Dear Dr. Garner,
I am glad that the good old summertime is here but it wreaks havoc on my feet. Something about the warm weather causes my feet and ankles to swell. I can’t even get into my shoes. I’m in good physical shape, and I try to exercise, but being a waitress, I’m on my feet most of the day.
Is there anything I can do to keep the swelling down? I’d appreciate any advice you can offer.
Swollen Feet in Flushing
Dear Swollen Feet,
I was just talking about this with noted podiatrists, Dr. Patrick Grisafi and Dr. Ronald Soave.
Unfortunately, swollen feet will affect most of us during our lifetime. But most of the time it is not serious and will improve.
Swollen feet and ankles typically develop when fluid seeps out of the blood vessels in the legs due to gravity, and it pools in the lower legs or ankles. This is more likely to happen in summer or after standing all day. However, it improves on its own.
Any number of causes can be responsible for swollen feet. I would like to review some of the more common causes:
- Injury
The most common cause for swelling. The ankle and foot can quickly swell and may be accompanied by bruising.
- Blood clot
A blood clot can cause swelling of the ankles and feet. It usually occurs in one leg at a time. A blood clot can be a medical emergency and requires immediate medical attention.
- Medical conditions
Heart problems such as congestive heart failure and high blood pressure can cause swollen feet and ankles.
- Liver disease
Liver disease can cause a change in hormone levels and certain chemicals that regulate fluid retention.
- Gout
There can be inflammation of the joint leading to swollen, red and hot painful foot.
- Pregnancy
Pregnancy hormones cause the body to retain fluid. The excess fluid puts pressure on the legs and feet and the expanding womb can block the blood vessels and cause swelling of the legs and ankles.
- Medications
Blood pressure medications, such as calcium channel blockers, diabetes drugs, antidepressants and NSAIDs, such as Motrin and Aleve, can all cause swelling of feet.
- Venous insufficiency
The veins work to pump blood back from the feet and legs to the heart. If the valves stop working properly, fluid can seep back down and pool, thereby causing swelling of the feet and ankles.
- Prolonged inactivity
Staying in one position for long periods of time such as driving or flying without moving can cause fluid to back up the leg circulation, which can cause swollen feet and ankles. Gravity makes the blood and fluid seep down to the feet and cause swelling.
- Lymphedema
Blockage in the lymphatic system causes excess lymph fluid and collects in the soft tissues causing swelling of the feet and ankles. It can be caused by any number of things, including infection, injury or cancer treatment.
There are a few other causes of feet swelling: summer heat, obesity and prolonged standing, such as in your case as a waitress. All can cause build-up of fluid. This will usually respond to support stockings and elevation of the legs and feet. Women in general have higher incidents of fluid retention due to hormones.
When should you seek attention? If the swelling occurs rapidly, is accompanied by pain, redness, warmth, shortness of breath or fever that lasts more than 24 hours.
Treatment for swelling of the feet and ankles is based upon the causes. If no cause is found, the doctor may suggest an Ace bandage, elevating the leg at night or when sitting and an exercise program. In addition, the doctor can evaluate the leg with a sonogram to determine if the blood vessels are operating properly.
I hope this answers your question. Have a great summer.
Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET TV, Tuesdays at 8 p.m. on Time Warner Channel 97, Cablevision Channel 30 and Verizon FiOS on Demand.
