Swollen ankles, feet and legs (oedema)
By the end of the day the foot no longer goes into its usual shoe, the sock leaves a deep mark, and pressing a finger into the shin leaves a dent that takes a…
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Medicines commonly prescribed for Swollen ankles, feet and legs (oedema)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 40 mgActive substance: furosemideManufacturer: Mabo Farma S.A.Prescription requiredDosage form: INJECTABLE, 20 mgActive substance: furosemideManufacturer: Laphysan S.A.U.Prescription requiredDosage form: TABLET, 40 mgActive substance: furosemideManufacturer: Aurovitas Spain, S.A.U.Prescription required
By the end of the day the foot no longer goes into its usual shoe, the sock leaves a deep mark, and pressing a finger into the shin leaves a dent that takes a while to fill in. That is oedema — fluid gathered in the tissues. Most of the time it is harmless and goes overnight, but occasionally it is the first visible sign that the heart, the kidneys, the liver or a vein is not coping. The difference between «I was on my feet all day» and «I need a doctor today» lies in the details, and that is what follows.
Why legs swell
The commonest causes are everyday ones, and then the swelling is even on both sides, soft, and gone by morning.
- Standing or sitting in one position for a long time — behind a counter, on a plane, in the car.
- Heat: blood vessels widen and fluid moves into the tissues more easily.
- A lot of salty food the day before.
- Excess weight and lack of movement: the calf muscles work as a pump, and without walking that pump stands still.
- Pregnancy, and in some women the second half of the cycle.
- Age-related changes in the veins: heaviness towards evening, a bursting feeling, thread veins, and swelling that clears overnight.
Medicines deserve a line of their own. Swelling comes with some blood pressure drugs (calcium channel blockers above all), hormonal treatments including the contraceptive pill and replacement therapy, steroid hormones, and part of the diabetes drugs and antidepressants. So do the anti-inflammatory painkillers — ibuprofen, diclofenac and the like — because they hold on to salt and water: with oedema, kidney disease or heart failure they are taken only with a doctor's agreement. None of these drugs should be stopped on your own initiative; the conversation starts with whoever prescribed them.
Illnesses can lie behind swelling too: heart failure, kidney and liver disease, an underactive thyroid, deep vein thrombosis, skin infection, damage to the lymphatic channels. It is not the swelling itself that gives them away but what comes with it.
One leg or both — what the difference tells you
This is the first question a doctor asks, and you can answer it yourself.
Both legs swell when the cause is general and fluid is being held throughout the body. That happens in heart failure (swelling starts at the feet and ankles, climbs upwards, is worse in the evening and comes with breathlessness), in kidney disease (the face swells too, particularly on waking, and the urine froths), in liver disease (the abdomen grows, skin and the whites of the eyes turn yellow), with too little protein in the diet, and with certain medicines.
One leg almost always points to a local cause, and that list is shorter but more dangerous: deep vein thrombosis, infection of the skin and the tissue beneath it, injury and, less often, a vein compressed in the pelvis or lymph drainage blocked after surgery or radiotherapy. A leg that swells suddenly is a reason to be seen the same day, not to watch and wait a week.
It is also worth noticing whether a finger leaves a pit. Soft swelling that pits means water has collected; firm swelling that does not pit, with skin that thickens over time and toes that look square, is usually lymphoedema, and it is managed differently.
When you cannot wait
Call an ambulance (across most of Europe, 112) if along with the swelling you get:
- sudden breathlessness or a struggle to breathe at rest;
- chest pain or a tight, heavy feeling in the chest;
- coughing up blood;
- fainting or feeling about to faint.
That can be a clot that has travelled to the lung. Do not drive yourself anywhere in that state.
See a doctor the same day, without putting it off, if:
- one leg has swollen within hours or a day, the calf aches and the skin is warm and tight;
- the skin has turned red, hot and painful and you have a temperature — that is how cellulitis and other skin infections begin;
- the swelling has come with breathlessness on slight effort or on lying down, and you have gained several kilograms in a week;
- you are passing little urine, or the urine froths or has gone dark;
- an ulcer or a weeping sore has opened on the skin;
- the swelling does not settle overnight, grows from day to day, or followed an injury.
Swelling in pregnancy
Mild swelling of the feet and ankles in the second half of pregnancy happens to most women, especially in the evening and in hot weather. It is not a disease, and rest with the legs raised, comfortable shoes and movement are usually enough.
