swelling

Causes of swollen feet and what to do at home

by Dr. Zsolt Zatrok 2023-09-26

If you notice that your ankles are swelling and your socks are leaving an impression above your ankles, don’t trivialise it! There are thousands of things that can cause swelling in your feet. Some of them are “harmless” and some require a lot of attention.

First things to do in case of swollen feet

If the oedema (swelling) is recent, the first thing you should do is find out what is causing it. If you want to be well, see a doctor as soon as possible and get it checked out!

Treatment can be effective if the cause of the swelling is identified. Treatment is most effective when the cause is the right one. There are many causes of swollen feet. Let’s look at these and how they differ.

The “simpler” causes of swollen feet

The cause of oedema (swelling) is obvious in some cases. For example, if you sprain your ankle, you know what is causing it and the swelling is temporary, i.e. it will go away on its own after a longer or shorter period of time (if there is no fracture)

Injuries

(strains, sprains, sprains, torn ligaments and broken bones) are almost invariably associated with swelling, and the cause can be twofold. On the one hand, small blood vessels that have ruptured during the injury may bleed and form a haematoma. Conversely, blood flow to the injury increases, serving a protective role by preventing potential pathogens from entering the body through the wound. This response involves sending a surge of white blood cells to the affected area. But the blood flow also brings with it substances that aid healing and regeneration. So the injury receives more fluid than usual, causing swelling.

Lack of exercise

(sitting or standing all day, long car, bus or plane journeys) can cause swelling in the feet even in healthy people. The edge of the sock creates a depression above the ankle. This is the easiest to eliminate – it disappears quickly with exercise, walking, jogging or cycling.

Arthritis

The area around the affected joint(s) is swollen, warm, painful, hard to move, and possibly red.

Rheumatoid arthritis

A common, autoimmune form of arthritis characterised by inflammation, swelling and pain in the joints.

Arthrosis

A painful condition resulting from wear and tear of the articular cartilage, which may be accompanied by swelling around the joint.

Gout

An acute attack of uric acid crystals, usually after heavy eating and drinking, with swollen and very painful joints in the feet (especially the thumb).

Splenic bursitis

A bursa is a slippery fluid-filled sac that acts as a pair between bone and muscle or tendon, aiding movement. Its inflammation causes swelling and pain, mostly in the back of the knee.

Infections (e.g., nasal folds, cellulitis)

When bacteria such as streptococcus or staphylococcus get into the skin. The skin becomes red, and hot and spreads rapidly to a larger area. It quickly becomes sensitive, painful and feverish.

General medical treatment

The fracture should be fixed (plastered)
in the case of an accidental injury, the swollen joint should be rested, iced, dressed (compression) and shelved
in case of infection, it is important to start medical treatment (antibiotic therapy) as soon as possible
in the case of a new inflammatory process, consult a doctor and, on the basis of the examination, be treated according to the disease
if the pain or inflammation is old (arthritis, arthrosis), you should not rush to the doctor every time the pain increases, as this will not help. In these cases, you can treat your pain yourself using home physiotherapy methods, as discussed with your doctor. Consult your doctor about which method or combination of methods to use.

The “more serious” causes of leg swelling

While it’s pretty obvious what’s causing the swelling after an ankle sprain, there are a number of conditions that can be the first signs of swelling in the feet. These are the ones that should make you take the onset of oedema seriously and rule out the following with medical tests.

Drug side effect

Some prescription medications can have the unwanted side effect of swollen feet. Most commonly, heart drugs called calcium channel blockers (amlodipine, nifedipine) are responsible. Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and some diabetes drugs can also cause swollen feet. Hormonal drugs that contain estrogen or progesterone (such as contraceptives) and certain antidepressants have a well-established history of causing oedema.

Treatments for adverse drug reactions

consult your doctor and ask him/her to substitute the drug with a different mechanism of action
choose another method of contraception

Pregnancy and swollen feet

During the last trimester of pregnancy (the third trimester in medical jargon), the growing baby “latches on” to the blood vessels running near the uterus. This causes them to be squeezed, making it harder for blood to flow. This can result in swelling in the legs.

