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Swollen Feet: Causes, Serious Signs and When to See a Doctor
Today let us briefly look at why leg swelling comes, whether you should take notice of it or not, when to take it seriously, what tests to get done, and how to recognise how serious it is.
1. Sitting or standing for a long time
The first cause: even if you sit for a long time, or lie down for a long time, you can get leg swelling, especially if you stand or sit for long. Suppose you travelled overnight by bus or train and sat the whole time; you can get swelling, because with gravity the legs swell a little. Normally, unless the muscles are active, blood does not go upwards. That is why the swelling comes.
The swelling increases towards the evening, and if you lie down and sleep well, it goes down again. This is common; it comes for everyone. If you want to test yourself, press on the shin bone of your leg. Small pits form. Many people get pits, but there is no danger; it is a normal thing. It comes in both legs, there is no pain, it comes to some extent and goes away. But if it comes too much, we should get it checked.
2. Venous insufficiency (weak leg veins)
The second cause is called venous insufficiency. In people who are heavy, damage can come in the leg veins. The heart is above and the legs are below, so usually water, or blood, keeps going downwards. The heart pumps from above, but from below, what pumps the blood up? When the leg muscles contract, some blood goes up and stops there, because there are valves. When you walk again, it goes up a little more, and again a little more. It moves like that, with a milking effect.
When those valves get damaged, the swelling stays down there. This too is more in the evening and a little less on waking up after sleep. It can be in both legs, but it comes even apart from travel. Then we should keep the legs elevated, use compression stockings, and consult a doctor once. This is also a common cause.
3. Medicines
The third cause is important: medicines. Leg swelling due to medicines is a very, very common thing.
- Painkillers: whatever type of painkiller you take, swelling can come. Some people get it with Dolo, with Ultracet, or with other painkillers such as Zerodol-P or Aceclo-P. Whichever one is taken, in susceptible individuals a single dose keeps the swelling for about 15 days. They forget they took the tablet, the swelling stays, and 15 days later they take it again for a headache or neck pain. It continues like that.
- Steroids: some people are given steroids for joint pains or take them for immunological conditions, such as Wysolone or Omnacortil. These can cause swelling too.
- BP tablets: the common one is amlodipine, sold as Stamlo or Amlong. Tablets with “AM” at the end, such as Telma AM, contain amlodipine. Not just amlodipine; other drugs in that category such as nifedipine or cilnidipine can also cause swelling.
- Some sugar tablets: glitazones such as pioglitazone can also cause swelling.
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So when swelling comes, the first thing to check is whether it is from the tablets we are taking. This type of swelling also comes in both legs and there is no pain. If it is like this, consult a doctor once and they will change the tablets you use. But if you simply stop the tablet yourself because of the swelling, problems can increase. So take a doctor's consultation and get the tablets changed; do not stop them.
4. Obesity
Swelling can come because of obesity. In heavy people it is harder for blood to go from below upwards, so weight itself can cause swelling.
5. Heart failure
Now the serious conditions. Fifth is heart failure. If the heart is not pumping properly, all the blood stays in the legs, so swelling comes. This also comes on both sides, but along with the swelling there is breathlessness, weakness and fatigue, more urination at night time, and weight going up. If there are problems like these, we should get the heart checked.
6. Kidney problems
Sixth is a kidney problem. Swelling can come even if the kidneys fail. How do we recognise swelling from kidney failure? What is the difference between heart failure and kidney failure? In heart failure, the legs swell from below upwards. In kidney failure, the eyes are puffy and the face is swollen too, along with leg swelling, and urine output reduces.
The reasons for kidney problems can be a urinary infection, high BP or high sugar. So if there is face swelling along with the leg swelling, it is usually related to the kidneys.
7. Liver cirrhosis
The seventh cause is liver cirrhosis. With it, albumin is low and that causes swelling. Along with leg swelling, the abdomen grows a lot. If you take alcohol and you have abdominal swelling along with leg swelling, get your liver checked immediately.
