Foot, leg, and ankle swelling Information | Mount Sinai
Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema
Painless swelling of the feet and ankles is a common problem, especially among older people.
Abnormal buildup of fluid in the ankles, feet, and legs can cause swelling. This fluid buildup and swelling is called edema.
The abnormal buildup of fluid in the body is called edema. Edema is commonly seen in the feet and ankles, because of the effect of gravity, swelling is particularly noticeable in these locations. Common causes of edema are prolonged standing, prolonged sitting, pregnancy, being overweight, and increase in age.
Painless swelling of the feet and ankles is a common problem, particularly in older people. Most of the time swelling can be relieved by elevating the legs above the heart while lying down and avoiding sitting or standing without moving for prolonged periods of time. Although swelling of the feet and ankles can be a minor problem, it can also be an indication of more serious illnesses such as heart failure, renal failure, or liver failure.
Painless swelling may affect both legs and may include the calves or even the thighs. The effect of gravity makes the swelling most noticeable in the lower part of the body.
Foot, leg, and ankle swelling is common when the person also:
Has a blood clot in the leg
Has a leg infection
Has veins in the legs that cannot properly pump blood back to the heart (called venous insufficiency, most often due to varicose veins)
Injury or surgery involving the leg, ankle, or foot can also cause swelling. Swelling may also occur after pelvic surgery, especially for cancer.
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.
Swelling may occur in women who take estrogen, or during parts of the menstrual cycle. Most women have some swelling during pregnancy. More severe swelling during pregnancy may be a sign of preeclampsia, a serious condition that includes high blood pressure and significant swelling.
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, and it collects in the legs.
Certain medicines may also cause your legs to swell. Some of these are:
Antidepressants, including MAO inhibitors and tricyclics
Blood pressure medicines called calcium channel blockers
Hormones, such as estrogen (in birth control pills or hormone replacement therapy) and testosterone
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 buildup and swelling.
Wear support stockings (sold at most drugstores and medical supply stores).
When traveling, take breaks often to stand up and move around.
Avoid wearing tight clothing or garters around your thighs.
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 911 or the local emergency number if:
You feel short of breath.
You have chest pain, especially if it feels like pressure or tightness.
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 swelling gets worse.
What to Expect at Your Office Visit
Your provider will take a medical history and do a thorough physical examination, paying special attention to your heart, lungs, abdomen, lymph nodes, legs, and feet.
Your provider will ask questions such as:
What 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 evening?
What makes your swelling better?
What makes your swelling worse?
Does the swelling get better when you raise your legs?
Have you had blood clots in your legs or lungs?
Have you had varicose veins?
What other symptoms do you have?
Diagnostic tests that may be done include:
Blood tests, such as a complete blood count (CBC) or blood chemistry
Chest x-ray or extremity x-ray
Doppler ultrasound examination of your leg veins
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.
Magee DJ, Manske RC. Lower leg, ankle, and foot. Magee DJ, Manske RC, eds. Orthopedic Physical Assessment. 7th ed. St Louis MO: Elsevier; 2021:chap 13.
Quick CRG, Biers SM, Arulampalam THA. Pathophysiology, clinical features and disgnosis of vascular disease affecting the limbs. In: Quick CRG, Biers SM, Arulampalam THA, eds. Essential Surgery: Problems, Diagnosis and Management. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 40.
Seller RH, Symons AB. Swelling of the legs. In: Seller RH, Symons AB, eds. Differential Diagnosis of Common Complaints. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 31.
Last reviewed on: 4/24/2021
Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The veins in your legs carry blood back to your heart. They have one-way valves that keep blood from flowing backward. If you have chronic venous insufficiency (CVI), the valves don’t work like they should and some of the blood may go back down into your legs. That causes blood to pool or collect in the veins.
Over time, CVI can cause pain, swelling, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.
A blood clot in a deep vein in your leg (called deep vein thrombosis) can damage a valve. If you don’t exercise, that can cause CVI, too. So can sitting or standing for long stretches of time. That raises pressure in your veins and may weaken the valves.
Women are more likely than men to get CVI. Your chances also might be higher if you are:
Over age 50
Pregnant or have been pregnant more than once
From a family with a history of CVI
Someone with history of blood clots
You may notice these in your legs:
Swelling or heaviness, especially in the lower leg and ankle
Varicose veins (twisted, enlarged veins close to the surface of the skin)
Skin that looks like leather
Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn your skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more likely to get infected, which can cause more problems.
If you have any of the symptoms of CVI, talk to your doctor. The sooner you treat it, the less likely you’ll get ulcers.