Consult your doctor, especially if the swelling extends beyond your legs and appears around your eyes, as this type of oedema may indicate a more severe condition.

Compression massage, a lymphatic massage machine, is perfectly safe to use. You can relieve swelling with a gentle 10-15 minute treatment (repeated up to 2-3 times a day).

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4 air chamber cuffs for legs, arms, hips
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Visceral Dilatation and Chronic Venous Insufficiency

A varicocele most often develops slowly in people who do sedentary work or do little exercise.

The feeling of “heavy feet” is the first sign of varicose veins. The veins slowly dilate, thicken and become tortuous. Blood in the veins becomes stagnant, i.e. it does not flow back towards the heart. Tightening pain and leg swelling appear. The first warning sign is when your socks “kick in”.

Vein insufficiency, if neglected, can lead to serious complications such as deep vein thrombosis or venous ulceration (a wound that does not heal)

Tips that could help

Wear compression stockings to slow the growth of oedema
Work every half an hour, exercise your legs thoroughly, walk around, stretch your leg muscles
Exercise regularly! You need at least 45 minutes of walking, slow jogging, and cycling every day to keep your muscles refreshed, your veins and lymphatic circulation flowing and your symptoms reduced
If you are unable to move for some reason, use a muscle stimulator. The device creates contractions in the leg muscles similar to walking effectively improving circulation in the leg and helping reduce oedema.
You can also use a lymphatic massage machine, a 15-20 minute treatment to “squeeze” stagnant blood and mucus out of the limb, quickly eliminating the feeling of heavy feet.

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Deep Vein Thrombosis and Varicose Veins

One of the first symptoms of thrombophlebitis (superficial vein inflammation) and thrombosis (deep vein inflammation) is swollen feet (especially the shin). As a layman, you can’t tell which one you have, so seek medical attention immediately. In any case, if you notice a painful swelling on your leg, over which the skin is warm, reddened or blue.

In superficial varicose veins (thrombophlebitis), a blood clot forms in the veins near the surface of the skin. This is less risky than deep vein thrombosis. In the latter, a clot forms in a deep vein between the leg muscles.

Treatments for acute thrombosis or varicose veins

Do not do any exercise – if there is a clot, muscle movement can push the clot further and this can lead to an embolism
if you experience any of these symptoms, seek medical attention immediately – preferably call an ambulance, but on no account walk!
Do not attempt any home mechanical treatment for these conditions, as they may result in an increase in symptoms! Treatment in this case can only be medical.
you will only have to wait about 3 months after the acute phase has started when the permanent and permanent condition after acute deep vein thrombosis occurs.

Post-thrombotic state

While you shouldn’t treat acute thrombosis, it’s essential to address symptoms that arise 3-4 months after thrombosis.

Thrombosis is the blockage of a blood vessel by a blood clot. Over a few weeks, this clot transforms, adheres tightly to the vein wall, is partially absorbed.

In the vast majority of cases, there is no full recovery after thrombosis, i.e. residual symptoms are expected. The main symptoms are persistent swelling, tightness, brownish-purple-reddish discolouration of the skin, and dryness of the skin.

If you want to avoid serious complications such as lymphoedema, wounds, and ulcers, you need to treat them regularly.

The main remedy is regular daily walking and cycling.

This can be supplemented by electrical stimulation of the leg muscles or compression massage.

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Lymphatic Massage solutions for post-thrombotic state.

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4 air chamber cuffs for legs, arms, hips
for mild lymphoedema
handling pressure identical in all air compartments
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4 air chamber cuffs for legs, arms, hips
for mild to moderate lymphoedema
handling pressure identical in all air compartments
4 treatment programmes

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Sickness

Oedema can be caused by heart disease. The heart’s contractions are weak, so it can’t circulate blood around the body properly, causing fluid to slowly build up in the legs. Common symptoms of congestive heart failure include difficulty breathing, feeling tired and having a dry cough.

