Feet and ankles more commonly swell as they are furthest away from the heart meaning the heart’s force of “pushing” blood through our blood vessels is weakest and because of the forces of gravity. Oedema is the medical term for fluid retention in the body. The build-up of fluid causes affected tissue to become swollen.
Why does fluid retention occur?
The swelling can occur in one particular part of the body, for example, as the result of an injury, or it can be more general. More general fluid retention tends to occur as a result of more serious health conditions such as heart failure or kidney failure.
As well as swelling or puffiness of the skin, oedema can also cause areas of skin that temporarily hold the imprint of your finger when pressed (pitting oedema); stiff joints; skin discolouration; aching or tender limbs; weight gain or weight loss; raised blood pressure and raised pulse rate
Types of oedema
Oedema in the feet and ankles is known as peripheral oedema. Other types of oedema can me more serious. They include cerebral oedema (affecting the brain), pulmonary oedema (affecting the lungs) or macular oedema (affecting the eyes).
What causes oedema?
Oedema is often a symptom of an underlying health condition. It can occur as a result of certain conditions or treatments including heart failure; kidney disease; chronic lung disease eg. COPD, emphysema (mainly caused by smoking); pregnancy; thyroid disease; liver disease; malnutrition; medication, such as corticosteroids or some medicines for high blood pressure such as calcium channel blockers (eg) amlodipine, lercanidipine; the contraceptive pill
Fluid retention in the leg may be caused by a blood clot, varicose veins or a growth or cyst. Oedema can also sometimes be due to immobility for long periods, hot weather, exposure to high altitudes and burns to the skin
Oedema caused by Congestive Heart Failure
Congestive Heart Failure (CHF) affects 2% of the Irish population but is more common amongst the elderly. It affects 6 to 10% of the population over 65. The average age of diagnosis is 76. It is the leading cause of hospital admissions in the over 65 age group, accounting for 20% of hospital admissions in this age group. Heart failure is often a cause of swollen ankles, especially in older people. This is because the heart is unable to pump blood as efficiently as it once did causing it to stagnate (due to gravity) in the lower extremities of our body. Ankle swelling is caused by heart failure that is occurring on the right side of the heart. Unlike the heart failure that occurs on the left side of the heart which causes fluid to drain into the lungs, congestive heart failure that occurs on the right side sends fluid to the legs, feet and ankles. Treatment options include diuretics such as furosemide which reduces fluid volume in the body and blood pressure medication such as ACE inhibitors (eg. Ramipril, Lisinopril) which dilate blood vessels allowing blood to flow easier, beta blockers (eg. Bisoprolol, Nebivolol) which regulate heart rate and digoxin which increases the strength of heart muscle contractions and can also slow down heart rate.
Other symptoms of heart failure include Fatigue; Shortness of breath, especially with activity or when lying flat; Weight gain over a short period of time i.e. days; Loss of appetite and abdominal swelling; Dizziness or near fainting episodes; Irritable cough, sometimes producing frothy sputum; Sudden severe breathlessness waking you from sleep and Confusion or difficulties in concentrating. If you are experiencing any of these symptoms you must seek medical advice.
Oedema caused by kidney or liver problems
Kidney disease can also cause foot and ankle swelling. When kidneys are not functioning properly, fluid can build up in the body as our kidneys are the body’s fluid extraction system. Liver disease can affect the liver's production of a protein called albumin. Albumin keeps the blood from leaking out of the blood vessels into the surrounding tissues. Inadequate albumin production can lead to fluid leakage. With liver disease, gravity causes fluid to accumulate more in the feet and ankles, but fluid can also accumulate in the abdomen and chest.
Oedema due to infection
Swelling in the feet and ankles can be a sign of infection. People with diabetic neuropathy or other nerve problems of the feet are at greater risk for foot infections. Diabetics are more at risk of minor skin irritations, blisters or tears developing into serious infections very quickly because diabetes causes nerve damage (diabetic neuropathy) that means you may not be able to feel pain in that area and a problem can escalate before they realise it. Diabetics tend to have poorer circulation which can make infection more likely. Diabetics must inspect feet daily for blisters and sores, because nerve damage can blunt the pain sensation and foot problems can progress quickly without the person realising it. Whelehan’s Pharmacy has a chiropodist in store on Tuesday’s and Thursday’s who can advise on diabetic foot care; our chiropodist has a special €25 rate for over 60’s.
What is BPro Cardio Screen Service?
Whelehans has a cardiovascular health check called BPro Cardio Screen. It measures the stiffness of your arteries to help identify risk of blockages and your risk of cardiovascular disease and circulation problems. It calculates a wave signal that indicates the elasticity of large, small, and peripheral artery walls as well as tests for stress, central blood pressure, heart rate, and more. It is now €35 (was €50); it only takes about 15 minutes to get checked. The next clinic is Thursday April 26nd from 9am to 6pm at Whelehans Pearse St. Book by calling Whelehans at 04493 34591 or message us on facebook.
To be continued… next week
BPro Cardio Screen is not meant as a substitute for proper medical assessment with your doctor and should not replace prescription medication
Written and researched by Eamonn Brady (MPSI), Whelehans Pharmacy, 38 Pearse Street, Mullingar. Enquiries 04493 34591; www.whelehans.ie