Swollen Leg & Swelling of the Feet, Ankle & Toes

Swelling of the leg may involve a noticeable distension of the shin or calf, ankles, feet or toesFoot swelling may be a common occurrence which most of us will experience at some point in life after a long day of standing or sitting but may also be an indication of a more serious pathology as in certain cardiovascular disorders.

Recurrent or persistent swelling of the feet should be investigated by a medical practitioner especially if you have a history of cardiovascular disease or have noticed a change in color, sensation or mobility of the leg, foot or toe.

Blood rich in oxygen and nutrients flow through the arteries to the target area. Blood carrying deoxygenated blood returns to the heart via the veins where it is quickly routed to the lungs to be replenished with oxygen.

Blood flowing to the leg has to return to the heart through a group of veins with intermittent valves located throughout the course of the vein. This venous blood (blood in the veins that is returning to the heart) has to flow against gravity and since the pressure is usually lower at the feet, other muscles of the leg assist with ‘pumping’ this blood back to the heart. This muscle pump is most active when we are walking and least when we are standing stationary or sitting. Blood travels short distances up the vein and back flow of blood is prevented by a series of valves in these veins.

Working alongside the blood vessels are the lymphatic vessels which returns lymphatic fluid (lymph) back up the body to empty into the blood system.

Swelling of the leg usually occurs as a result of inadequate flow of blood or lymphatic fluid back up to the torso of the body. However other localized causes may further contribute to swollen feet, ankles or toes.

Causes of a Lower Limb Swelling

1. Inflammation

  • Injury
  • Allergies
  • Insect bites
  • Exertion
  • Phlebitis
  • Lymphedema
  • Baker’s Cyst

2. Infection

  • Cellulitis
  • Venous ulcers
  • Diabetic ulcers
  • Athlete’s foot – severe cases of tinea pedis followed by secondary bacterial infection may cause swelling of the feet.

3.  Obstructed or Impaired Blood Flow

  • Varicose veins
  • Peripheral vascular disease
  • Thrombophlebitis
  • Deep vein thrombosis (DVT)

4. Systemic & Miscellaneous Causes

  • Generalized Edema (edema throughout the body) or Idiopathic Edema (edema due to unknown cause)
  • Congestive cardiac failure
  • Kidney failure
  • Liver failure or cirrhosis of the liver
  • Rheumatoid Arthritis
  • Gout (swelling of the toes)
  • Pregnancy – refer to Pregnancy Leg Swelling
  • Immobility
  • Prolonged standing or sitting

Symptoms

Swelling of the lower extremity may be clearly visible or detected as pitting edema and may be accompanied with other symptoms (concomitant).

  • Distortion of the anatomy of the leg, foot, ankle or toe.
  • Pain (claudication is pain of the calf muscle upon strain or intermittent)
  • Numbness or tingling.
  • Pale, red, blue to purple or black discoloration.
  • Itching with or without a rash.
  • Excessive warmth or cold and clammy skin.
  • Impaired mobility either due to loss of muscle control or weakness.

Diagnosis :

Swelling of the leg, foot, ankle or toes may be clearly visible and if one sided (unilateral), it should be compared to the other limb to verify the swelling. In cases of pitting edema, pressure with a finger on the swollen area will leave a finger imprint for a few seconds to a few minutes after the finger pressure is discontinued. There are two pedal (foot) pulses that are palpable, the dorsalis pedis pulse can be felt on the top of the foot or the tibialis pedis pulse which can be felt on the inner ankle. Feint or absent pulses may assist with identifying any factors reducing or obstructing blood flow.

A swollen leg may be indicative of other pathologies and further investigation may be required.

Treatment :

Treatment is dependent on the cause of the swollen legs, feet, ankle or feet.