Your doctor will take your medical history. They then will check the blood flow in your legs with a test called a vascular or duplex ultrasound. Your doctor will place a small device on your skin over the vein. Using sound waves, they can see the blood vessel and check how quickly and in what direction the blood flows.
Sometimes, you may need X-rays or specific scans to check for other causes of your leg swelling.
The main goal is to stop swelling and prevent leg ulcers. Your doctor may suggest a combination of treatments based on your age, symptoms, and other things. Some options to help manage CVI include:
You can help blood flow better in your leg veins. Steps include:
Compression stockings. These elastic socks put pressure on your legs to help blood move. They come in different tightnesses, lengths, and styles. Your doctor can suggest which might work best for you.
Movement. Try not to sit or stand for a long time. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.
Exercise. Working out helps pump your blood, too. Walking is a good, simple way to make your legs stronger and boost blood flow.
Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they’ll give you medicine to help prevent blood clots.
If your CVI is further along, you may need a nonsurgical treatment.
Sclerotherapy. Your doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.
Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.
Fewer than 1 in 10 people need surgery for CVI.
Here are your options:
Ligation. The vein is cut and tied off so blood can’t flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.
Microincision/ambulatory phlebectomy. This technique uses much smaller incisions, punctures and small hooks to remove damaged veins.
Vein repair. Your doctor fixes the vein or the valves. This can be done through an open cut on your leg or through a smaller opening by using a long, hollow catheter or tube.
Vein transplant. Your doctor replaces the problem vein with a healthy one from somewhere else in your body.
Vein bypass. This is done on veins in the upper thigh and only in the most severe cases. Your doctor takes part of a healthy vein from another part of your body. They’ll use that to reroute blood around the affected vein. You’ll usually stay in the hospital for 2-5 days.
First of all, it is necessary to closely observe the behavior of the legs , because the legs swell in different ways, and it is not always possible to immediately determine the cause. Observations will help the doctor to make the correct diagnosis and give the best recommendations for solving the problem. But everyone can help himself, besides immediately. Explains Dr. Santa Liepa, family doctor, homeopath.
Swelling of the legs is no joke, it can also indicate dangerous diseases. You should definitely consult a doctor. This should be done urgently if the swelling is associated with other complaints, such as high blood pressure, or swelling is on one side of the body.
It is necessary to carefully observe when and how the legs swell
The calves of the legs usually swell. It is necessary to observe whether the entire leg is swollen up to the knee, or only the ankle area, or perhaps the area under the ankles.
It is necessary to understand if there is swelling in the morning, or only in the evening and / or after prolonged standing, sitting, heavy physical exertion.
It is necessary to observe whether swelling interferes in hot weather or the legs swell even in cool weather.
If there is swelling of the legs in the morning, you should pay attention to what you ate in the evening, whether you drank a lot of tea before going to bed.
It is important to see if both legs are swollen. And is there swelling of other parts of the body: perhaps the hands, one arm, chest and armpit area, face, area under the eyes, etc. swell.
It is necessary to find out if the mother, father, grandmother and other blood relatives had edema.
It should be remembered whether there was at least a slight swelling before, or complaints appeared only now.
Causes of swelling of the legs
First, the doctor, after evaluating the condition of the legs, complaints and first examinations, will exclude:
heart and kidney failure, which most often appears after 40 years of age;
venous or arterial thrombosis;
oncological and other inflammatory processes;
disorders of the thyroid gland, other autoimmune processes.
If the doctor does not find any of the above, it is one of the most common causes of swollen legs: impaired venous and/or lymphatic drainage. Most often this problem occurs in women.
In this case, you need to contact a phlebologist and do a vein examination - Dopplerography, which shows how the superficial and deep veins cope when blood needs to be carried from the legs back to the heart. It is not so easy to establish whether the real cause of edema is a violation of the outflow of lymph.
Closure of superficial veins, which can be performed by various methods (if surgery is proposed), ensures that the damaged vein is not visible, but does not completely eliminate circulatory problems.
Disturbances in venous and lymphatic drainage cannot be completely cured, but if they occur, there is much one can do to delay the unpleasant consequences that can occur if the problem is ignored.
WHAT CAN YOU DO?
Any action that makes the body move is useful, facilitating the flow of blood and lymph, preventing fluid from accumulating in the interstitial space.
1. Drink your fluid intake in the first half of the day.
Everyone does not need to drink 2-3 liters of fluid per day, everyone has their own norm. However, you should drink enough fluids, and this should be done in the morning and afternoon. If the body has a tendency to retain fluids, drinking a cup of tea before bed can lead to swelling.
