Understanding and Managing Swollen Feet

Heart and kidney function are closely linked, and when either system isn’t working properly, fluid can build up in the body—including the feet. Kidney disease reduces the kidneys’ ability to filter waste and excess fluid from the blood. As damage progresses, swelling may appear in the feet, ankles, or legs. Heart disease can also lead to foot edema when the heart isn’t pumping effectively, causing blood to pool in the lower extremities.

These two conditions often overlap. High blood pressure, for example, can damage the kidneys, and people with kidney disease are at significantly higher risk for heart complications. In mild cases, diuretics may help remove extra fluid. In advanced kidney failure, dialysis may be required.

The liver plays a key role in maintaining fluid balance, in part by producing albumin, a protein that keeps fluid in the bloodstream. When liver function declines—due to cirrhosis, hepatitis, or another condition—albumin levels can drop. This allows fluid to leak into surrounding tissues, causing swelling in the feet and ankles. Advanced liver disease may also lead to portal hypertension, a rise in pressure in the vein that carries blood from the digestive organs to the liver. This can worsen fluid buildup in the lower body. Treatment depends on the cause and severity of liver damage and may involve lifestyle changes, medication, or even transplant in advanced cases.

Chronic venous insufficiency is a condition that occurs when the flow of the deep or superficial venous blood is impaired. Essentially, the valves in the leg veins do not work properly, and blood cannot flow effectively back to the heart. This causes blood to pool in the legs, leading to swelling. Chronic venous insufficiency can lead to many other symptoms, including discolored skin, burning or itching in the legs, flakey skin, leathery-looking skin, varicose veins, or ulcers near the ankles. Treatment can include compression therapy, medication, surgery, and lifestyle changes.

Deep vein thrombosis is when a blood clot forms in the deep veins, usually in the leg. When this happens, the foot, ankle, and calf may swell significantly on the affected side. DVT can lead to severe complications if the clot dislodges, including pulmonary emboli (PE), when the clot travels to the lung. In addition to swelling of the affected leg, symptoms of a DVT can include pain, tenderness, fever, and redness. Treatment is generally anticoagulation to prevent further clotting.

Symptoms of PE can include sudden shortness of breath, wheezing, sweating, rapid heartbeat, and pale, clammy skin. PE is a medical emergency. If you are experiencing symptoms, seek emergency medical care.

During pregnancy, the body holds onto excess water. Gravity causes the water to move to the lower extremities throughout the day. As pregnancy progresses, the pressure of the womb can press on the veins in the abdomen, causing fluid to build up in the legs, feet, and ankles. You can do some things to help reduce swelling, including wearing comfortable shoes, avoiding anything tight that might pinch the feet, resting and elevating feet as much as possible, taking regular walks, and doing foot exercises. Swelling can also be a sign of a severe complication of pregnancy called preeclampsia. If you notice the following symptoms, contact your doctor or seek emergency care right away:

• An increase in swelling in the hands, face, or feet
• A bad headache
• Vision problems, including flashing or blurring
• Heartburn that does not respond to antacid medicine
• Nausea or vomiting

Lymphedema occurs when the fluid that is usually drained through the lymphatic system accumulates in the tissues. This condition can occur after cancer treatments that remove or damage lymph nodes, affecting the lymphatic system's ability to drain completely. Treatment for lymphedema can include compression bandages, compression stockings, and massage.

Staying in the same position for a long and uninterrupted period is associated with lower leg swelling, especially if seated with the feet on the floor in a dependant position. Staying hydrated and increasing activity can help. Those with a sedentary lifestyle can start by stretching and doing low-impact exercise, like swimming or riding an exercise bike.

Some common medications can also cause edema, including amlodipine, gabapentin, pregabalin, pioglitazone, rosiglitazone, NSAIDs, some birth control pills, and oral steroids. If you are experiencing side effects from medication, talk to your doctor.

Foot and ankle injuries can also cause swelling. These injuries can include street fractures, sprains, and Achilles tendon injuries. Symptoms of an injury may include swelling, bruising, throbbing pain, increased pain with activity, and difficulty bearing weight. If an injury is mild, a mental health professional may recommend RICE protocol: rest, ice, compression, and elevation. In more severe injuries, surgery may be needed.

There are additional causes of swollen feet. Edema in the feet is more common in people with obesity. Long airplane flights or car rides often lead to some foot and ankle swelling, and some women may experience it during parts of their menstrual cycle. Gout is typically known to cause swelling in the big toe, but it can also affect larger areas of the foot.

Many things can cause swollen feet, from lifestyle factors to more serious conditions like heart disease, kidney disease, liver disease, or preeclampsia. Recognizing the symptoms of these conditions can help ensure you get appropriate medical care.