A Look into Swollen Feet & Ankles (Edema)

Whether your shoes are a bit tight at the end of a long day on your feet or you feel like you’re lugging around two bowling pins under your knees, swollen feet and legs can be a real drag. However, swelling is a common issue, affecting millions of people in the US alone, and there is help available.¹

What causes swollen feet and ankles?

Simply stated, swollen feet and ankles are caused by a return-pump problem. The heart works to push blood and fluid through the vessels, all the way to the tips of the toes. But once that fluid reaches its destination, there is no single pump to push the fluid back up the legs to the heart.

In ideal cases, the lymphatic system works with the veins and muscles to return this fluid to circulation. 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

This is far from a perfect system. Sometimes, the valves don’t seal tightly, sometimes there’s too much fluid to handle, and sometimes other issues come up. Some causes of swelling in the feet and ankles (also called lower limb edema):

·       Venous insufficiency: Most people over age 50 or so have somewhat leaky valves and swelling gets worse when they stand for a long time.

·       Pregnancy (especially the 2^nd and 3^rd trimesters): The growing baby requires a lot of extra fluid to be pumped, and sometimes its more than the system can handle.

·       Vein obstruction: Sometimes blood clots or unusual anatomy can block the return system.

·       Heart Failure (CHF): If the heart’s pump is weak, it can’t effectively deal with all of the returning fluid, and the pressure backs up all the way down the return line until the end – the feet.

·       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.

·       Infections: These cause excess amounts of fluid to be generated in the leg.

·       Not moving around much – like during surgery or on a long flight. The muscle-pumps aren’t working so fluid builds.

·       Some blood pressure medicines and other drugs²

What can help swelling go down?

Because swelling is a common problem, lots of suggestions exist about how to deal with it. The first step, though, is going to your doctor if the swelling is more than mild and occasional. Because there are so many possible causes, a professional is needed to help figure out what might be contributing to your swelling and what should be done to address that.

In addition to your provider’s recommendations, swelling relief can include

·       Manual lymphatic drainage (MLD): This is a special technique performed by a licensed therapist to help mobilize fluid.

·       Exercise: Keeping those leg muscles moving helps push the fluid back toward the heart.

·       Skin and nail care if you have changes in the skin and nails.¹

·       Elevation: Putting your feet up (especially above the heart) lets you use gravity to help drain fluid.²

·       Eating less salt, if high salt intake is causing the swelling.³

·       Compression – this isn’t safe for everyone with edema. If the swelling is related to a problem in the arteries and not the veins, compression can make the problem worse.² (See below for more.)

What footwear can help with swelling?

Because lymph fluid is usually pushed back toward the heart by muscles squeezing it, providing a little extra squeezing – in the form of external compression – can be really helpful.

However, if you have arterial related swelling, compression isn’t safe. If you aren’t sure, ask your doctor.²

Typically, doctors recommend a knee-high graded compression stocking of 30-40 mmHg for moderate-severe swelling. “Graded” means that the stocking is tightest on the foot and loosest on the knee. Because 30-40 mmHg is a lot of pressure, many people find this type of stocking too uncomfortable to wear.

In that case, a lighter pressure stocking of as little as 8-15 mmHg may be a good option for pain relief. (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

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

Shoes matter too. Having a supportive shoe can reduce pain and swelling for people who stand at work.⁵ Choosing a shoe that stretches and/or is adjustable can also help reduce pain when your feet change sizes throughout the day.

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

Sources:

1.     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/

2.     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/

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

4.     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/

5.     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 knowledge 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.