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Swollen feet can be a normal inflammatory reaction due to overuse or a strain—the result of taking a bad step, for example. But swollen feet can also indicate a life-threatening medical condition, such as congestive heart failure. It’s important to determine whether there’s a known cause (like stepping in a hole) or if there are symptoms (like shortness of breath) in need of a physician’s attention.
If you’re experiencing swollen feet, it may be nothing to worry about (see the “‘Normal’ Swollen Feet” section below). But it also could indicate a serious issue. So ask yourself these questions:
- Has the swelling been ongoing (as in, has it been there more than 24 hours)?
- Is the swelling worsening, and spreading up your leg, and are your feet are getting bigger?
- Do you have other symptoms, such as fever, bruising, shortness of breath, dizziness, lightheadedness, confusion, or pain?
- Is the swelling non-pitting, meaning you press on it for 10 or 15 seconds and the indentation doesn’t stay?
If you answered yes to any of these questions, you need to make a doctor’s appointment. If you answered no to these questions but you’re not certain why you’re swelling, you still should talk with your doctor.
And if you also have symptoms like chest pain, shortness of breath, or dizziness, you need to get to an urgent-care facility or emergency room now. Just four to six hours can make a difference in your heart health.
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Reasonable Swollen Feet
Sometimes swelling makes sense. Swelling is a natural component of inflammation—the redness, heat, and swelling is your body’s first step in the healing process. So, if you’ve been standing or walking for an unusual amount of time or you strained your ankle, some swelling is normal. You may also see edema in your feet and ankles due to obesity, although it’s wise to report that to your doctor.
Swelling is an accumulation of fluid in the tissues—edema. Most swelling is “pitting,” meaning you can press on it for 10 or 15 seconds and see the indent. An example of pitting edema: the indents our socks leave in our skin when we remove them. The swelling is slight.
Some women experience “idiopathic” edema during pre-menstruation or pre-menopause. Idiopathic simply means something occurs in our body without an underlying disease.
Non-pitting edema can be difficult to treat. It may indicate a problem with your lymphatic system or venous system. The swelling may be due to some type of internal pressure.
It’s important not to simply blow off any type of swelling. According to a 2015 report from the European Society of Cardiology, one in five people will develop heart disease, but most people don’t know that the two main symptoms of heart failure are leg swelling, starting at the feet and moving up through the ankles, and becoming breathless, especially when lying down flat, such as at night.
FIRST AID FOR SWOLLEN FEET
Applying first aid is an intelligent first step for swollen feet, especially if you’re aware of the cause. Apply first aid in the form of PRICE:
P: Protect the area
R: Rest your feet
I: Ice or a cold pack can help take down the swelling
C: Compress the area by properly applying a compression bandage
E: Elevate your feet to a level where they are above your heart
Some patients also report that massaging the swollen area helps reduce the severity. If you do not see some improvement in 24 hours, you should consult your physician.
Red-Flag Swollen Feet
Bilateral swelling—both legs—often indicates a systemic cause, such as congestive heart failure. It also could be as simple as your body retaining water.
Unilateral swelling—one leg—is usually due to a localized problem like deep vein thrombosis, a blood clot, or lymph problem. These are dangerous conditions. Swelling that increases dramatically over a short period of time, doesn’t resolve in 24 hours, or doesn’t improve with first aid (see sidebar) warrants medical attention.
Any swelling that includes redness, blistering, or pain is not normal. Swelling that is great enough to make your shoes feel tight is not normal.
If you find you cannot walk comfortably, that your feet also feel numb or “tingly,” or if your attempts at first aid (see sidebar) do not bring improvement within 24 hours, seek medical attention. Also, if your swollen feet seemed to have occurred as you started a new medication, consult your doctor immediately.
Many life-threatening illnesses are associated with swollen feet, including:
- Allergic reactions
- Blood clots
- Cardiac disease
- Cervical cancer
- Congestive heart failure (CHF)
- Deep vein thrombosis (DVT) or other vein abnormality
- Hormonal imbalance
- Kidney (renal) disease
- Liver (hepatic) disease, such as cirrhosis
- Obstructive sleep apnea
- Preeclampsia in pregnant women
- Pulmonary hypertension
These conditions warrant prompt medical attention. Yes, there are other symptoms related to these problems, but you may not be aware of the relationship. Don’t take the chance.
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When you visit your doctor, he or she will ask specific questions to formulate the history of the problem and determine if you have other symptoms. Anything you can tell him or her about when and where you first noticed the condition can make a difference.
The physical examination will include inspection of the swelling for texture, heat, tenderness, and pitting. Your doctor will listen to your heart and lungs and take your temperature and body weight.
The doctor will order lab tests—a urinalysis, complete blood count, and blood chemistries, for example. You may need a radiograph (x-ray), sonogram, MRI (magnetic resonance image), or EKG/ECG (electrocardiogram).
Treatment depends largely on the cause of your swollen feet, although diuretics, a.k.a. “water pills,” and a reduction of sodium in your diet are likely early steps. You also may be advised to wear compression stockings.
This article was originally published in 2018. It is regularly updated.