Pedal Edema: Feet Swelling Causes, Differential Diagnosis, Symptoms

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Feet swelling often reflect a hidden internal pathology or an external cause like injury.
Peripheral edema – Foot, leg and ankle swelling (including the swelling in the hands). It is often due to fluid retention. The swelling and fluid buildup doesn’t cause pain, unless they are caused by injury. 
Pedal edema – Edema of the foot. It is commonly seen due to ‘gravity factor’.  It is most common in the older adults. Swelling can be unilateral, occurring in one lower limb or bilateral i.e. in both lower limbs also.

 

Common causes of foot, leg and ankle swelling
Lifestyle factors:
obesity – Excess body weight eventually decreases blood circulation causing fluid build-up in the feet, legs and ankles.

Postural, Standing or sitting for long periods – When we stand or sit for prolonged periods, the muscles get inactive. The muscles can’t pump body fluids (blood) back up towards the heart from the periphery (upper and lower limbs). This causes retention of water and blood and subsequent swelling in the legs.

Medications:
– Steroids
– NSAID’s (Non-steroid anti-inflammatory drugs, such as ibuprofen and aspirin
– Certain anti-depressants, including tricyclics and MAO inhibitors
– Estrogen and testosterone
These medicines reduce blood circulation by increasing the thickness of the blood, and cause leg swelling.

Medical conditions and body changes:

  • Natural hormonal changes – fluctuating estrogen and progesterone hormones can cause reduced blood circulation in legs. These hormonal changes may occur during menstrual cycle and pregnancy.
  • Pericarditis – caused due to chronic inflammation of the pericardium (sac like membranes or layers around the heart). Pericarditis causes severe and chronic swelling of the lower limbs, especially legs and ankles apart from causing breathing difficulties.
  • Venous insufficiency – The veins are unable to pump adequate blood. This causes retrograde flow of blood with blood pooling in the legs. This causes swelling of legs, foot and ankle.
  • Lymphoedema – Lymph edema or lymphatic obstruction causes blocks in lymphatic system. Lymphatic system is made up of lymph nodes and blood vessels that help to carry fluid throughout the body. Any blockage in the lymphatic system causes fluid accumulation and swelling of tissues in the lower limb and also upper limb.
  • Cirrhosis of liver – means scarring of liver. This is often caused by alcohol abuse or infection like Hepatitis B or Hepatitis C. This condition can cause high blood pressure and poor circulation in the feet, legs and ankles. This in turn causes swelling of foot.
  • Pre-eclampsia – This condition causes high blood pressure during pregnancy. High blood pressure results in poor circulation. This eventually causes swelling in the legs, hands and face.
  • Blood clot in the leg –  When a blood clot forms in a vein of the leg, it can impair blood flow, leading to swelling of foot, leg and ankle and also considerable discomfort.
  • Injury and or Infection – Any injury or infection occurring in the foot, leg or ankle results in enhanced blood flow to the lower limbs. This subsequently ends in swelling.

Gist of conditions which cause Foot Swelling (Differential diagnosis of pedal edema)
Heart conditions
Congestive Heart Failure (CHF) – Here heart doesn’t (can’t) pump enough blood as well as it should
Hypertensive Heart Disease – are heart conditions caused by high blood pressure.
Ischemic Cardiomyopathy (IC) – occurs when the muscles of the heart are weakened. It is usually caused by heart attack or coronary artery disease.

Myocarditis – inflammation of the heart muscle. Caused by number of autoimmune diseases, viral, bacterial or fungal infections or parasites.
Infective endocarditis – The inner layers of the heart (endocardium) or the heart valves are infected. It can lead to stroke or heart failure.
Mitral Valve Stenosis – Mitral valve of the heart is narrowed such that not enough blood flows through it.

Pericarditis – Pericardium is the sac which surrounds and protects our heart. Inflammation of this sac containing the heart is called pericarditis.
Heart Failure – is characterized by the inability of the heart to pump an adequate supply of blood.
Rheumatic Fever – It is a complication of streptococcal throat infection. If it is left untreated it causes permanent damage to your heart i.e. rheumatic heart disease.

Lung conditions
Emphysema – one of the diseases that comprise the term COPD or Chronic Obstructive Pulmonary Disease. It is a long term progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs of the lungs).

