Swelling in Feet

Swelling in the feet means the accumulation of fluid in the feet. Swelling of the foot, ankle, and leg can be severe enough to leave an indentation (pitting edema) when you press with a finger on the affected area.

Swelling in the feet is very common and requires no treatment if you have been standing for a long time or if you have been walking extensively. However, if the swelling persists for a long time along with other symptoms such as breathlessness, pain or ulcers, it could be a sign of a serious health problem.

If one or both of your feet are swollen, it could cause discomfort, pain, and difficulty in carrying out day-to-day activities. If you are pregnant, then the feet can swell naturally because a pregnant woman’s body holds more water than normal. Sometimes if you stand for a long time, pain can become worse at the end of the day. Although it is not a serious issue for the mother or baby, it can be uncomfortable for the mother.

The mechanism of swelling in the feet can be related to an increase in the capillary filtration, which will push the fluid out of blood capillaries; a reduction in lymph drainage, which will block the lymphatic flow in your body; or a combination of the two. Since there are many diseases that can cause swelling in the feet, an appropriate diagnosis by your doctor, which includes detailed history and investigations for different causes, is needed. If there is no underlying disease causing the swelling, treatment is generally not required, but people in whom there is an underlying cause or swelling of the feet is due to certain medications, a suitable treatment is required. So it important to consult a doctor if you think the swelling is due to any medicine or is pathological.

The swelling could be painless involving the feet or the ankle region, which may increase with time, and there may be a change in colour and texture of the skin. Other symptoms may include an increased temperature of skin associated with a warm sensation upon touch and ulceration with pus discharge. Depending upon what caused the swelling, the following symptoms may be experienced:

• The skin when pressed down with a finger will form a pit or depression and on removing finger the area will fill up back to the swollen state.

• Small pits (depressed areas) found after removing shoes and socks are an important sign of swelling.

• Pits appear darker and their surrounding skin is paler than normal skin.

Causes

Swelling in the feet could be caused if you:

• are overweight, this can exert pressure on the legs causing swelling of feet.
• have a blood clot in the leg.
• are older in age.
• have a leg infection.
• have veins that are unable to send blood efficiently back to your heart causing pooling of blood and hence swelling.
• have had a surgery or if you have an injury involving the leg, ankle or foot. It mostly occurs in abdominal surgeries related to cancer.
• have a daily routine that requires you to stand or sit for prolonged periods.
• are a woman. You may have swelling in the different phases of the menstrual cycle or because of any estrogen-containing pills that you take.
• are pregnant. Slight swelling in the feet is common during pregnancy, but if it is increasing or painful, it may be a sign of preeclampsia, a condition that includes high blood pressure and swelling. It can lead to convulsions if not treated in time. This can be dangerous to the mother as well as the baby.
• have an underlying disease. Heart, kidney, or liver failure due to excessive fluid in the body could cause swelling in the feet. (Read more - Heart failure causes)

If you are taking medications. Some medicines may also be responsible for swelling:

• Medication for treating depression.
• Certain blood pressure-lowering medicines. (Read more - High blood pressure causes and treatment)
• Pills containing hormones, such as estrogen and testosterone. 
• Steroids.

You should consult your doctor immediately if you are doubtful that your swelling is not physiological and it may be due to the above-mentioned causes or is associated with other symptoms.

Risk factors

Risk factors for swelling in the feet are related to the underlying disease causing it.

People who are at an increased risk include those who have:

• Heart problems: heart failure or failure of the heart to pump blood properly due to an underlying pathology could cause swelling in the feet.
• Thyroid problems: the thyroid gland releases the thyroxine hormone for many vital functions. People with hypothyroidism, a condition in which the thyroid gland release insufficient thyroid hormone, could have swelling in feet. 
• Lymphedema (Lymphatic system blockage) and Venous insufficiency (when veins are not able to carry blood back to the heart).
• Obesity: this is a common cause of pedal edema.

The less common risk factors are:

• Anemia: Deficiency of iron in the blood or a low haemoglobin value.
• Disorder related to your stomach and intestine. (Read more - Stomach pain treatment)
• Liver disease.
• Medications, such as diuretics, if used for a long term.
• Obstruction of veins because of any surgery.

Here is how you can reduce the risk of developing swelling in feet:

• Always do a warm up before doing any physical activity. It is particularly important to help prevent injury.
• Always wear proper fitting shoes. Repeated stress on your feet can cause damage with time. The right shoes can help protect your feet.
• Do not stand for a long time. Prolonged and frequent standing causes blood to pool in the legs and feet.
• Sit with your feet raised above the ground level or try to take them above the heart level. Even slight elevation will reduce everyday swelling. Raising your feet will increase blood circulation.
• Keep your feet as cool as possible, especially in summers by wearing socks and keeping them in cold water for some time. You can spend time in the pool. It can keep your body cool and improve circulation.
• The best solution to avoid swelling is following a regular exercise routine as approved by your doctor.
• Try to sleep on your left side for optimum blood flow and reduced lymphatic congestion.

