Explainer: How to know if the swelling in your leg or ankle is normal? Experts answer – Times of India

36-year-old Prisha Singh noticed a strange swelling in her legs and ankle when she could not fit in her sneakers. She dismissed it and thought it was fluid retention or fatigue but when the swelling did not subside even after many days she booked a doctor’s appointment. It turned out that her kidneys needed attention.

Swelling of the feet, otherwise known in medical terminology as edema, is a common problem that people encounter. Many of us would have experienced some swelling of the feet usually after a period of long exertion or after a strenuous journey. “As most of us are aware, edema in the feet can be a simple benign thing or a harbinger of severe organ dysfunction that requires medical attention,” explains Dr. Subhash Chandra, Assistant Professor, Internal Medicine, Amrita Hospital, Kochi.

Dr. Allwin James D, MD, (Gen.Med) DM., (GE) Consultant, Meenakshi Mission Hospital & Research Center adds, “Mild edema usually goes away on its own, especially if you speed things up by raising affected limbs. above your heart.Medications that help your body eliminate excess fluid in the form of urine can be used to treat more severe edema (diuretics) .Furosemide is one of the most commonly prescribed diuretics.But based on your unique medical history, your doctor will assess whether These types of medications are right for you. ”

However, sometimes this swelling is not benign and can be an indicator of a major underlying health problem. Dr. Varun Verma, Deputy Director – Nephrology, Max Hospital, Patparganj shares, “Ankle swelling can be a marker of kidney disease. It usually signifies protein leakage in urine. It is possibly the first sign of kidney disease.” However, patients with heart failure, CLD or hypothyroidism may also have such swelling, but history and laboratory work may differ between these conditions. “I would recommend a visit to your doctor and an appropriate evaluation if you have this symptom. If you have any such findings, please have your urine evaluated. I would recommend a urine test along with a urine stain protein creatinine ratio. I would also recommend a detailed kidney function test and ultrasound. of the abdomen. I would also suggest thyroid profile, HBA1C, liver function tests and 2D echo. ”

Harmful swelling of the feet can also be due to certain medications, especially medicines used to treat high blood pressure such as calcium channel blockers Amlodipine, cilnidipine and vasodilators such as prasozin and hydralazine. Mild lymphatic dysfunction due to congenital causes can also cause a slight edema in the feet.

Warning signs that the swelling in the feet is ominous include a feeling of shortness of breath in connection with edema, a decrease in the amount of urine you produce, enlargement of the abdomen that occurs together with edema and what is associated with yellowing of the eyes and urine. Some other signs that the edema is dangerous include edema in a limb that occurs after surgery or a long journey. Edema accompanied by pain and redness in the leg that is painful to touch can indicate an infection in the legs called cellulite, adds Dr. Chandra.

Is your swelling linked to fluid retention?


Water retention is usually the result of water intake that exceeds our urine production. This may be the scenario in patients with chronic renal impairment who have reduced urine production but accidentally consume large amounts of water in the belief that they are helping their kidneys. Decreased urine output may also be due to a lack of compliance with medications designed to increase urine output such as diuretics that may have been prescribed by your doctor. Extremely reduced salt intake in the diet can also lead to fluid retention as the kidneys require a minimal amount of salt to excrete water in the urine.

The link between swelling and heart, kidney or liver dysfunction

Swelling of both legs may indicate severe heart, kidney or liver dysfunction. People who have previously had chest pain or have suffered a heart attack may develop edema at a later time due to heart failure. Such edema is accompanied by significant fatigue, shortness of breath on exertion and swelling of the abdomen. This edema occurs due to defects in the heart’s pumping mechanisms that lead to significant back pressure and congestion in the venous circulation, which in turn causes edema. This edema also occurs after a period of effort and can mainly be seen in the evenings, adds Dr Chandra.

Another mechanism of edema is an underfilling of the arterial circulation due to heart pump failure that activates certain hormones in the kidney called the renin-angiotensin system. Activation of this system leads to sodium and water retention in the kidneys and eventually edema.

Edema can also occur due to kidney failure. This edema is usually accompanied by facial swelling more towards the morning. Signs that edema is kidney related include decreased urine production, very high blood pressure and significant frothy urine, especially in the morning. Sometimes blood in the urine can also indicate renal causes of edema. Edema can be seen in patients with chronic renal failure where the basic excretory function of the kidney is severely impaired so that it can not eliminate urea and other toxic metabolites and get rid of excess water. Renal edema also occurs in a condition called nephrotic syndrome where large amounts of protein are lost in the urine, especially albumin. This protein is what maintains oncotic pressure in the blood vessels that holds fluid in the blood vessels. With the loss of oncotic pressure, the fluid seeps out of the blood vessels and causes edema. A similar mechanism occurs in cirrhosis and liver failure where the protein is not produced in sufficient quantities by a failing liver. Edema due to liver dysfunction may be accompanied by jaundice where there is yellow discoloration of the eyes and urine. Patients with a history of heavy alcohol use, obese individuals and people with hepatitis B and C infections are people who are most likely to develop liver damage-related edema.


Tests to rule out health problems


Patients with edema with the above symptoms must undergo tests to determine if they are suffering from organ dysfunction or other problems. Routine blood tests would include a complete blood count to assess if the patient has significant anemia as very low hemoglobin itself can cause heart failure. Other studies include kidney function tests that include blood urea and serum creatinine. Urine routine may indicate the presence of blood or protein in the urine as well as a 24-hour urine protein or a urine protein creatinine ratio may tell of heavy protein urea as a potential cause.

Liver function testing is done to check albumin and globulin levels as well as liver enzymes such as SGOT, SGPT and alkaline phosphatase that can shed light on ongoing liver damage. ECG and 2D EKHO are also performed to assess the heart’s pumping capacity, ejection fraction, structural abnormalities, regional wall movement abnormalities that contribute to cardiac edema. Blood tests for heart failure, including GDP or the brain’s natriuretic peptide, are also performed where high levels indicate heart dysfunction. Other tests include a thyroid function test because hypothyroidism is another common cause of edema in both legs.

A unilateral swelling of a bone requires examinations such as a venous ultrasound Doppler to look for thrombosis in the deep veins of the bone, a dangerous condition called DVT or deep vein thrombosis. Other tests done for unilateral swelling would include a blood test to rule out infection, especially if there is pain and redness over the swollen foot. In Kerala, unilateral swelling of the feet can also be due to filarial infection that leads to a dysfunction of the lymphatic vessels that helps transport fluid back to the breast. This justifies examinations such as lymphoscintigraphy that tell of some lymphatic dysfunction in the arms and legs, Dr. Chandra develops.

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