If the patient complains of swollen feet, there may be an instinct to play down or even crack a smile, and that would be a very serious mistake: they are sometimes a symptom of serious undiagnosed pathologies

Swelling, also known as oedema, of a part of the body is the stagnation of fluid, particularly water, in the subcutaneous panniculus, i.e. the tissues under the skin.

While swelling and the resulting enlargement of feet and ankles may be a fairly common phenomenon, it can also be a symptom of serious diseases.

Swollen feet have a symptomatology that may suggest something else

Speaking of swollen feet and ankles, the symptomatology associated with swollen feet can be varied and include, for example:

• warmth;
• redness;
• bluish-purple discolouration of the skin;
• itching;
• pain.

We must listen to the signals our body gives us and act with common sense.

If the swelling and any co-symptomatology are pronounced and tend to persist, even intermittently, it is advisable to proceed as soon as possible with a medical check-up for appropriate assessment.

Symptoms that should warn

In particular, swelling should raise alarm, as potentially indicative of a serious life-threatening condition requiring prompt medical action, when it is associated with:

• high fever
• palpitations and/or chest pain;
• shortness of breath; difficulty breathing; choking;
• numbness in the area, feeling of heat and pain especially in the calf area;
• swelling of the face, eyes, lips and mouth.

It is important to emphasise, then, that whether the symptomatology presents as unilateral or bilateral is irrelevant.

Obviously, in the case of trauma, only one of the two feet is likely to be involved, but the doctor emphasises how, for example, in cases of venous or cardiovascular insufficiency, it can also happen that first one foot swells and then, once this one has deflated, oedema forms in the other.

The causes of swollen feet

There can also be many causes of swollen feet, some of which are paraphysiological or do not cause particular concern.

Common causes

Slight swelling of the feet can be due to several common factors such as:

• sedentary lifestyle and standing still in the same position for too long;
• shoes that are too tight, especially for women who, if they wear flat shoes (without at least a 4/5 cm heel), may experience slight swelling of the feet in the evening;
• heat and high temperatures that cause physiological vasodilation;
• standing for prolonged periods;
• excessive consumption of alcohol and salty foods leading to water retention;
• pregnancy, during which a slight swelling of the feet is normal: the uterus, increasing in size, squeezes the vena cava causing oedemas in the legs and feet. If, however, the swelling is significant, it is necessary to make sure that it is not gestosis (pre-eclampsia), for which, in addition to oedema, there is increased blood pressure and problems with kidney function.

Other causes of swollen feet:

Foot oedema can also be caused by:

• trauma and fractures to one or more of the structures of the foot;
• inflammatory conditions, such as arthritis, gout, bursitis, arthrosis, tendonitis, vasculitis, Lyme disease, etc;
• infections, both systemic (e.g. streptococcus) and local (warts, mycosis, athlete’s foot). In particular in this case, redness and fever may be associated;
• allergies, such as in the case of insect bites, or the intake of drugs, foods and substances, which generally, in addition to oedema in the area of contact, can lead to swelling of the eyes, lips, face and even the larynx, progressively preventing the ability to speak and breathe. In this case, emergency medical intervention is required;
• taking certain medications, such as anti-hypertensives (to control blood pressure), anti-inflammatory NSAIDs, oestrogens, corticosteroids, diabetes therapies (thiazolidinediones).

Swollen feet as indicators of serious diseases

In some cases, however, oedema can be a sign of some major diseases that include:

• heart failure: when the heart cannot pump effectively, this leads to blood pooling in the lower limbs and abdomen, resulting in swelling. Fluids can also accumulate in the lungs (pulmonary oedema), leading to symptoms such as shortness of breath and breathing difficulties;
• chronic venous insufficiency: if the valves in the veins of the legs are weakened or damaged, blood from the peripheral areas of the body may struggle to return to the heart and stagnate, causing swelling as well as often the appearance of varicose veins;
• venous thrombosis: swelling in a leg accompanied by pain and heat may be due to a blood clot in the veins that totally or partially obstructs blood flow, leading to deep vein thrombosis;
• liver damage or disease, such as cirrhosis, can limit the organ’s capacity and reduce blood flow, leading to a build-up of fluid in the abdomen (ascites) and legs;
• damage to or disease of the kidneys: if the kidneys are unable to fully perform their task of filtering the blood and eliminating waste substances in the urine, oedema can occur, usually in the lower limbs and around the eyes;
• damage to the lymphatic system and lymphoedema: a malfunction of the lymphatic system or removal of lymph nodes and/or lymphatic vessels may lead to lymph stagnation (lymphoedema);
• diabetes: diabetes mellitus can cause changes in vascular and neurological function, especially in peripheral areas such as the foot, leading to swelling and ulcers in the limb;
• obesity: obesity and excess weight often cause circulatory problems with fluid accumulation in the limbs, which can also be linked to poor or difficult motor activity.

Swollen feet in the elderly

The population most affected by this phenomenon is certainly the elderly, due to factors also inherent to advancing age, which may be:

• ongoing drug therapy
• little movement;
• development of rheumatic and arthritic diseases.

In children

In children without particular problems, swollen feet are, in most cases, often related to trauma and injury.

When to seek medical advice

It is always a good idea to seek medical advice if the swelling is significant, causes pain and is constant or intermittent but frequent, also depending on one’s medical and family history.

Above all, in the case of pathologies such as lymphoedema, which lead to an accumulation of lymph in one or more limbs, if not properly diagnosed and treated, the oedema, which in the first stage disappears with night rest, ends up persisting in the morning, leading to a thickening of the skin tissue to the point of permanent swelling and deformation.

What examinations to perform for swollen feet

In the case of swollen feet, the doctor will prescribe simple first-level examinations such as

• haematochemical examinations, to rule out systemic pathologies and assess kidney and liver function;
• cardiological examination with blood pressure measurement and electrocardiogram, to make initial assessments of cardiac function.

On the basis of the findings of the cardiological examination, the possibility of an in-depth examination with echocardiography and/or echocolordoppler, a non-invasive and repeatable examination that allows us to assess the health, functionality and patency of veins and arteries, diagnosing and evaluating all the main vascular pathologies, may also be highlighted.

Medical treatment for swollen feet

Treatment for swollen foot(s) is indicated by the specialist on the basis of the cause(s) that emerged from the clinical evaluation. By way of example only, the following may be used

• anti-inflammatory and/or pain-relieving drugs, for the treatment of trauma, injuries, arthritis and inflammatory conditions;
• antihistamines, in case of allergies;
• antibiotics, in case of bacterial infections;
• anticoagulants and drugs to improve blood flow, together with compression stockings, as targeted therapies to improve cardio-circulatory function;
• diuretic drugs, which assist the drainage of excess fluids;
• manual therapy, such as massages together with compression bandages, which can also aid drainage of excess fluids.

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Source:

GSD