Oedema of cardiac origin requires medical treatment.

How to help yourself

Wear compression stockings to slow down the growth of edema
exercise regularly to suit your performance. Walking or slow cycling will stimulate the muscles to move blood and lymph circulation, reducing swelling
If you are no longer able to move and don’t have a pacemaker, use a muscle stimulator. The device creates contractions in the leg muscles similar to walking and is effective in improving circulation in the leg and helping to reduce oedema.

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Disease

In kidney disease, the kidneys do not function properly, so water and waste products remain in the body. The fluid builds up and causes swelling in the legs and even the arms.

Symptoms of kidney disease may include fatigue, shortness of breath, nausea, thirst, and bleeding.

If you suspect you have an STI, do not self-medicate and seek medical advice as soon as possible. There is no home medical device that can be used for kidney disease.

Once all the causes of leg swelling listed so far have been ruled out, you are “left with nothing” but nerve dysfunction.

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why does lymph accumulate again and again

Why does the lymph accumulate in lymphedema?

by Dr. Zsolt Zatrok 2021-03-30

You have lymphedema. You wear the compression stockings regularly, see your therapist every week for manual lymphatic drainage, but barely see any results …you don’t understand why the swelling doesn’t decrease, and why the lymph production does not just stop. Let me explain it.

Lymphedema is not curable today, meaning it can not be cured permanently despite all the treatment efforts. You should carry on with the treatments to prevent swelling and reduce limb circumference to a level close to normal.

The lymph is formed during each heartbeat, unstoppably as long as your heart beats!

This is absolutely normal. This is the case for all people. Those with a healthy lymphatic system do not develop swelling.

In a lymphatic disease, the collection and transport of lymph is problematic. Therefore, as soon as you stop a treatment, it will start to accumulate immediately. For some people, the accumulation process is slow, while others are less fortunate and their edema returns even within hours.

You should treat it as often as the edema recurring regularity requires.

How is lymph formed?

When your heart beats, it pumps out blood into your arteries, which deliver it all the way to your cells. Cells take up the substances from the blood that they require for their operation, and release waste materials they do not need.

Your veins collect this “used blood” and return it back to your heart. “Along the way”, your blood flows through your liver and kidneys, which filter out the toxins from it, finally with the help of your lungs, your blood gets “mixed” with fresh oxygen. From the lungs, your blood enters your heart again, which pushes it through the arteries into your body again.

Your arteries are strong and your heart is actively pumping your blood into them. However, your veins are “less efficient”. They cannot bring back all the fluid brought by the arteries. A little fluid stays between the cells (in the interstitial space), in your body after each heartbeat.

This is the “residual” lymph

Your lymphatic vessels are “responsible” for collecting the rest (residual lymphatic fluid). These above-mentioned vessels collect it, the lymph nodes filter out the pathogens from it, and eventually, get them back into your bloodstream.

In a healthy state, your veins and lymphatic vessels together collect (without leaving any residual lymphatic fluid) the amount of blood pumped through the arteries. Thus, by draining the interstitial fluid that collects in tissues, no swelling develops.

When does the lymph begin to accumulate?

Swelling (lymphedema) occurs when your lymphatic vessels do not work properly and cannot perform the “task assigned to them”. After each heartbeat, a little extra fluid remains that stays there. It accumulates slowly, multiplies, and becomes visible over time. It causes tension slowly. If the affected area/limb is very tense, it will cause you pain.

The lymphatic vessels cannot do their job if, on the one hand, they are congenitally poorly developed (you were born ill). But, on the other hand, as more often is the case, the lymphatic vessels may become damaged, destroyed, or occluded in an accident, or even more often times, during medical treatments (surgery, radiation therapy). And if there is no (vascular) channel/not enough channels, through which the lymph could be carried away, it stays in place and multiplies…

We are not yet able to “manufacture” new lymphatic vessels. Once ruined, they cannot be replaced. That is, the affected area/limb will always swell.

The balance may “break” for other reasons, too.

