provided by The Podiatry Institute, dedicated to advancing the standard of care in podiatric medicine and its effects on muscoskeletal health.



What Causes Foot Edema (Swelling) During Air Travel?

Swelling (edema) of the feet and ankles is common during long flights. It's usually caused by inactivity. As a passenger on a plane, you spend most of your time seated with your feet on the floor. This allows blood to pool in your leg veins. When you walk, the muscles in your legs contract and compress the veins, forcing blood back to your heart.

Also, the position of your legs when seated increases pressure in the veins. This contributes to leg swelling by causing fluid to leave the blood and move into the surrounding soft tissues. Another cause of swelling may be certain medications, such as calcium channel blockers.

You can usually relieve swelling after a flight by elevating your legs and feet and walking.

To help reduce swelling during a flight, you can:

Get up and walk around the plane once an hour
Rotate your ankles while seated

Swelling of the feet isn't a serious problem if it lasts only a short time. But excessive swelling that persists for several hours after you resume activity may be due to a more serious condition, such as a blood clot in the leg (deep vein thrombosis, or DVT) — especially if the swelling occurs in only one leg and is accompanied by pain. These symptoms require prompt medical attention.

On flights lasting six hours or more, consider taking these additional precautions to reduce the risk of DVT:

Avoid wearing tight clothing around your waist
Drink plenty of fluids to avoid dehydration
Stretch your calves once an hour

If you're at increased risk of blood clots, talk to your doctor before flying. He or she may recommend:

Compression stockings
Low-molecular-weight heparin given two to four hours before departure.

Aspirin is not recommended.


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