Edema is the medical term for swelling. It can have different causes. It can be cardiovascular if the heart, arteries, or veins are not working properly. It can be the result of inflammation following a trauma or chronic injury.
Fluid can build up in the legs and feet if the heart is not pumping efficiently. Weak heart muscle, a leaking heart valve, or insufficient blood supply to the heart itself can cause the heart to not pump effectively. The arteries which are responsible for carrying blood to the body can lose their elasticity, be hardened by cholesterol and fatty plaque build up, or narrowed by a long history of nicotine use.
Veins which are responsible for carrying the blood back to the heart rely on their valves to prevent blood from flowing backwards. Over time, the valves can stretch apart and lose their ability to prevent backflow. This is when we can see spider veins or varicose veins, and it can contribute to swelling due to fluid backup.
Typically, if swelling in the legs or feet is due to cardiovascular reasons, it is symmetrical. That is, it involves both legs pretty equally. When swelling is one sided and there is pain in the calf muscle, this could represent a DVT (deep vein thrombosis — also known as a blood clot). The clot can dislodge from the leg vein and travel to the lungs or heart where it can reduce or prevent breathing or cause a heart attack or stroke. These events, of course, can lead to death. That is why any new or sudden swelling, especially if it is accompanied by pain, should be evaluated immediately.
As mentioned, swelling can also be a sign of inflammation. It can be part of a widespread inflammation, such as an infection or autoimmune disease. These would be expected to be accompanied by other signs and symptoms, such as fever, chills, joint pain, and elevated lab values. These causes involve some investigation to determine.
Inflammation due to an injury — whether sudden or chronic — usually involves just one side and has pain which can be localized. That is, the part that is injured will be painful. You may think of what happens when you hit your shin or turn your ankle — that area hurts and swells after the injury.
Chronic injury can occur if a body part is working under strain. People with flat feet, for instance, can get tendonitis in the major muscle supporter of the arch as it attempts to support the collapsing arch. This can occur at any time in the life of a flat-footed person but often occurs after years of wear and tear.
Sudden pain and swelling in one or both legs, especially if there is redness with it, will probably result in a trip to the emergency room. If swelling with or without pain has been coming on gradually or you are being seen for your feet, your podiatrist can help determine what the cause may be and what first line of investigation is most appropriate.
Your physician may order an arterial or venous Doppler if a circulation problem or clot is suspected. If your physician determines that you have an injury to a part of the foot or ankle, she or he can provide a treatment regimen to include possible prescriptions, bracing, and physical therapy. They can also refer you to a peripheral vascular surgeon, cardiologist, or other appropriate specialist if the cause appears to go beyond the foot and ankle.
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