Common causes of swollen legs, ankles and feet

A build-up of fluid often causes swelling in the legs, ankles and feet. The medical term for it is called Oedema.

It is usually caused by:

• Standing or sitting in the same position for too long.
• Eating too much salty food.
• Being overweight.
• Being pregnant.
• Taking certain medicines – such as some blood pressure medicines, contraceptive pills, antidepressants or steroids.

Picture Credit: Cropped –“Swollen ankles” by Wandering Eyre is licensed under CC BY-NC-SA 2.0

At one end of the scale, occasional swelling in the legs, ankles or feet can be a normal response to heat, injury or pregnancy. But at the other end of the scale, Oedema can also signify a severe disease.

Oedema is the collection of watery fluid in the body’s tissues. Oedema can affect any part of the body, but because gravity makes fluid fall downwards, the feet and ankles are most frequently affected, causing them to become puffy and swollen.

The etymology of the word Oedema is late Middle English: modern Latin, from Greek oidēma, from oidein ‘to swell’.

Oedema can also be caused by:

• An injury – such as a strain or sprain.
• An insect bite or sting.
• Problems with your kidneys, liver or heart.
• A blood clot.
• An infection.
• Heart failure: If the heart isn’t working properly, blood backs up in the body. Fluid passes into the lungs and body tissues, causing breathlessness and progressive swelling in the feet and ankles.
• Lymphoedema, which is an abnormal collection of lymph fluid.
• A deep vein thrombosis (DVT) is a potentially serious blood clot in the deep blood vessels of the leg.
• Medications including blood pressure tablets, contraceptive pills, antidepressants and steroids.
• Low Haemoglobin (red blood cells).
• An accident or injury causing a strain or sprain.

The Lymphatic System
Chronic Oedema (sometimes called, Lymphoedema) is when you have swelling that has been present for three months or more and is not alleviated by limb elevation or diuretics.

The lymphatic system is a network of vessels throughout the body that helps fight infection and remove excess fluid. Lymphoedema is a life-long condition that produces swelling due to the overloading of this system and can affect any part of the body, for example, arms, legs, face and genitals etc. This condition must be treated as soon as possible.

In some cases, this excess fluid can leak out of the tissues onto the skin and cause unpleasant symptoms – such as skin breakdown, irritation and other skin conditions. This is often referred to as ‘leaky legs’.

Compression therapy involves wearing compression bandages, wrap compression systems or garments (these are all compression devices) designed and applied to reduce your Oedema and maintain the result. It is an essential part of Complex Decongestive Therapy (CDT), the foundation for lymphoedema treatment. CDT consists of a decongestion phase (Phase I), followed by a maintenance phase (Phase II). Compression therapy is part of both phases. (Source: HERE)

Symptoms od Oedema
Symptoms of Oedema include:

• Swollen or puffy ankles, feet or legs.
• Stiffness.
• Shiny, stretched or red skin.
• Discomfort in the feet and ankles.

Oedema doesn’t just cause swelling. It can also cause discomfort, stiffness and skin problems. Symptoms include swelling of the feet, ankles or legs; shiny, stretched skin; skin redness and stiffness and discomfort in the feet and ankles. Most Oedema should settle if you rest and put your feet up for a short time. If you’re worried about swelling that hasn’t settled, make an appointment with your GP.

Some swelling cannot wait for a routine appointment and investigations. You should call your GP or 111 for urgent care if you develop sudden Oedema and:

• The swelling is on one side only, especially if there has been no history of injury.
• The swelling is painful and severe.
• The foot or ankle is red or feels hot.
• Your temperature is raised, or you feel feverish, shivery and unwell.
• You have diabetes.

A DVT can cause a clot to lodge in the lung. A pulmonary embolism is a medical emergency and should also be treated urgently in the hospital. Call 999 if you have leg swelling and:

• Chest pain feels heavy, tight or worse when breathing in.
• Breathlessness.
• Coughing up blood.

How to ease swelling yourself
Swelling in your ankles, feet, or legs should go away on its own, but there are some things you can try to help.

Do

• Lie down and use pillows to raise the swollen area when you can.
• Get some gentle exercise, like walking, to improve your blood flow.
• Wear broad, comfortable shoes with a low heel and soft sole.
• Wash, dry and moisturise your feet to avoid infections.

Don’t

• Do not stand or sit for long periods of time.
• Do not wear clothes, socks or shoes that are too tight.

Other ways to get help

Immediate action required: Call 999 if:

• you feel short of breath or are struggling to breathe
• your chest feels tight, heavy or painful

You could have a blood clot in your lungs, which needs immediate treatment in hospital.

Treatment

Treatment for swelling or Oedema that does not go away on its own will depend on the cause. It may include lifestyle changes, such as losing weight or going on a low-salt diet.

Depending on the cause of your Oedema, a combination of medicines can be prescribed to help control swelling, improve the function of your heart and optimise your health. These could include Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers, beta-blockers, and diuretics or water tablets to decrease fluid congestion.

The first line of treatment for pulmonary embolism is blood thinners (often warfarin).

Sources and Further Information

https://www.nhs.uk/conditions/oedema/

https://londonmedical.co.uk/oedema-of-the-feet-and-ankles/

https://www.medicalnewstoday.com/articles/324324

https://www.webmd.com/a-to-z-guides/swollen-ankles-and-feet

Caution: No advice is implied or given in articles published by us. This guide is for general interest only – and should never be used as a substitute for obtaining advice from your doctor or other qualified clinician/medical practitioner. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible.