Swollen Feet

When is this a problem?

When feet swell up, the reason is always that there is extra fluid in them. (There is a little bit of fat in feet, but they are otherwise mostly bone, tendons and ligaments, and small muscles.)

Almost all of our body tissues are normally slightly wet. Since water is needed for essential bodily processes, "wet" is better than "dry".

Too wet in the feet equals edema of the feet, and usually of the ankles, too. Sometimes this is no problem, such as the swelling that occurs after prolonged sitting. (A fifteen-plus hour airplane trip is a common cause. Blood clots in leg veins happen here, too, but that's another story.) Gravity aids and abets this "dependent" edema, the cure for which is to get up and walk. Avoiding salty foods before such a trip will also help prevent the swelling, however if it does happen, it's 100% reversible.

Victims of vein disease, from bad varicosities to phlebitis, lose the effect of the valves in the veins. The flow of blood in these compromised veins is sluggish, and since the legs are at the bottom of us, there is a large column of fluid to handle. Without help, the veins can't handle all this extra load, and they literally leak into the surrounding tissues. Most of the leakage is watery, but in some patients (particularly diabetics) red blood cells also manage to get out of the veins.

This is the reason why those who have long term edema will often have brown pigment in their skin, often from the knee down to the soles of the feet. This color is what's left over after the red blood cells have disintegrated (it's like rusty iron) and it will never go away. If the edema is treated properly, and the swelling diminishes, the skin is probably not at risk for breaking down to form skin ulcers.

There are three ways to "self-treat" chronically swollen feet and ankles not attributable to serious disease (heart, kidney, liver). One involves constant use of pressure on the lower legs applied by means of good support hose. Get the ones that look like they mean business - these are not pretty or stylish, and usually are sold only in surgical supply houses. Second, elevate your legs whenever you get the chance, and avoid prolonged sitting with feet on the floor. Third, forget about adding regular salt to anything you eat - salt substitutes are OK as long as your kidneys are up to snuff.

Diabetics have a very troublesome dual-circulatory problem. Their small arteries are also not so great, meaning that blood flow in them is decreased. Swelling of tissues keeps out the good blood which is not coming easily through plugged arteries anyway. It takes little imagination to visualize what is going to happen - the tissue (skin is the most jeopardized) is going to break down and die. For diabetics, then, anything that keeps down swelling is not just desirable, it's mandatory.

If someone known to have heart disease develops swollen feet and ankles rapidly, there is cause for maximum concern, because this may be the first sign of heart failure. (Other early symptoms are fatigue and shortness of breath, particularly at night.) In this situation, the patient's veins are OK, and we're assuming they aren't diabetic, so what's up? To keep it simple, there is a general volume overload in the circulatory system, and water simply leaks out into the tissues. It shows up first in the lowest parts, as a result of the pull of gravity during the times the patient is partly or mostly upright.

An interesting "protective" effect of having water in the feet and legs is noted when a person with heart failure and edema lies down to rest. Since gravitational force is now equal throughout the body, the water is no longer limited to the legs and feet. It gets distributed elsewhere, including the lungs, where soggy tissue leads to shortness of breath. A patient with this symptom needs lots of help fast.

Remember osmotic pressure? It's what helps keep a lot of water inside arteries and veins where it belongs. In some types of liver and kidney disease osmotic pressure can't be maintained, allowing water to leak out into all sorts of places. Wearing elastic stockings won't prevent it or treat it. Support hose would result in skinny legs and feet, but puffy thighs and hips! Edema in these instances is a sign that bad things are happening. Help is needed, usually not with the same degree of urgency as is present for the heart patient we described above.

Here's a tag-ender for you. Some people, particularly women, will notice that their feet swell during hot weather. They are otherwise in perfect health and physically active. So what's going on? The easy answer is, "It's a hormone thing," which might or might not be true. If you take this symptom to your doctor, you may get a mild diuretic (not a great idea), advice to "cut down the salt" (a good idea), or a , "there-there" response (with "little girl" unspoken), ie "why are you wasting my time with this?" In this latter case, most varieties of mayhem directed at the doctor would be considered justifiable.