Swollen Feet and Ankles

Frequently asked Questions and Answers on Swollen Feet and Ankles in general….

What is swelling?

Swelling refers to an abnormal increase in size of a body part.

Is swelling the same as edema?

Medically speaking, they are the same because edema is the medical jargon for swelling [1].

Why are the feet and ankles most commonly affected by swelling and not the other parts of the body?

Gravity is the reason why the feet and ankles are the most commonly affected areas of the body.

What are the causes of swollen feet and ankles?

• Standing for a long period of time
• Long trips or flights
• Pregnancy
• Physical injury or trauma to the lower extremities
• Blood clot obstruction in the lower extremities
• Venous insufficiency
• Infection in the lower extremities
• Obesity
•  Surgery on the pelvis
• Increased age
• Medications such as calcium channel blockers, monoamine oxidase inhibitors, tricyclic antidepressants, steroids, and hormone replacement therapy [2]

What are the conditions linked to frequent or chronic swelling of the feet and ankles?

Sprained Ankle

When the ligaments that stabilize the ankle is stretched or injured, swollen feet and ankles may result.

Preeclampsia

If the swelling is accompanied by hypertension (high blood pressure) and proteinuria (presence of protein in the urine) in more than 20 weeks of pregnancy, preeclampsia may be suspected. Other signs and symptoms include changes in vision, abdominal pain, headache, nausea and vomiting.

Lymphedema

Lymph is a fluid rich in protein that travels through lymphatic vessels and nodes. If there is an occlusion within the lymphatic network, lymph builds up. The resulting condition is called lymphedema.

Venous Insufficiency

The veins are responsible for transporting deoxygenated blood from all the parts of the body back to the heart. If the vein is insufficient enough to transport blood from the lower extremities, blood pools up on your feet and this causes the swelling [3].

Swollen Feet and Ankles during Pregnancy

Why do pregnant women often have swollen feet and ankles?

During pregnancy, a mother’s body needs a whole lot of extra stuff since her body is responsible not only for her life but also for her child. The enlarged uterus on the latter part of pregnancy impedes circulation below its anatomical parts [4]. As a result, the pregnant woman’s feet might be enlarged by 25% of its prepregnant state because of increased blood volume and fluid retention [5]. This is normal.

Do they suffer from this everyday for 9 months?

Edematous feet and ankles is only common during the last trimester when the uterus becomes too enlarged it minimizes the blood flow from the pelvis down to the mother’s feet.

What can they do to get rid of this?

Picture1:  Pelvic Tilt Exercise

image Source: www. cchs.net

• Perform pelvic tilt exercises. Place your hands and knees on the ground with your back straight and knees apart. Work on your abdominal muscles by arching your back and turning your pelvis inwards.
• Swim every other day.
• Wear maternal support hose or stockings.
• Elevate your feet and rotate your ankles while sitting.
• Lie on your left side.
• Exercise regularly.
• Do not sit or stand for so long.
• Don’t cross your legs [6].

Does this problem go away as pregnancy ceases?

Yes, it does.

Questions on Other Factors Contributing to Swollen Feet and Ankles

Why do feet and ankles swell at the end of the day?

After you wake up in the morning, you stand up, go to places, go to study or work or whatever your daily routine is. You keep yourself upright all day you don’t even notice it. Because of this, the gravity causes the fluid to go down your body. The hours have passed and along with it is the accumulation of fluid on the tissues [5]. At the end of the day, you realize how tired your feet and ankles get because of swelling. Your feet is largest in the afternoon that is why when you buy a new shoes, you should do it in the afternoon.

However, this is not the case for some people, say for example the health care professionals who are on graveyard shift. The day for most people becomes their night and their night becomes the day. So they wake up late in the afternoon and maybe stay up until the morning. So their feet and ankles may become swollen around past midnight.

Contrary to how some would understand it, swollen feet and ankles don’t happen every afternoon. It actually depends on the circadian rhythm and activity of a person.

How can physical injury or trauma be a factor to cause swollen feet and ankles?

A physical injury or trauma disrupts the continuity of blood vessels. Consequently, they leak out and accumulate on adjacent tissues [7]. This causes edema.

Why do you develop swollen feet and ankles during long trips or flights?

It’s the same principle as standing up. When you sit, your feet and ankles are the body parts that are at the lowest level. With the aid of gravity, blood pools down your feet. This brings about the swelling.

What can I do to alleviate the swelling when I’m trapped inside a vehicle?

Perform in-flight exercises every 30 minutes. This will boost circulation on your feet and ankles thereby preventing swelling, edema, and deep vein thrombosis seen in “economy class syndrome” [8]

Picture2:  In-Flight Exercises

Image Source: Peters M & DK Publishing, Home Doctor, Penguin 2009

Does obesity cause you to have swollen feet and ankles?

Yes, it does. Your feet keep you upright. Obese people develop swollen feet and ankles because of their great weight. The cardiopulmonary system of an overweight person is already compromised due to their large surface area. Thus, the blood supply on their lower extremities is sluggish. Blood pools down their feet. Their weight adds up pressure to their feet to keep them standing.

Remedy or Treatment

What are the home remedies for swollen feet and ankles?

• Lie on your back and elevate your ankles and feet 6-12 inches without placing anything under your knees [8].
• Exercise your legs during idle times.
• Wear support stockings.
• Eat foods that are low in sodium content.
• Do not wear tight garments.
• Maintain a proper body weight [2].

How can you prevent this?

• Wear antiembolic stockings.
• Wear flat shoes. High heels cause the calves to be exhausted thereby limiting blood flow to your feet and ankles.
• Say no to girdles and tight underwear, pants, and knee-high socks.
• When you stand for a long period, flex your lower extremities from time to time and wiggle your toes.
• During long road trips, stop, get out of the vehicle, and stretch your legs.
• Wear flight socks with light compression to facilitate blood flow to your feet and ankles [8].

Under what circumstances should I need to be consulting a doctor?

• When you have shortness of breath or difficulty breathing
• Where there is chest pain
• When there is pain or tenderness on your calf
• When there is uneven swelling of your legs or if only one leg is swelling
• When you are taking medications that may have caused the problem
• When you develop fever
• If you have a heart or kidney disease and the swelling grossly gets worse
• If you have a liver disease and you develop swelling on the abdomen and legs [2, 8]

References

1. http://www.uptodate.com/contents/edema-swelling-beyond-the-basics
2. Foot, Leg, and Ankle Swelling accessed on http://www.nlm.nih.gov/medlineplus/ency/article/003104.htm
3. Swollen Ankles and Feet accessed on http://www.webmd.com/a-to-z-guides/swollen-ankles-and-feet
4. Brann JW, Surviving the Joy of Pregnancy, Women’s Health Care Topics 2006, p 105
5. Kluck MR, Hands on Feet: The New System That Makes Reflexology a Snap!, Running Press 2001, p 127
6. The ICEA Guide to Pregnancy and Birth, Simon & Schuster 2011
7. Injuries: To Ice or To Heat? accessed on http://lecom.edu/healthynews.php/injuries-to-ice-or-to-heat/76/0/2818/13542
8. Peters M & DK Publishing, Home Doctor, Penguin 2009, p 96