Chronic Bronchitis – is one type of COPD. Cigarette smoking is the most common cause. The bronchial tubes get inflamed. The inflamed tubes produce lot of mucus. This leads to coughing and difficulty in breathing.

Cor Pulmonale – is defined as an alteration in the structure and function of the right ventricle of the heart. It is caused by a primary disorder of the respiratory system. Pulmonary hypertension is the common link (often) between lung dysfunction and the heart.

Kidney conditions
Kidney Failure (Renal failure, Renal insufficiency) – is a medical condition of impaired kidney function in which the kidneys fail to adequately filter metabolic wastes from the blood.

Chronic Kidney Disease (CKD) – is a progressive and irreversible damage to the kidneys. The most common causes of CKD are high blood pressure and diabetes.

Obstructive Uropathy – occurs when the flow of urine reverses its direction due to a blockage in one of the ureters (tubes carrying the urine from kidneys to urinary bladder)

Glomerulonephritis – is acute inflammation of kidney or kidneys usually caused by an immune response. It is a serious illness that can stop your kidneys from functioning properly.

Acute Nephritis – is a condition which occurs when your kidneys become suddenly inflamed. It can eventually lead to kidney failure.

Liver and abdomen related
Cirrhosis of Liver – is a condition of liver wherein scarring and poor function of the liver occurs as an effect of long term exposure to alcohol or viral infections

Ascites – is a condition in which the fluid builds up inside the abdominal cavity. It is usually related to a sluggish functioning liver. Fluids fill the space between the abdominal lining and the organs i.e. the peritoneal cavity (space between the layers covering the abdominal layers)

Blood vessels related
Peripheral Vascular Diseases – is a circulation disorder that affects blood vessels (outside of the heart and brain), often those that supply the arms and legs.

Deep Vein Thrombosis (DVT) – is a serious condition that occurs when a blood clot forms in a vein located deep inside the body. This is an emergency condition which needs urgent care.

Varicose veins – Varicose veins are enlarged, swollen, twisting veins often caused by damaged or faulty valves. Any vein can become varicose but the most commonly affected are those in your legs and feet. This is one of the main causes for pedal edema.
Read related: Varicose Veins – Ayurvedic Treatment, Herbs, Home Remedies

Joint, soft tissue and injury related
Fracture
Sprains and strain – are the injuries occurring to the body, often resulting from physical activity. They are common injuries and can range from minor to severe damages depending on the incident and intensity of the incident.

Osteoarthritis – is a condition which occurs when the cartilage that cushions bones at the joints wear away. If this happens at the ankle joints, it causes swelling of the foot and ankle as part of the symptoms.

Osteomyelitis (bone infection) – A bone infection occurs when the bones are invaded by bacteria or fungi causing symptoms including fever, redness, stiffness and swelling.

Achilles Tendonitis – Achilles tendon is the tendon which attaches the calf muscles (muscles of the back of our leg) to the heel bone. Inflammation of this tendon is called Achilles Tendonitis. This tendon gets painful and inflamed due to overuse injuries. Swelling of foot and ankle is a symptom of this condition.

Other conditions
Nutritional Deficiencies (Malnutrition) – of occurs when the body doesn’t absorb the necessary amount of nutrients, one of the chief causes of foot swelling

Obesity – cause pressure symptoms on the lower limbs causing swelling of foot, ankle and leg

Hypothyroidism – is a common disorder of endocrine system wherein your thyroid gland does not produce adequate thyroid hormone.

Lymphedema – Lymphedema usually occurs when your lymph vessels are unable to adequately drain the lymph fluid, usually from an arm or leg. This causes swelling in an arm or leg.

Pregnancy & Teenage pregnancy – cause pressure symptoms on the lower limbs causing swelling of foot, ankle and leg

Pre-Menstrual Syndrome (PMS) – is a condition which affects a woman’s physical health, emotions and behavior during certain days of the menstrual cycle, generally just before her menses. It presents a wide variety of symptoms including mood swings, tender breasts, food cravings, irritability, depression and fatigue. Foot swelling is sometimes noted in women with PMS.
Read related: 25 Tips To Manage PMS Through Diet And Lifestyle Changes

Lou Gehrig’s Disease (Amyotrophic lateral sclerosis or ALS) – is a degenerative disease affecting the brain and spinal cord. It causes loss of control of voluntary muscles.