For example, if certain veins are removed or occluded in a limb during varicose vein surgery, then the (remaining) veins will no longer perform their function properly. This happens due to a decreasing venous capacity, thus more tasks will remain on the lymphatic vessels. But they have a certain capacity. In this case, your body cannot drain, collect the lymph and transport back to the heart due to the missing veins. The consequence is the same.

Drastic, surgical eradication of your crooked varicose veins can lead to braking the lymphatic balance and the formation of lymphedema.

What follows from this?

Because lymph production is an unstoppable process, from heartbeat to heartbeat, the development and onset of swelling is only a matter of time.

Luckily, it takes 1-2 days for you to start feeling the tension. Others are not so lucky, because in their bodies, the previous situation recur quickly, even 1-2 hours after stopping the treatment.

You should handle this situation and manage your disease in a way that you take into account the edema recurring time. If it recurs only every two days, it may be enough to treat it every two days. However, if it recurs within 2 hours, you should manage it more often, accordingly.

My advices

The accumulation of lymphedema occurs just as dirty laundry accumulates in the family. Every moment someone comes and throws a used shirt/pants/socks in the laundry. It constantly accumulates. It takes you less effort if you “throw” some of your clothes into the washing machine every day, than if you waited a month and spent an entire day washing a pile of dirty clothes.

From this, you can also understand that regarding the treatment of lymphedema, it is a big mistake to wait too long. Please, do not wait until the affected limb/area becomes tense, sore or the skin over the affected region ruptures, or becomes ulcerated! The longer you let it swell, the harder it will be to “clean it up”!

You are doing it right if you watch yourself carefully. As soon as you feel the edema, treat it by applying a short duration (20-30 minutes) and low pressure (40-60 mmHg) mechanical lymphatic massage. If needed, treat up to 2-3 times a day. This is better than carrying out a long, high-pressure treatment once a week …and a thousand times better than waiting for someone to schedule an appointment for you for a manual lymphatic massage. If your edema recurs in 2-3 hours, 1-2 massages a week is simply a waste of your money. It will not improve your condition in any way in the long run (it may help only for a 1-2 hours time period right after the massage, but no longer).

There will be two consequences if you wait too long between the treatments!

The greater the swelling, the harder it is to get rid of it. A single massage session cannot significantly reduce it.
The more you let it swell (the higher the pressure/tension), the faster your condition will worsen. Proteins start to deposit in your tissues from the lymph that “sits still in one place” for a long time. In a few years time, the area becomes so firm (fibrotic) as irreversible changes happen. Finally, your lymphedema grows to such a state that the specialists no longer consider it treatable,…only suffering remains which accompanies you. Please, accept my advices, and avoid that state.

Start treating your lymphedema as soon as possible, please, don’t wait years with it. Set the frequency of treatments to the recurring time of your edema. Don’t let it swell too long untill a painful state develops, with a large edema feeling firm due to great tension. You can treat it several times a day. It is much better if you apply more short duration, low pressure treatment sessions, rather than one long session with a high pressure. You can only do so if you own a compression therapy unit yourself! If you have only the simplest 4-chamber device at home, it’s also a thousand times better than not handling the problem at all.

You have one body and the better you treat it, the better you will feel.

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Diseases

Forms of Lymphedema

by Dr. Zsolt Zatrok 2021-02-18

Lymphedema is swelling of a limb, less commonly the trunk, neck, or head, caused by the accumulation of lymph between the tissues. The disease can be congenital (primary) or acquired (secondary). Despite the different forms, the symptoms and treatment are the same.

The lymphatic system and its function

In your body, the blood (which is largely made up of water) is “rotated”, and circulated by three systems.

