Bilateral pedal edema – Are both your legs swollen?

Dr Vivek Baliga Dr Vivek Baliga, Heart failure , , , ,

Pedal edema, also called leg swelling, is a common problem. Learn more about it in this article.

A large number of patients who come to see us at our practice often complain that their legs are swollen. The swelling is often painless but can be rather troublesome, interfering with their daily activity.

Swelling of both the legs due to accumulation of fluid is called pedal edema. There can be a number of reasons why a patient could develop pedal edema and in this article, we shall take a look at this a bit further.

What causes pedal edema?

bigstock-edema-25758464The most common reason why pedal edema develops is because of a reaction to inflammation or injury. Patients may notice that their legs are swollen if they have bumped up against a table, twisted ankle or have developed some form of skin infection.  Of course, these are not the only causes for pedal edema and it can result from a number of different medical conditions as well. Let’s take a look at this a bit further.

1. Gravitational oedema

Pedal edema can occur as a result of gravity. Sitting for long hours in one place (for example – a long flight or at an office desk) can result in fluid being drawn towards the leg due to gravity. This type of pedal edema is often seen late in the evening and completely disappears when waking up in the morning.

There is no specific treatment required for this as it often does not cause significant discomfort. If patients to find that it is uncomfortable, then it is best managed by keeping the legs elevated above the level of the hip if sat for long hours or getting up and walking around for a few minutes every couple of hours. In severe cases, a small dose of diuretics (water tablets) may help.

2. Heart failure

Patients who suffer from a weak heart are unable to pump blood effectively throughout the body. As a result, fluid oozes out of the blood vessels into the tissues under the skin. This results in pedal edema.

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Pedal edema is a lot more severe in patients who have heart failure, especially if the symptoms are poorly controlled and that treatment is not sufficient. It can cause mild discomfort in the legs and patients often state that their legs  are heavy and painful. On examination, both legs may be swollen all the way from the toes up to the knee or even up to the hip in some cases.

Treatment is offered in the form of diuretics and compression stockings. Patients are advised to keep their legs elevated above the level of the hip when they sat down at home. This helps keep the leg swelling down.

3. Low blood albumin levels

In some cases, patients who have low blood albumin levels can develop leg swelling. Albumin is a type of protein that is present in the blood that helps hold fluid in the blood vessels.  When the levels of albumin are low, fluid can seep out of the blood vessels and cause pedal edema.

4. Pregnancy

Pregnant women can sometimes develop mild pedal edema which often gets better after the baby is born. It occurs because the enlarging womb can compress the blood vessels causing them to leak out fluid. In addition, the amount of blood within the mother’s body also increases.

In the rare cases, women who are pregnant may develop certain complications such as blood clots in their legs or high blood pressure. This can also cause swelling in the legs and requires treatment.

5. Liver and kidney disease

Patients who suffer from liver disease or kidney disease can develop low albumin levels in the blood. This occurs because the liver is not producing enough albumin and the kidney is allowing albumin through into the urine ( normally there should not be any albumin in the urine).

6. Blood clots and tumours

Patients who develop blood clots in their legs (called deep vein thrombosis) can also develop swelling in the legs. These blood clots can occur due to a variety of reasons including keeping the legs immobile for many hours, recent fracture, or problems with the blood clotting mechanism itself. Patients who have a tumour within the abdomen can also develop leg swelling, particularly if the tumour is compressing on any blood vessels.

7. Drugs

Certain drugs such as calcium channel blockers (amlodipine), painkillers such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) and steroids can cause leg swelling. In most cases, these are just mild and do not cause any major problems to the patient’s health. In the event that they do, stopping the drugs will reverse the swelling.

8. Skin allergy or infection

Sometimes patients can develop leg swelling as a result of a skin allergy or an infection of the skin and its underlying tissues (called cellulitis). Patients may require antibiotics to treat this.

In a nutshell, the causes of pedal edema include –

Causes of Leg Swelling
  • Gravitational
  • Pregnancy
  • Heart Failure
  • Liver disease
  • Kidney disease
  • Blood clots (Deep vein thrombosis)
  • Drugs – Amlodipine, Steroids, Painkillers
  • Skin allergies or infection (cellulitis)

How is leg swelling treated?

The treatment of leg swelling depends on the cause. Patients who have developed swelling due to drug treatment they are on may require a change in tablets. If it is due to heart failure, then they may need more diuretics (tablets that help get rid of fluid). An infection will require antibiotics. A blood clot will need blood thinners.

In some patients in whom there is no clear cause for leg swelling and is likely due to gravity, compression stockings compression stockingsmight help. These are tight stockings that are custom made for the individual patient, and fit tightly around the foot and can extend all the way up to the hip if it is needed. They help promote blood flow and circulation in the leg, acting as a ‘pump’ to push blood back to the heart, thus reducing leg swelling. As is the case with any treatment, it is essential to obtain medical advice before wearing these, as there are some conditions in which it should be avoided, such as poor circulation in the leg.

A detailed discussion is out of the scope of this blog post, but the bottom line is this –

Businessman indicating up speech bubble with index finger

Leg swelling could indicate an underlying medical illness that needs treatment.If you are suffering from leg swelling that is either new or is getting worse, then ALWAYS seek medical advice from your doctor.

What do I do if have leg swelling?

If you are suffering from leg swelling, there are only a few things that you can do to manage it at home. However, in most cases, it is essential to see a doctor to find out why it has happened.

1.  Keep the legs elevated

Keeping the feet elevated above the level of the hip can help push the fluid out of the legs back to the heart. At night, keep a small pillow under the feet when sleeping.

2. Stay mobile

Avoid sitting or standing in one place for too long. If you work a desk job or stand for long hours, then make sure you move around every hour for a few minutes. Perform some foot rotation exercises and knee bending. Not only will this prevent stress on the joints, it will also help reduce swelling as the effect of gravity is decreased.

3. Keep hydrated 

This helps maintain good circulation. Make sure you seek advice from your doctor regarding how much fluid you can consume in a day. Patients with heart failure are advised fluid restriction, so ALWAYS make sure you discuss this with your doctor.

4. Low salt diet

In some patients, reducing the amount of salt in the diet can help reduce swelling. Talk to your doctor regarding this before you start any sort of diet.

When to get help

If you notice that your legs are swollen for any reason, it is not normal and needs looking into. It may well be gravitational and may not require treatment, but it is always a good idea to see a doctor if you have leg swelling. This way, the cause for the swelling can be identified, and timely treatment can be given if necessary.

In case you already suffer from leg swelling and find that it has become worse, arrange to see your doctor as soon as possible. If you find that you are becoming breathless as well or are not passing enough urine (a lot less than normal), then you may need treatment.

Conclusion

Leg swelling can indicate an underlying medical illness, and can be the first sign of it in many cases. Getting prompt treatment is important, and the type of treatment depends on the cause. If you have noticed your legs swelling up, make sure you see your doctor about it.

Dr Vivek Baliga
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About the author

Dr Vivek Baliga

Dr Vivek Baliga is a consultant physician with an interest in the management of diabetes and heart failure. He is the author of multiple health articles on this site and his blog 'HeartSense' (http://heartsense.in). In his spare time, he enjoys web designing and spending time with his family.

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