  • Diuretics may be useful for water retention (edema) especially in generalized edema as it increases the passing out of fluid. It is not advisable for women who are pregnant or recently given birth to use diuretics unless advised by their medical practitioner.
  • Antibiotics may be required for infections. Antimicrobial creams, gels or sprays may be useful for treating venous or diabetic ulcers.
  • Anti-clotting or anti-coagulating agents like warfarin may be useful for thrombophlebitis and deep venous thrombosis (DVT).
  • Anti-inflammatory drugs may assist with pain and inflammation or rheumatoid arthritis.
  • Corticosteroids may be useful for allergic or autoimmune causes of a swollen leg, foot, ankle or toe.
  • Anti-gout drugs are necessary for long term management of gout which can cause a painful swelling of the toe, especially the big toe.

Management :

Management should be directed at the causative factors and it is advisable that you seek advice from your medical practitioner before you attempt to manage your swollen legs conservatively.

  • Walking or moving your legs, feet or toes may assist with swelling when standing stationary or sitting for long periods. This is especially important for frequent flyers and those prone to deep venous thrombosis as the long flights and restricted space can aggravate DVT and swelling of the legs.
  • Varicose vein sufferers may benefit from the usage of compression stockings. However it is usually not advisable to use compression stockings if you suffer with peripheral vascular disease as this may aggravate or complicate your condition. Consult with your medical practitioner before using compressions stockings for your swollen legs.
  • Raising your legs to body level when sitting can assist with swelling but be cautious about elevating the legs significantly higher than the torso when sleeping. This is not advisable in certain conditions affecting the heart, liver or kidney. Medical advice should be sought.
  • Reducing your salt and electrolyte intake (low sodium diet) may be advisable in certain conditions (like kidney failure) although this diet may not directly reduce leg swelling.

Related Articles:

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  • Dr. Chris

    Hi Kathryn

    This sounds very much like peripheral vascular disease. Ask your doctor for a referral to a physician, who can assess and treat both conditions. You may need to see an orthopedist (orthopedic surgeon) for the tear and stenosis and he may refer you to a vascular specialist (vascular physician/surgeon) for further assessment if necessary.

  • Dr. Chris

    Hi Sgrover

    Your father needs to see a medical specialist. He may have PVD (peripheral vascular disease) and an infection may be ongoing. Of course, it could also be a skin disease and a secondary bacterial infection. It is difficult to say without seeing it in person. The fact that this has been ongoing with little improvement and no change in therapy is being considered should prompt you to seek a second opinion, preferably from a specialist. Consult with a specialist physician and probably a dermatologist as well.

  • Kyna

    I banged my knee at work on the edge of my desk, and my leg from the knee down is swollen. It’s been a week & 2 days now & I can’t walk at all without my crutches. I have had a ultrasound and no blood clots were found. I also had an MRI, the results showed just a bruise on my knee. My foot is completely swollen & it stays freezing cold, is there any other test I should have done, how long will it take for me to walk again?

  • Dr. Chris

    Hi Kyna

    An ultrasound and a MRI are the correct imaging techniques that should have been done. The cause of the swelling would most likely be a blood clot and even if it has not been identified at the time of these investigations, you should have it repeated should this condition persists. The fact that it is cold and you do not have any indication of a fever or other signs and symptoms of an infection still makes a blood clot the most likely diagnosis. If the swelling is not going down, you will have to go back to your doctor for further investigation. It is difficult to say how long it will take to walk again without knowing the exact cause of your symptoms. It is unlikely just a case of trauma to the knee unless you had some other pre-existing condition or there is more to the situation than you are aware of.