Heart and arteries. The heart is the most important engine of the (cardiovascular) sytem. The contraction of the heart pumps blood into the arteries. It flows through the ever-smaller diameter arteries then enters the capillaries and into the space between the cells (intercellular space).
Veins. Its capillaries “collect” the blood in the intercellular space and bring it back towards the heart. The flow of blood in the veins is driven upwards by the contractions of the muscles.
The veins do not collect all interstitial fluids (or tissue fluids), that is, what the arteries bring from the intercellular space, without residue. The “remainder” is the lymph, which contains proteins, water, fats, and “waste” produced by the cells. This is what lymphatic vessels (lymph-collecting vessels) collect. It flows through the lymph nodes, which filter out waste and foreign matter (e.g., pathogens). The lymph that has passed through several groups of lymph nodes eventually returns to the bloodstream.

What is Lymphedema?

Lymphedema is a circulatory problem in which part of the lymph is not collected, leaving it in the interstitial space and causing swelling.

Primary lymphedema results from developmental abnormalities leading to pathological lymphatics. It can affect the lymphatic vessels and their function, the lymph nodes, or even the entire lymphatic system. Primary (congenital) lymphedema

The abnormalities can be, for example, the underdevelopment of the lymphatic system (hypoplasia) or, on the contrary, overgrowth (hyperplasia).

Hypoplasia is the most common disorder in which the number of lymphatic vessels and/or lymph nodes is lower, or their sizes are smaller than normal.

In case of hyperplasia due to dilation of the lymphatic vessels (lymphangiectasia, dilatation) and/or increase in the size of the lymph nodes, the “ventils” in the lymphatic vessels – also known as valves- malfunction. These would be responsible for directing the lymphatic fluid towards the heart.

Imagine it as a floodgate that you lower or raise if necessary. If the flood-gate “gets stuck”, the water flow cannot be controlled.

In the case of underdevelopment of the lymphatics (Lymphatic aplasia), less lymph can flow through the lymphatic vessels and/or lymph nodes, meaning that the transport capacity is too “low”.

Occurrence

Primary lymphedema is significantly less common than its secondary form. According to a publication (1), roughly one in every six thousand people have congenital lymphedema. Three times more women are affected than men. There is no explanation as to why primary lymphedema is more common in women.

The role of inheritance

Primary lymphedema results from autosomal dominant inheritance, potentially involving several genes in its development (2). As a result, congenital lymphedema can be passed down to offspring, although not all children will inevitably inherit it.

To put it simply, we get one-half of our somatic genes from our mother and the other half from our father. If at least one gene from one of them carries the disease, then we can be sick, too. It may be that although both of our parents are lymphatic patients (have lymphedema), but we inherit the healthy gene from both of them, i.e., that do not carry the disease, so we won’t be sick.

In genetics, gene strength is characterized by penetrance, where strong penetrance indicates the development of the disease in every offspring who has inherited an abnormal gene. If, despite the fact that the offspring inherits the defective gene, but the disease develops in only a subset of cases, the penetrance is inconsistent or varying.

This is also characteristic of the lymphedema gene; i.e., despite having the gene, symptoms of lymphedema do not appear in all cases. The disease can “skip” one or more generations.

The varying appearance results in the edema affecting the left leg in one family member, the right leg in the other, and both in a third.

When does primary lymphedema occur?

In some cases, and especially in boys, developmental disorders of the lymphatic system can be detected even at birth. In contrast, in girls, the onset of symptoms usually occurs only later, during puberty or pregnancy, in most cases between the ages of 10 and 25 years.

It is generally true that the symptoms of primary lymphedema do not appear as long as the lymphatic system functions efficiently enough to perform its function.

Doctors typically diagnose lymphatic diseases when they observe swelling. In most cases of primary lymphatic diseases, they affect the lower extremities.

Secondary (acquired) lymphedema

The cause of secondary lymphedema is a lesion “acquired” in life. In general, the event leading to damage to the lymphatic system is well identifiable. This causes a sudden or gradual malfunction or obstruction in the lymphatic vessels and / or lymph nodes.

It usually affects the limbs, but may also appear in extreme forms, on the trunk, abdomen, head and neck, and external genitalia.

Occurrence: two worlds

Regarding secondary lymphedema, the world can be divided into two parts, which can also be categorized as poor and rich countries.