2. Stretch your legs every 45 minutes!
Fluid retention is promoted by prolonged sitting or standing, so at least once an hour you need to move, walk and stretch your legs. Sometimes it seems that there is nowhere to move in the office, but under the table you can do exercises that promote venous and lymphatic outflow.
It is best to take off your shoes and make circular movements with your feet in both directions, up, down, move your fingers.
A very good exercise in the sitting position - quickly and alternately tap the floor with your heels, the small blood and lymphatic vessels will begin to vibrate, and the blood circulation in the legs will improve.
An exercise that should be done as often as possible helps a lot: lie on your back, lift both legs and arms up to the ceiling and shake them for at least three minutes. From the outside, it looks like the beetle has rolled over onto its back and is waving its paws at the sky.
4. Massage your feet with cool water.
Heat increases the swelling of the legs, so in hot weather it is advisable to massage the legs in the direction from the ankles upwards with a stream of cool water, walk in cool water.
5. Compression stockings must be worn.
It is advisable to wear them every day, and besides, they can be purchased at medical centers, where experts will help you choose the right size and pressure. Compression stockings must be worn during flights and long trips.
6. Swim as much as possible.
Water itself provides a good massage for the vessels, while swimming promotes blood circulation.
Physical treatments should be done - Lymphatic drainage massage in a vacuum capsule and Lymphatic drainage boots. Both treatments promote fluid circulation. Since these procedures are performed on the machine, nothing can go wrong. However, if lymphatic drainage is done by hand, it can only be entrusted to a good doctor or physiotherapist. It is advisable to do the procedures twice a week - once for each leg, and complete a course of at least 10 procedures.
In the form of courses, you can take medicines prescribed by a doctor that strengthen the walls of the veins.
OTHER METHODS THAT CAN HELP
FOLLOW THE RECOMMENDATIONS OF AYURVEDIC MEDICINE . In the morning after waking up, it is useful to drink a glass of warm boiled water in a sip. It helps cleanse the body of accumulated mucus and fluids. During the day, drink between meals, not with or immediately after meals. If you are thirsty while eating, it is better to drink in small sips. If there are outflow disturbances, food products containing elements of earth and water (mucus) (Ayurvedic terms) are not suitable. These are dairy products, yeast dough, etc. The wisdom of Ayurveda helps best when a specialist recommends them individually.
TEA promotes lymphatic circulation. Hibiscus, tea from currant leaves and licorice are useful (they can be drunk if there is no suspicion of cancer). Tea should be drunk in the morning on an empty stomach. After 35-40 minutes, you should drink activated charcoal, which helps to remove toxic substances. You can drink this course for about a week. Hazel bark and leaf tea also help.
TAKE HERBAL PREPARATIONS to improve venous circulation. Useful food supplements, which include gingko biloba and plant extract of centella asiatica, are useful preparations made from chestnuts. Outwardly, alcohol tincture of chestnut helps: chestnuts must be cut, insisted in alcohol and then rubbed with this tincture.
A valuable opportunity for people who do not want to use artificially synthesized medicines, but decide to put their body in order according to the laws of nature, are HOMEOPATIC REMEDIES, which are individually selected by a homeopathic doctor.
Risks, if you do not pay attention to swelling of the legs
Since most often the outflow of venous blood and lymph is determined by heredity, it is necessary to try to do everything that reduces swelling of the legs in order to delay the moment when serious stagnation of lymph and venous blood begins.
They contribute to the development of dermatitis - the skin is dry, reddened, flaky and itchy. Later there is a risk of formation of poorly healing trophic ulcers. If there are serious violations of the outflow of lymph, elephantiasis can develop when the legs become like logs.
Hormonal changes lead to the formation of edema in women who do not have venous insufficiency. Recommended:
to wear compression stockings;
do not drink much liquid in the evening;
exercise your legs, avoid prolonged sitting and standing.
Swelling may be a sign of pre-eclampsia, in which case you should immediately consult a doctor.
Important! Swelling of the legs is a symptom that affects the whole body, therefore, with understanding and patience, everything possible should be done so that it does not prevent us from enjoying life.
treatment at Osteomed Osteopathy Clinic, St. Petersburg
OSTEOPATHY AND PAIN, Swelling and WEAKNESS IN THE LEGS
Almost any problems in the legs can be treated conservatively - that is, without surgical intervention. Often, the root cause of all negative changes is a violation of metabolic processes and blood circulation in the body: by adjusting them, you can help the body begin work on tissue repair. This is what the efforts of the osteopath are primarily aimed at.