  • Jenny

    Dr. Chris,
    I am a relatively healthy 42 year old woman who is maybe 20 lbs. overweight. Up until June of this year I was running 3-4 times per week for 3-4 miles at a time. I use good running shoes and walk before and after the run to warm up/cool down. In June I ran a 5K race and really pushed myself to get a good time. After the race I noticed some pain and slight swelling right behind my left ankle bone. I rested my leg for about a week and a half and then tried another run. The pain returned so I stopped. I didn’t run then all summer as I waited for the swelling to go down. Finally in September I was able to begin walking and then a little running without any discomfort. Last week I ran twice, the first time on cement with no side effects and the second time on a trail. After the second time, I spent the day in unsupportive shoes doing a lot of walking and that night my feet were swollen huge, the left one larger than the right. I rested again and about three days later I cleaned my house in flip flops and that night my feet were huge again. I saw my doc yesterday and their first fear was a blood clot, but the ultrasound showed nothing. By last night they were huge again. I have no health issues although lately I’ve noticed I’ve been more tired than usual, thirsty, nauseous, achy and moody. Some of these symptoms I attribute to withdrawing from a DepoProvera shot I had in June, but I can’t figure out why my feet are always swelling. I’m not sure if I should continue to hound my regular doc for tests for diabetes and heart disease or if I should go to a sports doc to look for an injury. I should also mention that I wore flip flops a lot this summer and then I switched to Tevas and tennis shoes and noticed the swelling behind my ankle went down quickly.

  • Dr. Chris

    Hi Jenny

    Leg swelling may at times be associated with hormonal changes, medication but its unlikely that it is due to the Depo injection given your fluctuating symptoms. A blood clot is the most logical assumption since it was of such sudden onset. It may worth evaluating again at a later stage. Given your active lifestyle, I would advise that you see an orthopedist (orthopedic surgeon) or sports physician if you have one in your area. First exclude a musculoskeletal cause, infection or insect bite. If it was diabetes or heart disease you would have noticed some other symptoms or it would have developed more gradually. Nevertheless it is worth assessing since you are in an age group where these chronic conditions can start up.

  • Jenny

    Thanks Dr. Chris. I will see a sports physician.

  • joe

    I am a 51 year old male, smoker, and I consume 6-8 cokes daily. My problem began August 11. I am a teacher who spent the entire summer sitting in a chair for long periods of time, or on my bed with my laptop preparing power-point presentation lessons. On the 11th I returned to work wearing new Dr. Scholl’s shoes from Walmart, driving a new used Honda with a stiff clutch, and to a standing position for the better part of the day. Over the summer I did exercise frequently by walking the apartment stairs and doing situps. The weekend before returning to work, while doing situps, I felt a pop behind my left leg and knee. There was no pain but I did stop. Upon returning to work I began feeling pain in my left calf. Gradually the pain has worsened over the past 10 weeks. I have visited forums and paid attention to others’ advice. I use an ice pack, elevate my leg,take 1 Naproxin daily (my wife’s), use Icy-Hot and eat healthy. This helps a bit but by 1PM I am in terrible pain. Last night I took one of my wife’s potassium pills, stopped by CVS Pharmacy today and bought Centrum Silver, Licorice, and Epsom Salts. Immediately upon arriving home, I took a nice long, hot soak in the tub. No relief. Next I took a Centrum pill, a garlic gel capsule, and drank some pickle juice. A liitle relief but not much. My next task was to elevate the leg while resting it on an icepack atop 2 pillows. Still not much relief. The swelling has not subsided, the pain is intense and the swelling persistent. Finally, I took one of my wife’s muscle relaxers which has helped a lot. I feel better for the moment but it is not a cure. I am not diabetic, have a strong heart, not prescribed any medications by any doctors. Your advice would be appreciated.

    Thanks,
    Joe

  • Dr. Chris

    Hi Joe

    Firstly, I am going to ignore much about what you said about the measures you took in an attempt to treat this without seeing a doctor. Self-medicating is dangerous. Secondly, using another person’s prescribed medication is a very dangerous and foolish practice. Medicine is not about one size fits all despite the belief of most non-medically trained people.

    This swelling could definitely be musculoskeletal but what is a bigger concern here is the possibility of a blood clot. This may be impairing the circulation in the leg hence the swelling. Given your age, your history of a sedentary lifestyle for the summer and your excess consumptions of caffeinated products (which act as diuretics), a blood clot if a very likely possibility. You need to see your doctor, have a scan and exclude any cause of blockage. It may be musculuoskeletal but you will only know this once you exclude a more serious cause. See your doctor immediately. Taking your time to do so can lead to a host of complications like a stroke or heart attack should the blood clot (if existent) dislodges from its original site.

