Swelling over the feet, known as pedal edema, is not uncommon and can occur due to various causes. It is often a worrying condition and may generate anxiety. However, it is usually treatable if detected early and managed appropriately. Timely identification and treatment of the underlying cause can cure it. ALSO READ: Is your weakness linked to high blood pressure? Normally, the fluid volume inside the body is maintained at a constant level by various physiological forces. Any disturbance in these mechanisms can result in edema. It is usually visible to the naked eye, and a finger pressed over the swollen area may leave a temporary indentation. ALSO READ: Understanding Eczema and its triggers Edema may develop in one foot or both. Unilateral edema is most often due to acute or chronic infection, blood clots in the leg, lymphatic obstruction caused by infection or cancer, trauma, and similar conditions. The swelling may remain confined to the foot or spread to the entire leg if the underlying cause persists. The cause can often be identified through physical examination and investigations such as cardiac, liver, kidney, and thyroid function tests. Treatment is then directed at the underlying condition. ALSO READ: Polycystic Ovarian Syndrome: The overlooked cause of infertility in women Bilateral pedal edema may occur due to disorders of the heart, liver, kidneys, thyroid gland, or protein malnutrition. These conditions alter the hemodynamic forces that maintain fluid and electrolyte balance, leading to fluid accumulation in the lower limbs. ALSO READ: How jogging boosts your body and mind In heart failure, edema typically appears in both feet after walking and later becomes persistent. As the disease progresses, it may extend to the legs, face, and entire body. The face may appear puffy, and the abdomen may become distended. In kidney failure and protein-deficient states, swelling in the feet usually appears in later stages. ALSO READ: How alcohol affects blood vessels: The link to peripheral vascular disease Fluid may also accumulate in the lungs or even around the heart in severe cases of these conditions. This presents as breathlessness on exertion and, in advanced stages, even at rest. Patients may find it difficult to lie flat, as breathlessness worsens in the supine position. Middle-aged women may develop pedal edema due to hormonal changes. This is generally a benign condition and resolves spontaneously after menopause. However, other underlying medical conditions should always be ruled out through appropriate evaluation. Swelling over the feet should not be taken lightly. A seemingly minor symptom may progress and lead to irreversible damage. Once edema spreads from the feet to the entire body, the functioning of the heart and lungs may become compromised. However, if diagnosed early, the underlying condition causing bilateral pedal edema can often be effectively treated. Protein deficiency can be assessed through clinical signs and blood protein levels and is reversible once corrected. Pedal edema can often be diagnosed clinically through a detailed history and physical examination. Relevant investigations help confirm or rule out underlying conditions. Dietary salt restriction is useful in managing pedal edema. However, complete elimination of salt may lead to muscle cramps and weakness; therefore, balance is important. Diuretics - commonly known as water pills - which promote the removal of excess fluid and salt from the body, are used in the treatment of edema. When used for prolonged periods, edema may sometimes become refractory, requiring higher doses. The risk of side effects such as electrolyte imbalance, muscle cramps, tinnitus (ringing in the ears), and photophobia may also increase. Thus, a vicious cycle may develop, where the patient becomes dependent on diuretics while also experiencing adverse effects. Rest reduces the body’s metabolic demand, thereby decreasing strain on the affected system and helping relieve symptoms such as breathlessness associated with edema. Ultimately, the definitive treatment is management of the underlying cause. Therefore, if swelling of the feet is noticed at any time, it should not be ignored and should be evaluated promptly. The writer is a specialist in internal medicine.
