Swollen feet: sign of an illness?

After a long-haul flight or a lengthy road trip, when the legs have been immobile for a long time, a person may notice that their feet and ankles look swollen. UA good sleep with legs propped up on pillows or a warm foot soak helps in reducing the swelling and drives away the tiredness.

Sometimes feet and ankles swell up for no apparent reason and the swelling does not subside, getting worse over a period of time. That’s a cause for worry — chronic swollen feet may be an indication of an underlying medical condition.

What is oedema (swelling)?

Oedema is the medical term used to describe swelling in any part of the body that occurs because of fluid retention. Gravity may cause blood to flow towards the veins in the lower part of the body and the water in the blood gets trapped in the tissues of the legs and feet, causing oedema.

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Swollen feet and ankles (also called peripheral or pedal oedema) due to fluid retention are not unusual in a variety of situations and most often will subside on their own. Typically, they may happen due to:

1. Pregnancy and menstrual cycles
2. Being immobile or standing/sitting for a lengthy period without a break
3. Consumption of foods with high salt content
4. Taking steroids, blood pressure medicines, hormone replacement or anti-depressant medications

“Swelling in the feet is usually painless in medical causes such as renal diseases, liver or heart failure, so if the swelling does not resolve on its own after a few days it should be investigated for an underlying condition and appropriate treatment should be given,” says Dr Raveendra KR, consultant physician and professor of medicine, Bangalore Medical College and Research Institute, Bengaluru. “If the oedema is a result of a foot infection, inflammation of blood vessels, injury or bone fracture, then it will be painful. Swollen legs are also an indication of malnutrition, especially protein deficiency mostly seen in children or elderly people. The most common treatment is to keep the feet elevated; if this does not help, it is better to seek medical attention.”

Other causes for swollen feet

1. Injury or infection in the legs: Injury to the ankle or foot because of impact causing a sprain, ligament tear or fracture in the bone can result in painful swelling in that area. Certain infections can also cause swelling of the feet
2. 2. Allergic reaction/insect sting: Rashes or hives on the feet caused by an allergic reaction to a substance can result in that part becoming swollen. Oedema can also result from an insect bite or sting
3. Venous insufficiency: This is a condition wherein the valves inside the veins of the legs become damaged, causing weakening of the veins. Chronic venous insufficiency affects the flow of blood from the legs to the heart and the lower limbs get filled with blood, making them bulge. Age and medical problems such as varicose veins are risk factors for venous insufficiency
4. Phlebitis: Inflammation of the veins is called phlebitis and it occurs when there is damage to the veins or when blood clots block flow of blood inside the veins. Swelling is accompanied by pain and redness in the feet
5. Kidney failure: When the kidneys are not functioning properly, they are not able to remove the excess fluid and sodium from the body, which build up in the blood vessels. The fluid retention leads to oedema in the feet and ankles
6. Heart disease: Swollen feet could be a symptom of a heart problem. A defective heart is not able to pump blood properly to other parts of the body, especially the lower limbs. So, the veins in the legs get filled with fluid, which get trapped in the tissues and they become swollen
7. Liver problems: A damaged liver is not able to produce certain proteins like albumin in the blood, causing a deficiency. This, in turn, leads to fluid retention in the tissues of the body, especially in the face, legs, hands and feet

In the study ‘Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends’, published in the journal Annals of Family Medicine, researchers Liu F, Allan GM, Korownyk C, Kolber M, Flook N, Sternberg H, and Garrison S examined data from 2004 to 2016 and found that internet searches for ankle swelling and related terms peaked the most during the summer season.

However, heart failure admissions were seen to be prevalent in the winter months. “[An] analysis of body composition in dialysis patients shows extracellular water content to be seasonal, increasing in spring and summer,” the study said.

When to consult a doctor

• The swelling is accompanied by discolouration of the skin
• The leg is so puffy that pressing with a finger leaves a depression over the affected part
• Only one foot is swollen
• The swollen foot feels warm and painful, and there is redness in the affected area
• The swelling comes suddenly and does not subside for days or weeks

Treatment for swollen feet

1. Swelling that is temporary will go away with resting, propping up the legs with pillows and raising the feet above the heart
2. Walking and moving the legs will allow the fluid stuck in the tissues to flow
3. Immersion in water may help reduce swelling in the legs, feet and ankles
4. Reduce salt content in food and eat a well-balanced diet that includes protein
5. Some studies show that massage by a trained therapist, wearing bandage or support stockings, and reflexology can treat swollen feet effectively
6. For injury, infection or organ failure, investigations must be done and supportive treatment given without delay