Peripheral Oedema

Peripheral oedema is swelling in the lower legs, ankles, feet, or hands caused by a buildup of fluid in the body’s tissues, ranging from minor discomfort after prolonged sitting to a sign of serious heart, kidney, or liver disease.

Table of contents

• What is Peripheral Oedema?
• Signs and Symptoms
• What Causes Peripheral Oedema?
• Who is Affected?
• How is it Diagnosed?
• Treatment and Management
• How to Care for Yourself
• When to Seek Medical Help

peripheral edema, dependent edema, swollen ankles, swollen feet, swollen legs, oedema

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What is Peripheral Oedema?

Peripheral oedema is swelling that occurs when too much fluid builds up in the tissues of your body, particularly in your lower legs, ankles, feet, or hands^[1]. The term “oedema” (also spelled “edema” in some countries) refers to an accumulation of fluid in the spaces between cells, called the interstitial space^[2]. Because gravity naturally pulls fluids downward, this swelling most commonly appears in the legs and feet^[3].

The human body contains different fluid compartments. About one-third of total body water exists outside cells in what is called the extracellular space. This space is further divided into blood plasma within blood vessels and interstitial fluid surrounding the tissues. Fluid balance between these compartments is controlled by pressure systems that push fluid out of blood vessels and pull it back in^[1]. When something disrupts this balance, fluid accumulates in the tissues and causes visible swelling.

Peripheral oedema can affect one or both legs. If swelling appears suddenly and is painful, you should see a doctor as soon as possible^[2]. The swelling may range from mild, localized puffiness to severe, widespread fluid retention throughout the body, which is called anasarca^[1].

Signs and Symptoms

The most obvious symptom of peripheral oedema is swelling or puffiness in the affected areas. This swelling occurs when a buildup of fluid makes a part of your body larger than it normally is^[5]. While swelling can happen anywhere in the body, it most commonly affects the feet, ankles, and legs^[6].

Common signs of peripheral oedema include^[8][6]:

• An area of your body appears larger than it was before
• The skin over the swollen area looks stretched and shiny
• Changes in skin color near the swollen area
• Discomfort, stiffness, or a heavy feeling in the affected limb
• Difficulty walking if your legs, ankles, or feet are swollen
• Mild pain or soreness in the affected area
• Dents or pits that remain in the skin after pressing on it (called pitting oedema)
• Clothing or jewelry that previously fit comfortably becomes tight and uncomfortable

Sometimes swelling develops quickly over a period of 72 hours. Other times, the swelling increases gradually over days, weeks, or even months^[3]. The swelling may not become obvious until approximately 2.5 to 3 liters of excess fluid have accumulated in the tissues, as soft tissues can accommodate substantial volume before visible swelling appears^[1].

Peripheral oedema can sometimes affect only one side of the body, called unilateral oedema. For instance, someone may have swelling only in their right leg or only in their left foot^[3].

What Causes Peripheral Oedema?

Peripheral oedema can result from a variety of causes, ranging from simple, temporary situations to serious underlying diseases. The condition occurs when something disrupts the normal balance of fluids in your body^[2].

Common everyday causes include^[8][6]:

• Standing or sitting in the same position for too long
• Long airplane flights or car rides
• Eating too much salty food
• Being overweight
• Hot weather, as the body tends to retain more fluid when temperatures are high

Medical conditions that can cause peripheral oedema include^[3][4]:

• Congestive heart failure (when the heart cannot pump enough blood to meet the body’s needs)
• Kidney disease or kidney failure (impaired kidney function can lead to fluid retention)
• Liver disease, including liver cirrhosis and liver failure
• Chronic venous insufficiency (when veins in the legs have difficulty returning blood to the heart)
• Deep vein thrombosis (a blood clot in a deep vein, usually causing swelling on one side)
• Lymphedema (problems with the lymphatic system)
• Pulmonary hypertension (high blood pressure affecting the arteries in the lungs)
• Obstructive sleep apnea
• Thyroid diseases
• Preeclampsia or eclampsia (high blood pressure conditions during pregnancy)

Medications that can contribute to oedema include^[4][6]:

• Blood pressure medicines, particularly calcium channel blockers
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroid medications
• Hormones, including estrogen in birth control pills or hormone replacement therapy
• Some antidepressants
• Certain medications like pregabalin

Other causes include pregnancy, vitamin deficiencies (such as thiamine deficiency), allergic reactions, infections, burns, trauma, and insect bites^[3][8].

The most common cause of peripheral oedema in people over 50 years old is venous insufficiency^[3].

Who is Affected?

Peripheral oedema is common and can affect anyone at any age. However, certain groups are more likely to experience it^[6]:

• Pregnant women
• Adults who are 65 years or older
• People who are overweight
• People with underlying medical conditions affecting the heart, kidneys, or liver

Recent estimates indicate that approximately 20% of adults older than 50 years have some form of oedema^[9]. Because many mild cases resolve on their own, the exact rate of occurrence is unknown^[6].

• Feet
• Ankles
• Legs
• Hands
• Arms

How is it Diagnosed?

Your healthcare provider will diagnose peripheral oedema through a physical examination, looking for swelling especially in areas where your skin has a shiny or stretched appearance^[6]. They will also ask about your medical history, which is often enough to determine the cause^[5].

During the examination, your provider may test for pitting oedema by pressing a finger into the swollen area. If a dent or pit remains after removing the finger, this indicates fluid in the tissues. Healthcare providers use a grading scale to measure the severity based on how deep the pit is and how long it takes to disappear^[6].

The evaluation should consider the location of swelling (one side versus both sides) and how quickly it developed (sudden versus gradual)^[9]. Acute swelling in one leg warrants immediate evaluation for deep vein thrombosis^[9].

Laboratory tests that may be ordered include^[9]:

• Basic metabolic panel (measures kidney function and electrolyte levels)
• Liver function tests
• Thyroid function testing
• Brain natriuretic peptide levels (to assess for heart failure)
• Urine protein/creatinine ratio (to check for kidney disease)
• Blood tests to check overall health

Imaging studies may include^[9][5]:

• Ultrasound examinations
• Compression ultrasonography to check for blood clots
• Duplex ultrasonography with reflux to diagnose chronic venous insufficiency
• Echocardiography (ultrasound of the heart) to assess for heart failure
• Vein studies

In some cases, your provider may use validated decision tools, such as the Wells score for assessing the likelihood of deep vein thrombosis^[9].

Treatment and Management

Treatment for peripheral oedema depends on the underlying cause. While mild oedema often resolves on its own, more serious cases require specific interventions^[5].

Medications commonly used include:

Diuretics, also called “water pills,” help the body eliminate excess fluid through urine. These are effective for treating oedema caused by systemic conditions like heart failure, kidney disease, or liver disease^[10][1]. One of the most common diuretics is furosemide. In patients with heart failure who don’t respond well to furosemide, another diuretic called torsemide may be more effective in reducing the risk of hospitalization and cardiac complications^[9].

If your oedema is caused by a medication you’re taking, your healthcare provider might change the dose or switch you to a different medicine that doesn’t cause swelling^[10].

Compression therapy is effective for most causes of oedema. Compression stockings or garments apply gentle pressure to your legs, helping to improve blood flow and reduce swelling^[9][10]. These are particularly helpful for people who spend long periods standing or sitting. However, compression stockings should not be used if you have peripheral artery disease^[9].

For patients with chronic venous insufficiency, some natural remedies show moderate evidence of benefit. Ruscus extract and horse chestnut seed have demonstrated effectiveness in improving oedema symptoms^[9].

Patients who have had deep vein thrombosis should wear compression stockings to prevent a condition called postthrombotic syndrome^[9].

For lymphedema, pneumatic compression devices may be used alongside standard therapy^[9].

Treatment must address the underlying cause of oedema. Pulmonary oedema (fluid in the lungs) requires immediate intervention, while other forms of oedema may allow for a more gradual approach to removing fluid^[1].

How to Care for Yourself

There are several steps you can take at home to reduce swelling and prevent oedema from worsening^[8][20]:

Elevate your legs or the swollen area. Raise your legs above the level of your heart for 15-20 minutes several times a day. Use pillows or cushions to prop up your feet comfortably while lying down or sitting. This position encourages fluid to move away from your feet and back toward your heart^[8].

Stay active. Get some gentle exercise, like walking, to improve your blood flow. Physical activity helps pump fluid from your legs back to your heart. Aim for at least 30 minutes of moderate exercise most days of the week^[8][20].

Move regularly if you sit or stand for long periods. Take breaks to move around and stretch. When you aren’t moving regularly, fluid can pool in your legs. Simple actions like flexing your feet, walking for a few minutes, or rotating your ankles can make a significant difference^[20].

Reduce salt intake. Follow a low-salt diet, which may reduce fluid buildup and swelling. Eating too much salty food can cause your body to retain excess fluid^[8].

Maintain a healthy diet. Eat a balanced diet rich in nutrients. If you’re not getting enough protein or vitamin B1, this can contribute to oedema. Staying well-hydrated by drinking plenty of water is also essential^[22].

Wear proper footwear. Choose wide, comfortable shoes with a low heel and soft sole. Avoid tight clothing, socks, or shoes that restrict blood flow^[8].

Take care of your skin. Wash, dry, and moisturize your feet to avoid infections, as swollen skin can be more vulnerable^[8].

Lose weight if needed. Being overweight can contribute to oedema^[8].

Manage stress. Chronic stress can negatively impact circulation. Incorporating stress-reducing activities like yoga, meditation, or deep breathing exercises can help improve circulation and overall wellbeing^[25].

Never stop taking any prescribed medicines without first talking to your healthcare provider, even if you think they may be causing swelling^[20].

When to Seek Medical Help

You should see a doctor if^[8][14]:

• One or both of your ankles, feet, or legs are swollen and it has not improved after treating it at home for a few days
• The swelling gets worse
• Self-care measures do not help
• You do not get better as expected

Seek urgent medical attention if^[8][14]:

• You have swelling in one ankle, foot, or leg with no obvious cause, such as an injury
• The swelling is severe, painful, or starts very suddenly
• The swollen area is red or feels hot to the touch
• Your temperature is very high, or you feel hot and shivery
• You have diabetes and your feet, ankles, or legs are swollen
• You have heart disease or kidney disease and the swelling gets worse
• You have a history of liver disease and now have swelling in your legs or abdomen

Call emergency services immediately if^[8][14]:

• You feel short of breath or are struggling to breathe
• Your chest feels tight, heavy, or painful
• You’re coughing up blood

These symptoms could indicate a blood clot in your lungs, which requires immediate treatment in hospital.

Successful treatment depends on controlling the underlying cause. Severe swelling can cause permanent damage to nerves, resulting in peripheral neuropathy. Many cases from temporary or minor causes resolve on their own with no lasting damage^[4].