Swelling of the feet and ankles is a result of fluid buildup within the tissues and muscles. In healthy persons, foot swelling occurs occasionally and resolves spontaneously after resting and elevating the feet. When swelling persists or is severe, it can cause complications, including stiffness, painful chronic swelling, scarred tissue, skin ulcerations, difficulty in walking, an increased risk of infection, and a decrease in blood circulation. The medical term for excessive swelling of the foot and lower leg is peripheral edema.
Peripheral edema can happen to anyone at any age, but is more common among adults. Elderly people also experience peripheral edema from wear and tear on their muscles and blood vessels and from medical conditions, such as diabetes. Athletes or people who engage in high-impact activities may also be susceptible to peripheral edema.
There are two types of edema: pitting and non-pitting. Pitting edema causes the skin to become indented if the swollen area is pressed on for five seconds. The dent will then slowly fill back in. Non-pitting edema does not leave a dent in this manner. The swelling is generally painless and can occur in one or both feet. If you have painful edema, contact your primary care physician immediately.
What Causes Feet to Swell?
There are various causes for peripheral edema, including:
- Injury or trauma, such as a sprain or fractured bone
- Being overweight
- Consuming too much salt
- Consuming too much alcohol
- Menstruation and/or PMS
- Sitting or standing in one position for a long period of time
- Medications such as diabetes medicines, high-estrogen birth-control pills, anti-depressants, steroids, and calcium channel blockers
- Underlying medical conditions
- High altitudes
Many women who are pregnant experience rapid weight gain, which applies pressure to the legs, ankles, and feet, causing swelling. Excessive swelling during pregnancy could be a sign of preeclampsia, which could lead to additional problems. Swollen feet can also be a sign of an underlying condition such as heart, kidney, or liver failure. These conditions produce excess fluids in the body. Other conditions that may cause swollen feet include:
- Blood clots
- Arthritis in feet
- Thyroid disease
- Infection in the leg
- Venous insufficiency (when the veins in your legs are unable to pump blood back to the heart adequately)
- Varicose veins
- Insect bite
- Burns, including sunburns
- Leg or foot surgery
- Allergic reaction
- Laxative abuse
- Diuretics abuse
- Drug abuse
- Sodium retention
- Lymphatic obstruction
When to See Your Doctor
Persistent swelling of a foot or both feet may indicate an underlying problem. Seek immediate medical attention from your primary physician if the swelling is accompanied by other symptoms, such as pain, fever, redness, and warmth. You should also seek medical treatment if the swelling has failed to resolve or worsened after you have taken steps to control it. If you are pregnant and concerned about your swollen feet, it is important to tell your obstetrician and/or primary physician.
People who have swollen feet once in a while or who can pinpoint the cause of the swelling (for example, the start of a new job that requires standing all day) may not need to see a physician. If your feet continue to swell after taking precautionary steps to prevent swelling, then you may want to see your primary physician or a podiatrist. People with swollen feet who stand all day for work may find relief by wearing orthotics.
Diagnosing Swollen Feet
To determine the cause of your swollen feet, your doctor will ask you to describe your symptoms and provide a detailed medical history. He or she will be able to tell a lot about your swollen feet just by looking at them. Whether the swelling is in one foot or in both feet and whether it is accompanied by other symptoms (pain, redness, warmth, skin discoloration) can help identify the cause.
If a single cause is not apparent from your clinical presentation, medical history, and a complete physical examination, your physician may recommend testing either to confirm a suspected cause or to help rule out other possible causes. The type of test depends on your presentation but may include a urinalysis, blood testing, biochemistry, clotting screen, radiography, ECG, ultrasound, or biopsy. Depending on the results, you may need to be referred to a specialist for further evaluation.
Swollen Feet Treatment and Prevention
Treatment for swollen feet depends on the cause of the swelling. Generally, your doctor will try to treat the cause first to see if there is a reduction in the swelling. There are things you can do at home to help reduce swelling in your feet, including:
- Elevation; legs need to be placed one foot above heart level for a period of ten to fifteen minutes, three to four times a day
- Limiting mobility
- Anti-inflammatory medication
- Medications such as acetaminophen, aspirin, and ibuprofen
- Leg wedges during sleep hours
- Proper footwear
- Support socks, such as elastic stockings
- Drinking plenty of water
- Reducing salt intake or limit yourself to two grams per day
- Avoid long periods of standing and sitting
- Losing excess weight
- Walking more often to improve muscle strength and circulation
- Do not abuse laxatives or drugs
- Diuretics (may not be effective if certain medical conditions are present)
- Protein replacement
Most of the treatment options listed above can also act as preventive steps to enable you to avoid swollen feet altogether. It’s very important that you pay attention to your feet. Feet do not swell up on their own. If you know that a certain activity is causing your swollen feet, you may want to avoid that activity as much as possible. It’s also important that you inform every doctor you may see of all medications you are taking. Simple changes in your lifestyle and diet can improve your overall health and prevent other foot problems.
Questions to Ask Your Doctor
Here are some questions you may want to ask your doctor if you are experiencing swollen feet:
- What are the best support stockings to prevent or reduce the swelling?
- Should I make a change in my diet?
- What vitamins and minerals help my muscles the most?
- What other symptoms should I watch for?
- (If applicable) Why does the swelling seem worse at night or in the morning?
- (If applicable) Why doesn’t the swelling subside after I elevate my legs?