  • BayleighB

    I have this fluid filled knot on my leg right above my ankle, its been there for about a week and a half i have not hit my leg or anything it just showed up and it’s starting to hurt my foot and i have this burning sensation in my foot. Should I go see my doctor?

  • Dr. Chris

    Hi Bayleigh8

    The fact that it came up suddenly and is causing pain/burning in the foot should prompt you to see a doctor. It may be an abscess or even the start fo cellulitis although it would have been preceded by some injury in some cases. A clot is also a possibility but you should have noticed some swelling (venous) or coldness of the foot (arterial) at this point. See your doctor.

  • FRMijac1211

    It first started out May 2010 with swelling in my calves,ankles & feet.. would come and go, on and off.. then in June 2010, I started getting a purplish rash, like hives, on my legs, from waist to ankles.. sometimes when swollen it would be painful, burning aching feeling, almost like pins and needles but worse.. it would really itch right before the swelling would start.. then it would last for like 3 or 4 days then start to subside.. it would never go away completely.. then like 3 days later I would get the itching again and the swelling would pick back up again… I’ve been to the ER 3 times already, and each time they told me it was Cellulitis gave me antibiotics and sent me home.. I did a follow up appt. with my family doctor while still taking the anti biotics.. It’s now been 7 months and it’s only getting worse, now I’m starting to have problems with my bowels, feels like i have to go but nothing comes out.. I’m at my wits end here, I don’t know what else to do, plus I don’t have health insurance…

  • Dr. Chris

    Hi FRMijac1211

    If it was diagnosed as cellulitis then it most probably is. It is unlikely that the doctor’s would make a mistake 3 times in a row. It is important to identify the cause of the recurrent cellulitis. From your initial symptoms, it appears that you may have peripheral vascular disease. This means that the circulation to your legs is impaired and this needs to be investigated and treated. Peripheral vascular disease is one of the risk factors for recurrent cellulitis and unless this or any other underlying condition is not treated, it is likely that the cellulitis will recur. You should consult with a vascular specialist if possible and speak to your doctor about a possible cause of this recurring cellulitis.

  • Saffire

    I had a total hip replacement Nov 19th and left the hospital bout nov 24th. i didn’t notice til a day or 2 later that my left foot where i had my replacement was very dark blue. and as the days went by my friend would check on it and make me keep it elevated but it just looks like it’s getting worse now i have black and blue bruises going up my leg and only really feels swolleen at night. could it be cuz i have not really rested since surgery always walking and standing? because i can’t sit or lay down for to long because it bothers my hip. and around where i had my surgery its fine theres no bruises or anything.

  • Dr. Chris

    Hi Saffire

    See your surgeon immediately. There are a couple of possibility that may have caused this. A blood clot or clots could be blocking some of the blood draining out of the leg (veins). These may be small clots so while it is not causes as pronounced symptoms as mentioned in Venous Stasis, it may still be affecting blood flow to a significant degree. Another possibility, apart from clots or compromised veins, is that the medication your are using is affecting blood flow in a number of ways. Despite the fact that your hip is bruise free, the veins or even arteries (less likely or you would experiencing more acute symptoms) is being affected. Prompt medical attention should be sought just as a precautionary measure. It may resolve on its own but do not leave it unattended just in case it can lead to further complications.

  • Bri

    My friend has a really weird problem with her right leg. She’s gone through a lot of doctors and noone knows what her problem is. Her leg has been constantly swollen all the way to her foot for now 2 years straight. She has all of the symtoms above mentioned.
    She is only 15 years old and started with this problem in January of 2009.
    We are in desperate need of any advice from a doctore or someone that has expirience this issue.
    Appreciate your help on this.
    Thank you

  • Dr. Chris

    Hi Bri

    Not sure which symptoms you are referring to because there are a number of conditions mentioned above. If the range of investigations have been done and proven to be inconclusive, this could be related to a circulatory problem which is common even in teens who are obese or sedentary. Nevertheless she needs to see a doctor who can examine and diagnose the cause. If she is not getting any answers from her family doctor, she should try to see a specialist physician at this point.