From time to time, even in healthy people, the feet swell. For example, during a long flight. Some women have swollen feet during menstruation due to fluid retention. Too much exposure to the sun can cause leg swelling, your feet may swell due to an allergic reaction to something. Varicose veins, trauma, foot or ankle sprains can also cause swollen feet. These are the obvious causes of swollen legs, and there are some painful conditions that cause permanent swelling of the legs, ankles, or feet.
The most common chronic swelling of the legs is caused by heart failure or is a consequence of phlebitis of the lower extremities. These two states are easy to distinguish. Phlebitis usually affects only one leg; in congestive heart failure, both legs are affected. Phlebitis brings pain, and cardiac edema is painless. Edema has its own characteristics depending on the causes. Consider heart failure.
The left ventricle (left side of the heart) pumps blood through the arteries for the entire body. Flowing to the tissues, this blood gives up its oxygen and collects carbon dioxide (CO 2 ) and other mining products. The oxygen-free blood travels through the veins to the right side of the heart. The right ventricle pumps blood to the lungs, where it is refilled with oxygen. The blood returns to the left ventricle of the heart and the cycle repeats.
If the heart muscle is weakened by a heart attack or long-term high blood pressure that has not been treated, a virus or heart valve disease, then it is not able to pump all the blood that has returned from the veins into the lungs. After some time, blood begins to accumulate in the veins. The liver, which is located below the heart, as a result of this overflows with blood and becomes very enlarged. Gradually, the veins (and on the legs too) expand. Further, the liquid component of the blood will seep into the tissue, causing swelling.
With weakness of the left side of the heart, fresh blood is retained in the lungs. Because of this “pulmonary congestion”, breathing becomes difficult and a cough appears. Usually, the right and left halves of the heart weaken together, so a patient with heart failure has both swelling in the legs and difficulty breathing.
Other causes of swelling of the lower extremities
Phlebitis , a condition in which one (or more) veins on the surface or deep inside the leg becomes clogged or inflamed. With inflammation, the leg turns red, swells and hurts. Blockage of the vein prevents the blood from flowing freely through the vein, the blood stagnates and gradually seeps into the surrounding tissue. The walls of the vein become more permeable as a result of inflammation. Phlebitis affects one leg, while in heart failure both legs swell.
In people with severe kidney disease, edema appears on all parts of the body - on the legs, on the face, on the hands (it is difficult for them to put on or remove rings from their fingers). This general edema is caused by the loss of protein (albumin) in the urine. Albumin is produced by the liver and circulates in the blood. A healthy kidney prevents its release into the urine. But diseased kidneys pass albumin into the urine. If your urine test shows the content of albumin, the conclusion follows - your kidneys are sick. But albumin is also found in tissues, not just in the blood. Healthy kidneys maintain balance. In kidney disease, a large amount of albumin is lost, the body tries to restore balance. Therefore, fluid from the bloodstream seeps into the tissues, increasing the content of albumin there. Excess fluid in the tissues causes general edema.
Diseases of the liver , especially in advanced stages, cause swelling of the legs for two reasons. The first is when damaged liver cells are unable to produce albumin in sufficient quantities. The result is the same as with damaged kidneys, which pass it into the urine. The body tries to equalize the amount of albumin in the blood and in the tissues that receive fluid from the bloodstream, resulting in edema. The second reason is that scar tissue in the liver prevents blood flow from the legs to the heart. Blood stagnates in the veins on the legs, swelling appears. Tumors may form in the abdominal cavity or glands may enlarge, which will compress the veins, causing swelling in the legs.
Starvation - the cause of leg swelling. Have you seen pictures of starving children? They have bloated bellies. Why is this happening? The abdomen swells due to a lack of protein in the diet. Fluid will flow out of the blood vessels into the tissues. In this situation - in the abdominal cavity (as occurs with diseases of the liver and kidneys). A sharp decrease in thyroid function will lead to the spread of edema throughout the body, including the legs. Edema will appear due to the transfer of fluid from the vessels to the tissues (as with a protein imbalance of hepatic or renal origin), when the body tries to balance the concentration of albumin.
In recent years, 90,003 90,006 heart surgeries are increasingly being performed. One of these operations is coronary bypass surgery. In such an operation, the veins of the legs (strips of veins from one or both) are used as new vessels through which blood bypasses the clogged vessels of the heart. Sometimes a vein in the leg is removed for a considerable length. Therefore, such operations led to the emergence of a new cause of swelling of the legs. This is a serious phenomenon, but it does not cause concern because it disappears in a few months. The veins remaining on the legs adapt to new conditions, the working rhythm is restored and the swelling disappears.