8. Pregnancy
For some people, the eighth cause: in pregnancy swelling can come normally. This also comes on both sides and is not dangerous. A gynaecologist will see you once and tell you.
Swelling on one side only
9. Lymphoedema
The ninth cause is called lymphoedema, what we call filariasis (bodhakalu). One side becomes very thick, the skin becomes thick, and even when pressed no pits form.
10. DVT (a clot in the leg vein)
The tenth cause is DVT, and with this we need to be a little careful. If blood clots form inside the blood vessels, pain comes along with the swelling, usually on one side. If that comes, we must treat it immediately. If the clots stay in the legs it is okay, but if they come out of the legs and go upwards into the circulation, they go through the heart into the lungs. That is very dangerous; it is called pulmonary embolism. So if one leg swells and pain comes, we need to go immediately.
11. Thyroid
The eleventh cause is a thyroid-related problem. This comes on both sides, but pressing does not leave pits. The metabolism becomes slow, there is constipation and you cannot bear the cold. If there are things like these, you can think of a thyroid problem.
12. Cellulitis (infection)
The twelfth comes on one side: cellulitis, an infection. How to recognise it? There is pain and swelling, but along with being warm, the leg becomes red. If the leg turns red like that, it is cellulitis. We must give antibiotics immediately; if the infection goes into the blood, it is dangerous.
Other causes
Swelling can come when the leg is injured, which we know immediately. Apart from this, it can come in people who take a lot of alcohol.
Some people have what is called idiopathic cyclical oedema. We do not know why it comes for them. It just keeps coming. Even after many tests, nothing comes out. Only after the doctor has looked for all the causes and found none should we consider it idiopathic.
For example, some people do not get swelling when they are in Karimnagar, but get swelling when they come to Hyderabad. They say the water did not suit them. They should also get tested once.
What you should do
- Notice whether you have been walking more than usual or sitting for a long time.
- If your weight is high, reduce it.
- If you are using the medicines I mentioned, meet the doctor once and get the medicines changed.
Tests doctors do
When you go to a doctor, they do a CBP, RBS, creatinine, thyroid and LFT. Along with these tests they do a scan of the legs once and an echo of the heart once. With these, liver problems, kidney problems, heart problems and anything else are found out.
Red flags: when to go to a doctor immediately
- If breathlessness comes along with leg swelling, go to a doctor immediately.
- If leg swelling comes on one side only with severe pain, it may be DVT; go to a doctor immediately.
- If it comes on one side with infection, red and warm locally, you should also go to a doctor.
Similarly, if the swelling has come newly and it is troubling you in any way, go to a doctor once. Swelling can have two kinds of reasons: an innocuous reason, or a serious reason. Doctors can determine which one quickly. So if leg swelling is persistent, go to a doctor once and get it checked.
In his words: the key point
Swelling with breathlessness, one swollen and very painful leg, or one red and warm leg needs a doctor immediately. If leg swelling is persistent, get it checked once.
Frequently asked questions
Is swelling of both feet after a long journey normal?
Yes. Dr. Mukharjee explains that sitting or standing for long makes the legs swell with gravity; it increases by evening and goes down after sleep. It is common and not dangerous unless it is excessive.
Can painkillers cause swollen feet?
Yes. In susceptible people a single dose of a painkiller can keep the legs swollen for about 15 days. Steroids, amlodipine-type BP tablets and pioglitazone can also cause swelling.
How do I tell kidney swelling from heart swelling?
In heart failure the legs swell from below upwards with breathlessness and weakness. In kidney failure the eyes and face are puffy too and urine output reduces.
When is leg swelling an emergency?
When it comes with breathlessness, when one leg is swollen with severe pain (possible DVT), or when one leg is red and warm (infection).
— Dr. M. S. S. Mukharjee
Senior Interventional Cardiologist
Pulse Heart Super Speciality Hospital, Miyapur, Hyderabad
This article is for educational purposes only and isn't a substitute for individualised medical advice. Talk to your own doctor before starting, stopping or changing any medicine.