There are a number of patients who come in with swollen feet as one of their problems. However, an encounter with a family friend who is having serious issues but couldn’t understand  the  cause, prompted a revisit of this condition. Painless swelling of the feet and ankles is a common problem, especially among older people.  Abnormal build up of fluid in the ankles, feet, and legs can cause swelling. This fluid build up and swelling is called oedema.

Painless swelling may affect both legs, and may include the calves or even the thighs. But the effect of gravity, makes the swelling most noticeable in the lower part of the body.

 Causes

Foot, leg, and ankle swelling is common when the person also:

• – Is overweight
• – Has a blood clot in the leg
• – Is older
• – Has a leg infection
• – Has veins in the legs that cannot properly pump blood back to the heart.

Injury or surgery involving the leg, ankle, or foot can also cause swelling. After pelvic surgery, especially for cancer, swelling may occur too. Long airplane flights or car rides, as well as standing for long periods of time, often lead to some swelling in the feet and ankles.

Additionally, swollen legs may be a sign of heart, kidney, or liver failure. In these cases, there is too much fluid in the body.

Certain medicines may also cause your legs to swell, some of which are:

• – Antidepressants
• – Blood pressure medicines called calcium channel blockers
• – Steroids

Infection

Swelling in the feet and ankles can be a sign of infection. People with diabetic neuropathy or other nerve problems of the feet are at greater risk of foot infections. If you have diabetes, it is important to inspect your feet daily for blisters and sores, since nerve damage can blunt the pain sensation, and foot problems can progress quickly.

Foot or ankle injury

An injury to the foot or ankle can lead to swelling. The most common is a sprained ankle, which occurs when an injury or misstep causes the ligaments that hold the ankle in place, to be stretched beyond their normal range.

Lymphedema

This is a collection of lymphatic fluid in the tissues, that can develop because of the absence of, or problems with the lymph vessels, or after removal of lymph nodes. Lymph is a protein-rich fluid that normally travels along an extensive network of vessels and capillaries. It is filtered through the lymph nodes, which trap and destroy unwanted substances such as bacteria. When there is a problem with the vessels or lymph nodes, however, the fluid’s movement can be blocked. Untreated lymph build up, can impair wound healing, and lead to infection and deformity. Lymphedema is common following radiotherapy or removal of the lymph nodes in patients with cancer.

Venous insufficiency

Swelling of the ankles and feet is often an early symptom of venous insufficiency, a condition in which blood inadequately moves up the veins from the legs and feet, back to the heart. Normally, the veins keep blood flowing in the correct direction, with the help of one-way valves. When these valves become damaged or weakened, the blood leaks back through the vessels, and fluid leaks out into the soft tissue of the lower legs, especially the ankles and feet. Chronic venous insufficiency can lead to skin changes, skin ulcers and infection.

Home Care

Some tips that may help reduce swelling:

• – Put your legs on pillows to raise them above your heart while lying down.
• – Exercise your legs. This helps pump fluid from your legs back to your heart.
• – Follow a low-salt diet, which may reduce fluid build-up and swelling.
• – Wear support stockings.
• – When traveling, take breaks often to stand up and move around.
• – Lose weight if you need to.

Never stop taking any medicines you think may be causing swelling, without first talking to your health care provider.

 When to Contact a Medical Professional

Call your provider right away if:

• – You have heart disease or kidney disease and the swelling gets worse.
• – 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 provider if self-care measures do not help, or the swelling gets worse.

Testing

Diagnostic tests that may be done include:

1. Blood tests
2. Chest x-ray or extremity x-ray
3. Doppler ultrasound examination of your leg veins
4. ECG
5. Urine analysis

Your treatment will focus on the cause of the swelling. Your provider may prescribe diuretics to reduce the swelling, but these can have side effects. Home treatment for leg swelling that is not related to a serious medical condition, should be tried before drug therapy.

                                            Your feet mirror your general health . . . cherish them!