There is one exception worth knowing about in advance. If the swelling comes on quickly, takes in the face, the eyelids and the hands, and is joined by headache, flashing spots or a haze in front of the eyes, pain under the right ribs or nausea, this may be pre-eclampsia — a rise in blood pressure that is dangerous for both mother and baby. That needs urgent assessment, not a wait for the next booked appointment. Swelling of one leg only during pregnancy also calls for immediate examination: the risk of clots is higher in these months than usual.
What you can do yourself
If there are no warning signs and the swelling comes on in the evening, simple things help.
- Raise your legs above the level of your heart for at least half an hour several times a day, lying down with a pillow under the calves.
- Move. Walking, circling the ankles, rising onto your toes while sitting at a desk — all of it switches on the calf pump.
- Do not stand or sit still for hours; on long journeys get up and stretch every hour.
- Cut down on salt: ready meals, cured meats, cheese, tinned food and sauces supply far more of it than the salt cellar.
- Wear wide, low-heeled shoes with a soft sole, and avoid tight socks whose elastic digs in.
- Compression stockings help with swelling of venous origin, but they should be chosen with a doctor: with thrombosis, severe heart failure or arterial disease of the legs they do not suit everybody.
What not to do is take water tablets on a friend's advice. They shift the water but not the cause, and in some situations they dehydrate and upset the body's salts. There is no need to restrict what you drink on your own account either.
Looking after the skin of swollen legs
Skin on a swollen leg is stretched, nourished less well and cracks easily; infection enters through the crack, and the result is exactly that hot red patch which sends you looking for urgent care.
Wash your legs daily, dry them thoroughly, especially between the toes, and use a moisturiser. Check feet and legs every day in good light for cracks, rubbed areas, redness and weeping. Cut the nails carefully and treat athlete's foot rather than putting up with it — it is a common way in for infection. Anyone with diabetes and reduced feeling in the feet needs this check more than anyone else, because pain there may simply not register.
What the doctor will look into
You will be asked when the swelling started, whether it affects one leg or both, whether it settles by morning, whether there is breathlessness, how your weight has changed over recent weeks, what medicines you take and whether there have been long flights, operations or injuries. Then come an examination of the legs, pressing on the shin, comparing the circumference of both, looking at the skin, listening to heart and lungs, and measuring blood pressure.
Everything else follows the suspicion rather than being ordered in a batch. Where thrombosis is suspected the key test is a duplex ultrasound scan of the leg veins; a D-dimer blood test helps rule it out when the probability is low, but on its own it neither makes nor cancels the diagnosis. For suspected heart failure there are an electrocardiogram, an echocardiogram and a natriuretic peptide test; for suspected kidney trouble, urine tested for protein and a blood biochemistry panel; for the liver, liver enzymes and an abdominal ultrasound. The thyroid and the blood protein level are checked as well.
How it is treated
What gets treated is not the swelling but whatever is causing it, so there is no single tablet for it.
- Venous insufficiency: compression, movement, legs raised, and sometimes a procedure on the veins.
- Deep vein thrombosis: blood-thinning drugs prescribed by a doctor and for a set period.
- Skin infection: antibiotics, rest and the leg elevated.
- Heart failure: treatment of the failure itself, including water tablets, less salt and weighing yourself at home.
- Kidney and liver disease: treatment of the underlying condition and the diet your doctor sets.
- If a medicine is to blame, the doctor will change it or lower the dose.
- Lymphoedema: compression, specialist lymphatic drainage massage, skin care and exercise; this swelling does not go away entirely, but it can be kept in check.
Losing weight and walking regularly help with almost any cause, because they take the load off both the veins and the heart.
Online consultation with a doctor
A remote appointment answers the first question well: which group you are in, «stood about all day in the heat» or «this needs investigating». From your answers the doctor will work out whether it is one leg or both, how the swelling behaves over the day, whether there is breathlessness and weight gain, will go through your list of medicines to spot the ones that hold fluid, will explain any tests you have already had and will say which investigations make sense and in what order. Compression stockings and skin care can be discussed here too.
The limits are obvious: over video no one can feel a calf, scan the veins or record a heart tracing. If one leg has swollen, if the skin is hot and red, or if breathlessness has appeared, an in-person examination is needed — and with sudden breathlessness, chest pain or coughing up blood, an ambulance.
This material is for information only and does not replace medical advice.
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