Why Are My Feet Swollen?
There are a number of causes of swelling in the feet and legs and many of them are not as bad as you might think. The most common causes of swelling are chronic health issues and, if treated correction, the swelling doesn’t pose a serious health risk. The most common causes of swelling in the feet and legs are peripheral vascular disease (PVD)/ varicose veins, water retention due to kidney issues, congestive heart failure, arthritis, tendinitis, chronic joint diseases (such as rheumatoid arthritis), injuries and surgery.
The vein network in the lower leg, ankle and foot is unique and works differently than other parts of the body. This anatomic difference, along with gravity, is the cause of many of the types of swelling. This difference is in the system which returns blood to the heart. There are two systems of veins that return blood to the heart: the superficial and deep systems. In the rest of the body, the deep vein system is the main way the blood is returned, but below the knee it is the superficial system (the veins that are visible). Inside these veins are valves, which keep blood from flowing backward due to gravity. The valves are vital to the proper function of the veins. This different pathway of blood return is central to the problem of swelling in the foot and ankle and when there is damage to these veins the result is peripheral vascular disease (PVD).
The most common cause of swelling in the feet and legs is peripheral vascular disease (PVD). The most common cause of PVD is high blood pressure over the course of several years. A chronic increase in blood pressure causes damage to the arteries and veins, leading to thickening and hardening of the walls of the arteries and damage to the valves in the veins. Hardening of the arteries is called atherosclerosis and creates increased pressure on the veins, which causes them to dilate (swell). When the veins dilate, the valves inside of them no longer work correctly. This causes pooling of blood in the legs and feet, leading to chronic swelling. Varicose veins result from this chronic pressure.
If severe and untreated, chronic swelling in the legs and feet due to PVD can cause issues, including venous stasis dermatitis (which is a rash) and venous ulceration (which is an open wound on the leg). The first line of treatment, and often the best, is compression stockings, which help create pressure against the dilated veins to help them do their job better, clearing out the chronic swelling. There are some procedures, which are performed by a vascular surgeon, which can help with severe PVD including scerlosing injections and laser vein ablation. These procedures can help improve chronic swelling due to PVD.
Water retention is another common cause of chronic swelling in the legs and feet. This condition is usually due to kidney issues. The kidneys are responsible for removing wastes from the body, but also serve an important function in regulating the amount of fluid in the body. When the kidneys are not functioning as they should, too much fluid is retained in the body. The body’s response to this is to deposit the fluid in the legs to get it out of the blood stream. The swelling that results is called “pitting edema”, and this name is given because when the skin is pressed with a finger, a dent will stay in the skin for a few seconds, creating a “pit”. The treatment for this type of swelling is aimed at helping the kidneys function better to remove the fluid. Compression stockings are also helpful. A kidney specialist (nephrologist) is an important part of the process for best results.
Congestive heart failure is another common cause of leg and foot swelling. This is caused by a variety of factors, many of which are genetic but high blood pressure plays a big role as well. In congestive heart failure, as in kidney disease, there is too much fluid in the blood stream and so it is deposited in the legs and feet to get rid of it. This kind of swelling is also “pitting edema”. Treatment is very important and a cardiologist is the right specialist to handle this type of condition. Compression stockings can also be helpful in this case but care must be taken to use them under the supervision of a cardiologist.
Chronic joint and tendon problems can also lead to swelling in the feet and legs. This can be a chronic or acute condition. One of the big hallmarks of arthritis in all its forms (osteoarthritis, rheumatoid arthritis, psoriatic arthritis, reactive arthritis) is swelling around the affected joint. Swelling in these cases is caused by the inflammatory process, which your body uses as a defense mechanism, much like during a fever during a viral illness. The problem in arthritis is that the inflammatory process is trigged by a misinterpretation by your body of a disease, especially in cases such as rheumatoid arthritis, where the immune system tells the brain that normal parts of the joints are foreign invaders and must be killed. Rheumatoid arthritis is an example of an autoimmune disease, meaning that the immune system attacks the body’s normal tissues because it is confused and thinks they are going to hurt the body. Other examples of autoimmune diseases are Psoriasis, Crohn’s disease, Lupus and Parkinson’s disease.
Both Psoriasis and Crohn’s disease are ones that can cause chronic swelling in the feet and legs. In Psoriasis, the body attacks the skin, but it can also attack the joints of the foot, most commonly the toe joints and cause a “sausage digit”, which as the name sounds is severe swelling in the toes. Swelling due to Crohn’s disease is known as reactive arthritis. The immune system in this case attacks the intestines but can also cause chronic arthritis, leading to swelling.
Injuries and surgery to the foot and ankle can cause significant swelling during the initial (acute) phase. Swelling in these cases is usually accompanied by bruising, pain and inability to walk. Much to the chagrin of most people, the swelling is usually the last symptom to go away when the injury or surgery is healed. The bones and/or ligaments and tendons heal but the swelling remains. Veins die, are reabsorbed and re-grow constantly in the body as part of normal maintenance. When many are disrupted as part of the injury or surgical process, the vein network must be repaired and this takes on average 6 months to return to normal. Swelling in this case, in the absence of pain, is not something to be concerned about and will resolve in almost all cases.
No matter the cause, new swelling should be investigated to find the underlying cause. If properly treated, all forms of swelling can be improved.
The doctors at Advanced Foot and Ankle Center have comprehensive training in all forms of foot and ankle conditions and are here to serve you. Please call with any questions you may have.
Eric Silvers, DPM
Christopher WItt, DPM