Some medicines also cause swelling of the legs . Among them is testosterone, which is often prescribed for impotence. Steroids related to cortisone, which are prescribed for arthritis, asthma, cancer, can cause leg swelling with prolonged use. Also, estrogens (female hormones), birth control pills, some antidepressants . A number of drugs that lower blood pressure (aprezolin, reserpine, aldomet, ezimil) can also be attributed to this category.
Diseases of the pericardium (pericardial sac), caused by a viral or other infection, or the consequences of heart surgery, make it hard and tight. The normal contraction and relaxation of the heart muscle is difficult, which leads to a decrease in blood flow to the right ventricle of the heart. The blood stagnates, the veins swell first in the neck, then in the abdomen, and finally in the legs.
Here is a general idea of how and why the legs and feet swell. The following is information that will help you figure out what exactly you have:
Swelling on one leg indicates the absence of a general disease: lack of protein in the blood, kidney and liver disease, heart weakness, and others.
Heart failure is characterized by swelling of the legs, not the face or fingers.
A swollen abdomen that accompanies swelling of the legs indicates a diseased liver, not a disease of the heart, especially if the abdomen is swollen before the legs.
But, for a more accurate diagnosis, you must make the following observations.
Press firmly with your finger on the leg that is swollen, and hold it for a few seconds, then release. You will get a dent that lasts for about a minute or two. It's called "the dimple". If you have swelling due to an underactive thyroid gland, these dimples will not be present, but they are observed in most other cases.
If the face is swollen in addition to the legs, then this is not related to the heart or liver. Rather, the problems are related to the thyroid gland (perhaps its function is lowered) or there is a general allergic reaction (perhaps to medications). Other causes include compression of the heart by the pericardial sac, trichinosis, infection (obtained from eating poorly processed food, such as undercooked pork that is infected with worms), or kidney disease.
Brown pigmentation of the skin on swollen legs, especially around the ankles, may be associated with chronically dilated varicose veins. Especially if the disease is old. Pigmentation arose from blood that leaked through the thinned wall of the vein into neighboring tissues.
Painful swelling, reddened and hot leg, indicative of injury or infection. Phlebitis is also possible.
Heart failure without complications, diseases of the liver and kidneys, swelling does not give pain.
Are your feet swollen all day or just at night? Round-the-clock swelling of the legs increases the likelihood of protein metabolism disorders or vein problems. Deterioration in the evening, indicates cardiac weakness.
The sudden development of edema suggests a blockage, thrombosis, infection in the veins (less likely a general disorder of protein metabolism).
Abdominal enlargement preceding swelling of the legs indicates a cause in the liver or thickened pericardium. And an increase in the abdomen after swelling of the legs indicates a problem with the kidneys or heart.
Whatever the cause of leg swelling, do not try to get rid of it with diuretics. Treatment will be effective only when an accurate diagnosis is established. And this can be done by a specialist and only after examination and analysis. Remember, self-medication leads to serious consequences (sometimes to death), do not risk your health.
Pain and weakness in the legs
Almost everyone met with pain in the legs. Usually, discomfort is caused by fatigue, monotonous posture and walking in uncomfortable shoes.
However, discomfort in the legs can be a symptom of various diseases that require urgent medical attention.
The causes of muscle weakness, pain and trembling in the legs are very, very many. At a young age, it can be uncomfortable shoes with high heels, overwork at work, the costs of professional activity, standing or sitting in one position for a long time. Sometimes, sudden severe weakness in the muscles of the legs can be observed in women who have recently given birth due to the weakening of the body.
The second category is the elderly. For them, weakness in the muscles of the legs is quite natural. After all, over time, the body wears out and ages, unfortunately you can’t get away from this.
And another group is people with various diseases, where muscle weakness, trembling and pain in the legs is one of the main symptoms. There are a lot of such diseases, but they are conditionally divided into three main groups:
Firstly, these are diseases of vascular origin. Varicose veins of the lower extremities and obliterating endarteritis. They are characterized by circulatory disorders, intermittent lameness and sharp sudden pains and weakness in the legs during prolonged physical exertion.
Secondly, disorders of the musculoskeletal system - arthritis, arthrosis, intervertebral hernia, scoliosis, osteochondrosis, etc. Here, the root of the problem lies in the deposition of salts, inflammation of the musculoskeletal system and nerve entrapment.
Thirdly, malfunctions of the endocrine system. The most common are hypothyroidism and diabetes. With these diseases, due to hormonal imbalance, numbness and weakness in the legs in the morning after waking up are typical.
Foot pain prevention
But whatever is at the root of this problem, it can and should be eliminated. And there are a huge number of methods for this. For young people, these are preventive measures, because any disease is easier to prevent than to cure.