  • Michelle

    I need help. About 23 years ago I got hit by a car. I had major damage to my left side of my body. I had 2 pins and staples and had my tendons put togther again. I have had swelling in this leg since I could remember. Well 3 1/2 years ago I was diagnosed with rhematoid arthritis. I am on Plaqenail and Sulfdazine. Advil is my best friend and helps alot. Since my leg swells, so does my foot. I now have a large bunion. I am also having alot of ankle pain and swelling. What research I have done says that the bunion can be causing the ankle swelling. Because I tend not to walk even on this leg. Any help will be appreciated. Thank you Michelle

  • Dr. Chris

    Hi Michelle

    In your case, you have to consider that your RA and history may be the problem. Of course, it could also be venous insufficiency of the legs which means that the circulation in the veins is hampered – this tends to arise in a person who is sedentary. You should speak to your doctor about your concerns. If possible, light walking may help. Don’t get distracted with other possible causes without focusing on your primary conditions.

  • SOMA SAMANTARAI

    my father is around 50 yrs. & sudddenly he got swelling in both of his legs & not able to walk properly. he wasadmitted in aiims,india on 27-11-10 & doctors are saying some local virus infection but not able to catch that infection.so he is not able to walk properly till now. doctors are saying to do physiotherapy exercises 7 practice walking with dynamic splint. pls help me as it is very urgent.

  • Dr. Chris

    Soma Samantarai

    Without a proper diagnosis, there is no way of knowing for sure or advising you any further. You should see a private doctor who can conclusively diagnose the cause and then advise you on the proper treatment.

  • JN

    I’m an obese 26 yo woman who have had high blood pressure for about 3 years (+ max 1 year before it was diagnosed). Just about half a year ago I got it under control, the medication had to be increased several times for it to take effect. At highest it was about 160/115, now around 135/85. I have a high risk of getting diabetes since it runs in the family, however the latest blood test about 2 months ago was ok (it was a simple blood test, not a glucose tolerance test). I was recently also diagnosed with serious obstructive sleep apnea, I haven’t received the CPAP yet. I rarely exercise and I work by computer all day long and in the evenings also.

    I first noticed I had bilateral non-pitting edema on my upper, inner calves which doesn’t go away and compression stockings seems to make it worse, as well as exercise. It has been there now for at least 7 months. I went to the doctor who made some tests (kidneys, diabetes, ultrasound for Baker’s cyst and various other blood tests) and nothing was found. ECG was also normal.

    Now I have noticed I also have bilateral pitting edema on the lower legs, I actually have no idea how long it has been there because the legs look normal to me (I’m probably used to it) but when I press the skin it is very clear that I have edema. This is probably not related to the non-pitting edema.

    Now I am terrified that I have some serious condition like heart failure. Is it possible although I am relatively young, my ECG was normal and I have no other symptoms (like shortness of breath or anything like that)? Although I had hypertension for a while before it got under control I don’t want to believe it damaged my heart so badly during that time, or can it?

    The pitting edema does not go away during the night, sometimes I even feel it gets worse during the night. I can’t see any changes if I elevate the legs. So venous insuffiency also seem to be out of the question? Can it be related to the sleep apnea?

    There is no pain in the legs, not when I’m moving or when they are touched, but they can seem a bit stiff sometimes.

    I’m very grateful for you time and efforts.

  • Cassetta2010

    On the 19th of November I had back surgery. Since I should I consider this normal systems of the surgery or no?

  • Dr. Chris

    HI Cassetta

    There is no way of us knowing if this is a normal symptoms in your case and you need to discuss it with your doctor. Swelling is not uncommon but should ease especially once you start moving around again. However if the swelling only started up now and is progressing then medical attention is necessary. A common finding in these types of surgery is that the change in gait (the way you walk) may also cause strain and swelling of the limbs. Speak to your doctor.