Symptoms of Pedal edema
Swelling – As the name suggests, swelling of the foot, leg and ankle joint is the most important symptom

Bilateral, soft enlargement that spreads quickly – Swelling caused by dependent edema, pregnancy, medications and most diseases produce swelling that is bilateral (present in both feet or ankles) and usually begins as a soft, puffy skin enlargement in the feet that spreads rapidly to the ankles

Indention – The skin over the swelling is easily indented when pressed down with a finger (pitting edema). The skin slowly returns to its more puffy state when the finger pressure is removed. The indentions are seen in the puffy skin when shoes or socks are removed. These are classic signs of swelling.

Normal to pale color of the swelling – The skin color with this swelling is often normal or slightly pale. Indention marks are slightly darker than the surrounding swollen tissue.

Raised feet relieves edema – Elevation of feet and ankles higher than their hearts, may resolve the swelling completely. However, in some chronic diseases and with some medications taken for long time periods, the swelling becomes chronic and the skin becomes more rigid, reddish and sometimes mildly discolored or mottled and will not return to normal after a few hours of elevation. Example, many people with chronic congestive heart failure will have chronic bilateral swelling of feet and ankles with skin changes.

Diagnosis of pedal oedema:
Diagnosis is based on thorough examination of the patient and swelling which includes inspection, palpation (feel of swelling) and interrogation (questions related to swelling). The doctor may try to elicit the nature of swelling. The doctor may ask you regarding the time of swelling, location or locations of swelling, the time of the day when the swelling tends to be worse, associated symptoms and any factors that appear to make the swelling worse or better.

You may be asked to undertake one or more of the below mentioned tests so as to arrive at a diagnosis about the swelling. They are –

  • Blood tests including blood count
  • Kidney and liver function studies
  • Electrolyte analysis
  • X-rays to view bones and other tissues
  • Ultrasound to examine the organs, blood vessels and tissues
  • Electrocardiogram – to access heart functions

Doctors may recommend home remedies if swelling is caused due to lifestyle habit or a minor injury. The doctor may address and treat the specific health condition or disease which is causing the swelling.

Treatment of foot swelling / pedal edema
Treatment of foot, ankle and leg swelling is done by treating the primary condition or disease causing the pedal edema.
Doctor may advise one or more of the home remedies and preventive measures, lifestyle changes and diet corrections.

Compression pump therapy – The pumps use pressure to get blood and fluids moving up through the body, which reduces the swelling and improves circulation
Discontinuing hormone replacement therapy which causes swelling in some women
Discontinuing contraceptive pills, which can also cause swelling in some people

Leg wedges, specially designed cushions placed under the legs to elevate your feet while sleeping, Use of compression socks, hosiery or calf sleeves which provide graduated compression that helps reduce swelling

Air pressure leg and foot massagers provide the benefits of compression pump therapy such as simulating circulation and alleviating pain
Low impact exercise which helps with circulation and can alleviate swelling, this includes walking, Yoga and light aerobics.
Click to Consult Dr Raghuram Y.S. MD (Ayu)


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Comments

  1. Lymphostasis / Lymphoedema / Lymphoma / Edema – Treatment. An overseas friend’s right foot was smashed in the car door and after one year now he had developed Lymphostasis or Lymphoedema or Edema of the upper part of the foot. Fluid is accumulated and swelling and pain is there. After consulting an Ayur Doctor who recommended use of Murivenna+Karpooradi+Punarnavadi Tailam. Using for 10 days there was no effect. Could you please suggest which is the best treatment as the friend is young and find it difficult to do daily work. Thanks in advance.

    • Dr J V Hebbar MD(Ayu) says:

      Kanchanara guggulu tablet – 2 tablets 2 times a day after food for 1 month, along with the oil combination local application can help.
      For personal health advice, please consult an Ayurveda doctor directly.
      If you want my help in finding a good Ayurveda doctor for you, then let me know your place.

      For email advice (not a reliable option, we do not promise any cure), please write to our health experts here (paid service) – https://easyayurveda.com/consult/

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