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Foot, leg, and ankle swelling

Definition

Painless swelling of the feet and ankles is a common problem, particularly among older people.

Alternative Names

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema

Considerations

Painless swelling may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in the lower part of the body.

Common Causes

Foot, leg, and ankle swelling is common with the following situations:

• Prolonged standing
• Long airplane flights or automobile rides
• Menstrual periods (for some women)
• Pregnancy -- excessive swelling may be a sign of preeclampsia, a serious condition sometimes called toxemia, which includes high blood pressure and swelling
• Being overweight
• Increased age
• Injury or trauma to your ankle or foot

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.

Other conditions that can cause swelling to one or both legs include:

• Blood clot
• Leg infection
• Venous insufficiency (when the veins in your legs are unable to adequately pump blood back to the heart)
• Varicose veins
• Burns (including sunburn)
• Insect bite or sting
• Starvation or malnutrition
• Surgery to your leg or foot
• Blockage of the lymph nodes in the legs (lymphatic obstruction)

Certain medications may also cause your legs to swell:

• Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone
• Blood pressure medicines called calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil)
• Steroids
• Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)

Home Care

• Elevate your legs above your heart while lying down.
• Exercise your legs. This helps pump fluid from your legs back to your heart.
• Wear support stockings (sold at most drug and medical supply stores).
• Follow a low-salt diet, which may reduce fluid retention and swelling.

Call your health care provider if

Call 911 if:

• You feel short of breath.
• You have chest pain, especially if it feels like pressure or tightness.

Call your doctor right away if:

• You have decreased urine output.
• 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 doctor if self care measures do not help or swelling worsens.

What to expect at your health care provider's office

Your doctor will take a medical history and conduct a thorough physical examination, with special attention to your heart, lungs, abdomen, legs, and feet.

Your doctor will ask questions like the following:

• What specific 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 the evening?
• What makes your swelling better?
• What makes your swelling worse?
• Does the swelling get better when you elevate your legs?
• What other symptoms do you have?

Diagnostic tests that may be performed include the following:

• Blood tests such as a CBC or blood chemistry
• ECG
• Chest x-ray or extremity x-ray
• Urinalysis

The specific treatment will be directed at whatever underlying cause is found. Diuretics may be prescribed. These are effective in reducing the swelling but have some side effects. Home treatment for benign causes of leg swelling should be tried before drug therapy under medical supervision.

Prevention

Avoid sitting or standing without moving for prolonged periods of time. When flying, stretch your legs often and get up to walk when possible. When driving, stop to stretch and walk every hour or so. Avoid wearing restrictive clothing or garters around your thighs. Exercise regularly. Lose weight if you need to.

References

Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 48.