Swollen Lower Limb(s)

Swelling of the lower limb as a result of fluid buildup in the tissues is called oedema. The more common causes of such include various illnesses, medications, and occasionally allergies.

Treatment often consists of a combination of exercise, diet, lifestyle adjustments, and medication. Oedema in the feet, legs, hands, and arms is called peripheral oedema.

While most would associate oedema exclusively with the skin, however, oedema can occur in the lungs, brain, gastrointestinal tract, abdomen, liver, eyes, and other organs. The most commonly affected areas are the feet, ankles, and lower legs. It’s more likely to occur in older persons, however, anyone can be affected.

Grading of peripheral oedema

● Grade 0: No indentation of skin after applying finger pressure for 10 seconds and then releasing.
● Grade I: Mild indentation (pitting) that disappears in less than 10 seconds after the removal of pressure.
● Grade II: Moderate indentation (pitting) which last 10-15 seconds after the removal of pressure.
● Grade III: Severe indentation (pitting) which lasts more than 15 seconds after the removal of pressure.

The more common causes of lower limb oedema

● Gravity pulls water down into your lower limbs. The pull of gravity is accentuated, especially in a hot climate, if you are sitting or standing in one spot for an extended period.
● If the valves in the veins of your legs are not functioning properly, this often leads to fluid accumulating in your feet and ankles.
● A range of medical conditions can result in fluid build up in your lower limbs—especially diseases affecting such organs as the heart, lungs, kidneys, liver, and thyroid.
● Some medicines for pain, diabetes, and high blood pressure, along with steroids, and oestrogens can cause oedema.
● Pregnancy often causes mild oedema. This is only a problem if associated with high blood pressure and or protein in the urine.
● Premenstrual fluid retention.
● Diets high in salt can result in fluid retention and oedema of the feet and ankles.
● Being overweight.
● Inadequately functioning lymphatic system as a result of injury, surgery, infection, or cancer.
● A deep vein thrombosis (DVT) – i.e. a clot in the deep venous system of the leg.
● Low protein levels in the blood.
● Large uterine fibroids and other pelvic masses.
● Injuries.
● Insect bites.
● A soft tissue infection.
● vA tight circumferential bandage.
● Chronic severe anaemia.

Some of the (associated) symptoms

● The feet and ankles look swollen.
● The skin is often shiny.
● Difficulty seeing the veins or bones in the foot or around the ankle.
● Applying pressure with your fingers to the swollen area leaves an indentation/ dimple (pitting).
● The feet may feel heavy and ache, and you may have difficulty walking.
● Difficulty getting your feet into closed footwear.
● Reduced urine output.
● Weight gain.
● Blurred vision.
● Prominent neck veins.
● Shortness of breath.

Possible complications of lower limb oedema

● Chronic ulcer (“sore foot”).
● Difficulty walking.
● Poor circulation.
● Cellulitis (infection in the soft tissue).
● Pain and stiffness in the lower limbs.
● Stasis dermatitis.

How can lower limb oedema be managed?

The specific treatment depends on:

● The cause
● If it’s likely to be temporary or long-term.
● The patient’s preferences
First and foremost, your doctor will take a detailed history and conduct a thorough physical examination. To determine the specific cause, they may order various tests. Such tests may include:
● Complete blood count.
● Kidney function (including creatinine).
● Liver function (including blood albumin).
● BNP (for heart failure).
● D-Dimer.
● Thyroid function.
● Ultrasound of lower limbs and pelvis.
● Echocardiogram.

General measures which are often recommended:

● Avoid standing or sitting for long periods of time in one position.
● Elevation of feet while seated or on pillows while lying.
● Compression stocking.
● Reducing salt intake.
● Medicines that help your body get rid of excess fluid (i.e. water tablets/ diuretics).
● Gentle exercise including walking often helps.
● Wear comfortably fitting footwear.
● Underlying heart, lung, kidney, liver, thyroid, and lower leg circulatory problems are treated appropriately.

See your healthcare provider immediately:

● If you were to experience shortness of breath, chest pain, fainting, dizziness, or coughing up blood.
● If there is any increase in temperature, pain, or redness in one or both legs.
● If the oedema is only in one leg.
● If the overlying skin becomes bruised or cracked or a sore develops.
● If there is an accompanying fever

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg. com,
1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment.
Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.