In poor areas, the lack of clean drinking water is the main cause of the disease. In Africa, India, Southeast Asia and South America, as well as in the Pacific Islands and the Caribbean, the most common cause of lymphedema is a filamentous worm, Wuchereria bancrofti. The worm enters the body with the contaminated drinking water and then its larvae travel in the lymphatic vessels and destroy them. This worm infection is called filariasis. According to the WHO, 1.3 billion people are at risk of the disease and more than 120 million people are still infected, 40 million of whom have severe lymphedema.

Worm-induced lymphedema is virtually non-existent in developed countries, where clean drinking water is widely available.

In rich countries, the most common causes of secondary lymphedema are accidental injury (trauma), surgery, or radiation for therapeutic purposes.

It is a very common companion to breast cancer surgery and radiation therapy. Breast cancer is one of the most common malignancies, with hundreds of thousands of new cases identified each year. That is, potentially this many new lymphedema patients “develop”.

Main causes of acquired lymphedema

Swelling does not develop as long as the venous and lymphatic systems jointly collect the tissue fluids brought by the arteries. In a healthy person, a balance exists between the amounts transported in and out.

Injuries

Lymphatic injury and the destruction of the lymphatic vessels can be caused by several things.

It can also occur in the event of an accident, injury or bone fracture. Lymphatic injuries or cutting of the lymphatic vessels can also occur during curative surgeries. It is very common a few years after varicose vein removal surgeries. Liposuction for cosmetic purposes can also have late consequences.

With luck, the ruptured lymphatic vessels – being damaged in the course of an injury or surgery -, “fuse together”. Many times, however, the developing scar constricts, narrows the vessel and so the lymph cannot flow. The phenomenon is a bit similar to when you break a garden watering hose – so water can’t flow.

A “side effect” associated with therapy

During tumour removal surgeries, it is common to remove the regional lymph nodes and lymphatic vessels in addition to the diseased tissues. Thereafter, radiotherapy treatment is also given to the affected area. The radioactive rays cause inflammation of the treated lymph nodes and lymphatic vessels. It heals slowly and with scarring, thus lymphedema may develop even years after treatment.

The “normal” side effect of breast cancer treatment is the development of lymphedema. Obviously, only the treatment of the tumor can lead to saving the patient’s life. Based on my experience, a substantial number of patients I have encountered lack awareness of the expected consequences and, as a result, find themselves unprepared to address them.

How long does it take for lymphedema to develop?

When lymphatic vessels or lymph nodes become blocked or are entirely absent, it’s clear that the affected area cannot drain lymph.

In mild and lucky cases, lymphatic vessels remain in the area, which dilate and take over the extra load. When the lymph nodes and the lymphatic vessels of a region are removed, then there is no “route” left for the lymph to leave. It accumulates in the tissues, causing swelling in the lower and upper limbs, but it may also affect other parts of the body.

Secondary lymphedema may develop immediately after surgery and/or radiation, however, the average time of appearance of this complication is between 14 and 24 months after surgery. Sometimes, it can take a few, or even 20 years after surgery/injury to develop. This is due to the fact that other lymphatic vessels can assume the functions of the affected lymphatic vessel(s). With advancing age, other factors, for example, body weight gain, further surgeries, radiation, injury, infection, etc. may occur. However, further damages caused by these can no longer be compensated.

Nevertheless, in many cases, despite the accident, surgery or irradiation, the symptoms do not appear, but the risk of lymphedema onset lasts for a lifetime.

Lymphatic massage aka Compression Therapy units

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4 compression chamber cuffs
Use it equally in oedema affecting the arms or legs.
Optimal for arm swelling, developing after breast removal surgery (mastectomy)
Eliminate the feeling of heaviness of legs, and tension pains caused by varicosity.
Relieve swelling of your feet associated with varicosity in pregnancy.

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Home treatment of mild to moderate lymphoedema without complications
For cardiac swelling after mastectomy, this device is usually sufficient
It is effective in relieving the heavy legs and tightness caused by varicose veins
You can also use it to reduce leg swelling in pregnancy varicose veins

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