  • Dr. Chris

    Hi JN

    Although swelling is not usually seen with peripheral arterial disease, it is possibly that this is the cause. In these cases, compression stockings and elevating the legs makes the condition worse. However this is just one possibility. Given you medical history and weight problem, it could be possible that other conditions may also be present which are not commonly seen in your age group. You need to see your doctor as soon as possible. This could also be related to one or more medications that you are using.

  • JN

    Thank you for your answer. How bad is it to get peripheral arterial disease this young? I understand there is no cure for this, but is it possible to with life style changes live a normal life without reduction in life expectancy?

  • Dr. Chris

    Hi JN

    I think you should read this article on peripheral arterial disease before making assumptions on life expectancy and so on – Peripheral Arterial Disease.

    There are modifiable and unmodifiable risk factors. If you issue is things that are modifiable, meaning that medication and lifestyle changes can reduce or even totally remove it, then there is no long term issue. The unmodifiable risk factors are those that cannot be treated and in these case you will have to be very cautious throughout life. Bottom line, with proper treatment, lifestyle and dietary changes, you can avoid complications of PAD and even reverse it. Youth is always a factor and puts the odds in your favor.

    I do have to highlight one fact here based on the information you provided – your obesity is most likely responsible for most of the ailments you currently have. While there may be genetic risk factors (this is an example of an unmodifiable risk factor) and side effects of medication and so on at play here as well, without proper weight management your chances of long term recovery is going to be difficult. You are also at high risk of developing other serious and even life threatening conditions due to your current health status (obesity + existing chronic conditions). Much of what you need to do for weight loss will also help with PAD, if it does exist.

  • santhiswaroop

    hi sir

    yesterdayy i am playing suddenly i had fallen so my leg next day swelling i went to doctor doctor given arcoxia for reducing pain and swellen

    i kept my 10 cm height and i am sleeping but still my leg swollen not reduced generally how many days it will take to reduce

  • Dr. Chris

    Hi Santhiswarup

    It is difficult to say how long this would take as it depends on the nature of the injury and so on. Your doctor would have a better idea as he assessed you. But yes, one day is a bit too soon so you should be patient. It is advisable that you follow up with your doctor by the second or third day. If you notice extreme swelling, a lot more pain, numbness, fever or loss of movement, then you should see your doctor immediately.

  • Rebecca

    I had surgury on a hip replacemen monday the 28 of feb 2011 It all looks good but my hole leg is swelled When I get up to walk on it I can but the there is pain in the hip till I set down then the pain in the hip goes away n the sweliing is still there. My doctor said I could take 800m of iburofen every 8 hours I have did that but just started in the last 24 hrs

  • Dr. Chris

    Hi Rebecca

    Post-op swelling is not uncommon and with the legs, it tends to aggravate over days since you are stationary. The leg requires movement for circulation. However, any sudden or severe swelling, especially if you find that the leg is turning red, feeling warm to touch and is painful needs to be investigated for the possibility of an infection. See your doctor, let him examine your leg and if all is clear then you can rest assured that this is just temporary. Ensure that you follow up with your doctor regularly.

  • Mar

    Hi..I am a 50 year old woman, healthy and of normal weight. For as long as I can remember I have always had puffy ankles that sometimes get worse, especially when on vacation in hot climates. Can I do anything to help this..I am active and eat a healthy diet mostly. Thanks

  • Dr. Chris

    Hi Mar

    It is always advisable to have this checked up by your doctor to exclude venous insufficiency (problems with the leg veins) or even heart failure which could also cause this swelling. If your doctor says that there is no underlying problem, then there may not be too much to worry about. Mild swelling may happen with certain hormonal changes, and is more prominent prior to menstruation. Hot weather is a known physiological cause of leg swelling. But nevertheless, speak to your doctor about it.