Understanding and Managing Swollen Feet

Kidney disease occurs when the kidneys are damaged and cannot filter the blood as they should, which causes waste to accumulate in the body. Most people do not have any symptoms of kidney disease until the damage is advanced. If you have kidney disease, you are more likely to get heart disease. In fact, heart disease is the most common cause of death in people with kidney disease. Heart disease is any problem that prevents your heart from pumping as effectively as it should. The problem can start in either your blood vessels or your heart. In turn, high blood pressure can cause kidney disease as the blood vessels narrow, restricting blood flow and affecting their ability to filter blood.

When the kidneys can no longer remove waste and excess fluid, fluid accumulates in the tissues, leading to swollen ankles and feet. Treatment can involve taking diuretics to help remove the fluid from the body, but if the kidneys are too damaged, dialysis may be necessary.

The liver has many roles, including contributing to fluid balance. The liver produces albumin, a protein that keeps fluids in the bloodstream and prevents them from leaking into tissue. When the liver is damaged, it does not effectively produce albumin. Fluid can leak into the tissues, leading to swelling in the ankles and feet. If someone with liver disease develops portal hypertension (high blood pressure in the blood vessel that carries blood from the abdomen to the liver), the increased pressure can affect the other veins in the abdomen, which can also cause swollen feet and ankles. Treatment for liver disease depends on the cause. Some liver problems can be treated with lifestyle changes, while others will require medication, surgery, or a transplant.

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.