Your doctor will take a medical history and perform a complete physical examination, particularly related to your heart, lungs, abdomen, lymph nodes, legs, and feet.

Your doctor may ask the following questions:

• Where do you have the swelling? Is it in your ankles, feet, or legs?
• Does the swelling change as the day progresses?
• What do you do to relieve swelling?
• When did you feel it has become worse?
• Does raising legs help to relieve your swelling?
• Do you have a history of any disease?
• Do you have any other symptoms?

Your doctor can advise you the following tests which include blood and urine tests, and imaging to find out the exact cause of swelling in your feet:

Blood tests

• Complete Blood Cell Count which includes haemoglobin estimation, platelet count, white blood cell count, and haematocrit.
• Liver and Renal Function Tests to diagnose chronic kidney disease, liver disease, and malnutrition.
• Serum Lipid Profile: Nephrotic syndrome is associated with hyperlipidaemia. It is also related to heart diseases.

Urine test

Urine Analysis is done to check for any pus cells or infection.

Imaging Studies

• Chest X-ray and ECG: these tests can be done if a heart disease is suspected.
• Doppler study: for diagnosing deep vein thrombosis and chronic venous insufficiency
• Lymphoscintigraphy: lymphedema can be identified using a radio-nucleotide tracer, which is injected into the first web space, and the flow of the lymph is monitored using a gamma camera. This gives an indirect evidence of lymphatic obstruction.
• Echocardiography: it is used for the assessment of the left ventricular function of the heart in patients with congestive heart failure. It can also measure the pulmonary artery pressure and helps in diagnosing lung diseases.

Treatment

Mild swelling (edema) usually improves on its own, especially if you manage it by raising the affected foot higher than your heart level. Swelling in the feet that is not due to a health problem can be treated by simple lifestyle changes with the guidance of your doctor, but swelling due to an underlying health problem needs detailed history, relevant investigation, and drugs along with other lifestyle modifications.

• Swelling due to standing for a long duration can be treated by taking rest and elevating the feet. Put your legs on pillows to raise them above your heart level while lying down.
• If the swelling is due to hot weather, then you can simply avoid the warm atmosphere and try to keep your feet cool, for example, by soaking your feet in cool water for 15-20 minutes.
• If your swelling is a cause of fluid retention or any heart disease, your doctor will advise you to restrict salt intake (low salt diet) and excessive fluids.
• Your swollen feet may be because of your excess weight. In this case, your doctor will advise to follow a proper diet and to exercise, which will help in weight loss.
• Compression stockings are rarely beneficial, and patients with severe swelling do not generally tolerate them well.
• If swelling in the feet is due to pregnancy, no treatment is required, but extensive swelling should not be ignored, as it may be a sign of eclampsia (convulsions).
• Apply ice on the swollen area as soon as you can for 15 to 20 minutes. Then, repeat every three to four hours. This will give temporary relief.
• If the swelling is severe, drug treatment may be needed. Your doctor can give you drugs, such as diuretics, to remove excess water from the body for reducing swelling, which was caused due to a heart disease, such as congestive heart failure.
• The doctor may advise cast, surgery, and rest in case of severe injury.
• In case of swelling with pain, your doctor may advise you painkillers such as paracetamol and ibuprofen, and rest.
• Drinking plenty of water can also be helpful.
• Your doctor may advise medications for anemia and the underlying heart diseases such as high blood pressure, high cholesterol, along with suggesting a low-protein diet, calcium and vitamin D supplements and healthy lifestyle changes.
• If the swelling is due to medications, your doctor may reduce the dose or withhold the medication.

Lifestyle management

Some changes are required in day-to-day life such as:

• Exercise
  Exercise helps increase blood circulation and improves lymphatic flow. So start doing at least one exercise a day with proper guidance from your doctor or a fitness expert. You can adopt any routine exercise such as walking or jogging.

• Elevation
  Elevation of the feet decreases venous filtration by lowering venous pressure that will increase blood circulation.

• Graded External Compression
  Graded external compression opposes capillary filtration, keeping fluid in the venous system.

• Lymphatic Massage
  Lymphatic massage will stimulate lymph drainage to flow proximally, improving its circulation.

Prognosis

The outcome depends upon the underlying cause. Proper medication and care are needed along with regular follow-up. Following points should be noted:

• A sudden increase in swelling.
• Swelling accompanied by pain in the chest.
• Shortness of breath with exertion or while lying down.
• Fainting or dizziness.
• Cough stained with blood.
• Cold, pale skin in only one leg.

Complications

If ignored or timely medical advice is not taken, it can lead to

• Increased swelling with time.
• Feeling of warmth or redness of the swollen skin.
• Sudden pain that was not there before.
• Chest pain.
• Giddiness.
• Confusion or disorientation.