HEALTHWATCH
Are your feet swollen?
DR HIRAMALINI SESHADRI
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Often just keeping your feet up may be the solution but it’s not always innocuous.
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Photo: AP
Recently, after an eight-hour drive I noticed that my legs were swollen. How come?
Well, being on the wrong side of 50, early varicose veins, tucking into salty pickles… all had a role, I knew !
Anyway, that night I just put my feet up at a nice 45 degree angle and slept. Come morning and the oedema was gone.
Swelling of the feet is a common problem for many and often, simply putting up your feet can solve the issue; but not all swollen feet are so innocuous!
If you find that your feet don’t fit into your shoes anymore or that pressing down with a finger leaves a ‘pit’ on the leg or foot, you need to check it out.
Causes
Some of the not-so-nice causes of swollen feet are long-term lung problems, a failing heart and cirrhosis of the liver. These conditions result in fluid overload; and fluid always collects most at the bottom i.e. in the feet.
In bedridden folk, by the same card, fluid collects at the back. A porous kidney that lets out all your protein, as in nephritic syndrome, also causes oedema.
Normally it’s the protein in the blood that keeps the water of blood inside blood vessels. When this protein is lost water leaks out of blood vessels as it were and oedema develops.
Severe protein deficiency as in kwashiorkor causes swelling by the same mechanism.
Hypothyroidism often presents with swollen feet as the body retains excess water in thyroid deficiency.
Certain other hormones can cause swelling too; women on hormone replacement often develop oedema. Premenstrual tension can also cause swelling; with the period the oedema vanishes !
Pregnancy itself is probably the commonest cause of oedema in women; it is usually harmless but when combined with a high blood pressure, could be the beginnings of pre-eclampsia.
In certain parts of India filariasis is a common cause of leg swelling. Usually however, it picks on one leg; though one does see the odd case of bilateral filariasis.
A potentially dangerous cause of swollen legs is thrombosis of the deep veins of the legs.
Women are more vulnerable; long hours of air travel (or even a car drive!), post-op ‘rest’, taking hormone tablets(even oral contraceptives) makes one prone to it. Trouble starts if a bit of the clot breaks loose and gets stuck in the lung or heart or brain circulation! In hospitals prevention of deep vein thrombosis in bedridden patients gets top priority.
Old age and anaemia are two other common causes of swollen legs and feet. Immobility spells swelling; and mobility generally comes down in old age.
Just why anaemia causes swelling we do not know ; but many anaemic ladies tend to have swollen ankles.
Medicines, like certain tablets for high blood pressure, pain killers and hormone tablets can also cause swollen feet. Rheumatoid arthritis, gout, scleroderma, psoriatic sausage toes, sprains, trauma, fractures and the like can cause swelling too; but they usually come under the painful swollen feet category.
The take home message is that if you find your feet don’t fit into your shoes any more , or if pressing down with a finger leaves a depression in your leg, see your Doc!
Treatment
What’s the treatment? Depends on the cause! But a good rule of thumb is to cut back on salt, make sure there is enough protein in your diet, putting up your feet, walking regularly and getting into right weight. If prone to swollen feet, definitely use support stockings if you are taking a long flight.
Soaking your feet in concentrated salt water for a while helps too; it reduces swelling osmotically. You must have noticed that wading in the beach long enough makes your footwear ‘loose’.
The most at risk are pregnant software engineers; sitting at a computer for hours on end with a swollen tummy as well, often proves to be a double whammy.
The illiterate village-woman who squats and has to walk to get firewood, fetch water and so on is better off. Researchers have found that swollen feet are part of the price we pay for ‘civilization’. Aboriginals, forest tribals, and simple village folk who live far away from ‘civiliSation’ have less of this problem !
The writer is Senior Consultant, Holistic Internal Medicine and Rheumatology, Chennai. E-mail: hiramalini@yahoo.com
Photo: AP
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