A Look into Swollen Feet & Ankles (Edema)

Swollen feet and ankles, a condition commonly referred to as edema, can transform ordinary activities into uncomfortable chores. This condition affects millions of people in the U.S., presenting not only physical discomfort but also potential indicators of underlying health issues.

There are different types of edema that can affect parts of the body. This article will be focusing on edema types that affect the lower body extremities including peripheral edema and lymphedema.

What causes swollen feet and ankles?

Edema in the lower limbs is generally caused by inefficient blood and fluid return to the heart. Under normal circumstances, the lymphatic system, veins, and muscle contractions assist in propelling fluids back to the circulatory system. When the leg muscles squeeze (contract), like during exercise, extra fluid moves to the next chamber closer to the heart, and special one-way valves keep it from running back down. This fluid is eventually returned to the lungs, heart, and the rest of the body.²

However, sometimes the valves in your veins don't close properly, or there's an excess of fluid that your body can't effectively manage, leading to fluid buildup and pooling in your lower legs. Below are common causes of swelling in the feet and ankles (also called lower limb edema):

Venous insufficiency - Common in individuals over 50, this occurs when valves in the veins do not function properly, especially after prolonged standing.

Pregnancy (especially the 2^nd and 3^rd trimesters) - Particularly in the second and third trimesters, the increased bodily fluid required for fetal development can exceed what the system can manage.

Vein obstruction - Blood clots or anatomical anomalies can impede fluid return.

Heart Failure (CHF) - A weakened heart struggles to handle fluid return, causing backflow pressure that leads to swelling.

Severe liver or kidney disease -Both of these organs handle special proteins in your blood that keep fluid in the vessels and out of the tissues. So, when they can’t do that, fluid builds.

Inactivity – Extended periods of sitting or lying down, such as during flights or post-surgery, can prevent muscle pumps from activating, leading to fluid accumulation.

Medicine – Some blood pressure medications can exacerbate swelling.²

What can help swelling go down?

Managing swelling in the feet and ankles involves a combination of lifestyle changes, proper care, and sometimes medical intervention. If swelling is more than mild and sporadic, consulting a healthcare professional is crucial due to the multitude of potential underlying causes.

Here are some effective strategies to help reduce swelling:

• Elevate your Feet - Elevating your feet above the level of your heart several times a day can help reduce swelling by encouraging fluid to drain away from the affected area. For example, propping your feet up on pillows while lying down can be an effective way to combat edema.²
• Compression Socks - Wearing compression socks or stockings can provide gentle pressure that helps prevent fluid buildup in the feet and ankles. These garments are especially useful if you spend long periods standing or sitting, as they help improve circulation and reduce swelling. Compression socks are available in various compression levels. Always consult with a healthcare provider to assess the appropriate compression level for you.²
• Maintain Regular Activity - Regular physical activity, such as walking or swimming, promotes circulation and can help reduce fluid retention in the lower extremities. Gentle exercises that engage the calf muscles, like ankle rotations or toe flexes, can also stimulate blood flow and help manage swelling.
• Dietary Adjustments - Reducing your salt intake can help minimize water retention, which is a common cause of edema.³ Opt for a diet rich in fresh fruits, vegetables, and whole grains, and be mindful of the sodium content in processed foods. Also, drinking plenty of water might seem counterintuitive when dealing with swelling, but staying hydrated helps your body flush out excess fluids and can reduce water retention.
• Foot Massage - Gently massaging your feet and ankles can help move excess fluid out of the affected area. Use upward strokes to push the fluid toward the heart, which can aid in reducing swelling.¹
• Consult a Healthcare Provider - If swelling persists or is accompanied by other symptoms like pain, redness, or shortness of breath, it’s important to consult a healthcare professional. Persistent edema can be a sign of an underlying health condition that may require medical treatment.

Using Footwear and Compression Solutions for Edema

Proper footwear and compression treatments can play pivotal roles in managing edema. Orthopedic shoes can provide the necessary features to accommodate the fluctuations in swelling at the feet and ankles throughout the day. Adjustable interior depths from multiple removable inserts and adjustable lace or strap can be beneficial for those with edema. For more severe swelling cases, a shoe with an elastic collar can accommodate severe ankle swelling and prevent restricting blood flow at your feet and ankles.

Since compression socks are not recommended for those with arterial related swelling or those unsure of the cause of the swelling, it is always important to consult with a healthcare professional before using compression stockings.

Compression stockings come in a variety of compression levels (20-30 mmHG, 30-40 mmHg, etc.) that have a graded compression meaning tighter compression at the feet and ankles and gradually decreasing pressure up towards the knee. This graduated compression helps promote blood flow back up towards the heart, counteracting the effects of gravity that can cause blood to pool in the lower legs.

A lighter compression level stocking, such as 8-15 mmHg, may be a good option for mild to moderate swelling. (https://flowfeet.com/insoles/1769-mediven-comfort-calf-high-compression-stockings-15-20-mmhg.html) Different types of bandages can also be used to wrap the legs, depending on your specific needs – though these tend to be hot and not very breathable.⁴

Other compression treatment options can include intermittent pneumatic compression wrap devices – like the kind used in hospitals and during surgeries – though these can be difficult to get at home.²

Regardless of the socks you choose, be sure to wash them every day.³

Understanding and addressing the causes of swollen feet and ankles are essential for effective management and improving quality of life. Incorporating suitable footwear, regular physical activity, and professional medical advice can significantly aid in alleviating symptoms.

Sources:

Hettrick H, Aviles F. All edema is lymphedema: Progressing lymphedema and wound management to an integrated model of care. Wound Manag Prev. 2022;68(1):8-15. https://pubmed.ncbi.nlm.nih.gov/35263273/

Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and management. Am Fam Physician. 2013;88(2):102-110. https://pubmed.ncbi.nlm.nih.gov/23939641/

Dugdale III DC. Foot, leg, and ankle swelling: MedlinePlus Medical Encyclopedia. Medlineplus.gov. https://medlineplus.gov/ency/article/003104.htm

Sibbald RG, Elliott JA, Coutts P, Persaud-Jaimangal R. Evaluation of longitudinal and tubular compression treatment for lower limb edema. Adv Skin Wound Care. 2020;33(12):643-649. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082994/

Lin YH, Chen CY, Cho MH. Influence of shoe/floor conditions on lower leg circumference and subjective discomfort during prolonged standing. Appl Ergon. 2012;43(5):965-970. https://pubmed.ncbi.nlm.nih.gov/22342130/

About author:

Derek Roach is a foot health specialist and has worked in the foot health industry for over 10 years. He is knowledgeable in various foot conditions and shoe features to help with those conditions. Also, he has been quoted on CNN, The Penny Hoarder, HuffPost, Dapper Confidential and other popular publications for foot and shoe-related topics.