Thu | Oct 17, 2019

Dear Doc | Swelling feet can be a problem

Published:Sunday | September 22, 2019 | 12:06 AM

Q Dear Doc, my feet keep swelling. It does not happen all the time, but very often. It was first shown to me by my nail technician when she was doing my toes, and every time I go to her, she points it out. She is now saying that I could have heart disease, and I’m now very concerned. Is what she says true, or could there be another cause? And is there anything I can do to prevent it from happening?

A The quick answer to your question is yes. However, it is yes to both! Yes, your swelling can be caused by heart disease, and, yes, there are other things that can cause it.

Edema is the medical term for swelling, which is caused by the collection of fluid in the body’s tissue spaces and organs. Edema can occur nearly anywhere in the body, but some of the most common sites are:

- The lower legs or hands (also called peripheral edema).

- Abdomen (also called ascites).

- Chest (called pulmonary edema).

Edema typically causes swelling and puffiness of the skin, making it appear stretched and shiny. It is usually worse in the areas of the body that are closest to the ground because of gravity; therefore, edema is generally the worst in the lower legs. This swelling to the legs is even more noticeable after walking about, standing, sitting in a chair for a period of time, or at the end of the day. Pressing on the swollen area for a few seconds will also leave a dimple in the skin after the pressure from pressing is released.

There are a number of different problems that can cause edema such as:

Chronic venous disease

A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs.

Edema can also develop as a result of a blood clot in the deep veins of the lower leg. This is called a deep vein thrombosis (DVT). In this case, the edema is mostly limited to the feet or ankles and usually occurs only on one side.

Pregnancy

Pregnant women are known to have swollen feet, and this is because they retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near to the end of a normal pregnancy. Swelling in this situation, without other symptoms and findings, is common and is normal.

Monthly menstrual periods

Some women have edema that occurs in a cyclic pattern (usually once per month), which is as a result of the hormonal changes related to the menstrual cycle. This type of edema is common and does not require treatment, because it resolves on its own.

Drugs

Edema can be a side effect of a variety of medications, including some diabetes medications, high blood pressure medications, non-prescription pain killers (such as ibuprofen), and oestrogens.

Kidney disease

The edema of kidney disease causes swelling in the lower legs and also swelling around the eyes.

Heart failure

Heart failure, which is due to a weakened heart – resulting in impairment of its pumping action – causes swelling to the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. This can be a very dangerous condition requiring emergency treatment.

Travel

Sitting for long periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem.

Make note, however, that not all types of edema require treatment, such as edema related to pregnancy or menstrual cycles.

Treatment of edema includes several components:

Reduce salt in your diet: Sodium, which is found in table salt and processed foods, can worsen edema. Reducing the amount of salt you consume can help to reduce edema.

Diuretics: Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care, because removing too much fluid too quickly can lower the blood pressure, cause light-headedness or fainting, and impair kidney function.

Compression stockings: Leg edema can be prevented and treated with the use of compression stockings. These stockings are available in knee-high, thigh-high, and pantyhose styles. Knee-high stockings are sufficient for most patients. These stockings are available with varying degrees of compression.

Stockings with small amounts of compression can be purchased at pharmacies and surgical supply stores without a prescription.

People with moderate to severe edema, those on their feet a lot, and those with ulcers usually require prescription stockings. A healthcare provider may take measurements for stockings or may write a prescription for stockings and then have a surgical supply or specialty store take the necessary measurements.

Body positioning: Leg, ankle and foot edema can be improved by elevating the legs above heart level for 30 minutes. Ideally, this should be done three or four times per day, but it may not be practical for those who work to elevate their legs several times per day.

deardoc@gleanerjm.com