In the United Kingdom, it is estimated that approximately 400,000 people suffer from lymphoedema, or chronically swollen feet and ankles. This figure does not include people who have experienced swollen feet during hot weather or after a long flight. Lymphoedema is characterised by chronic inflammatory fibromatosis or hypertrophy of tissue structures’ fibro-connective tissue. It was known as ‘elephant leg’ in Roman times (elephantiasis).
Swollen feet and ankles can have serious physiological consequences and are rarely discussed on social media. Swollen feet are often associated with illness and ageing, but this is unjust because younger, healthy people can also develop oedematous feet and ankles, colloquially known as ‘cankles.’
It is critical to distinguish between having swollen feet and having lymphoedema, a chronic condition. Both conditions are caused by fluid retention, but oedema is a more transient condition in which swelling can be reversed by treating the underlying cause, whereas lymphoedema is a progressive disease that is difficult to treat.
Oedema is characterised by swollen ankles that pit and indent when pressure is applied. The length of time it takes for the indent to disappear indicates the severity of the condition. In a person with lymphoedema, there may be no pitting or the indents may take a long time to disappear.
Oedema and lymphoedema are symptoms of a weakened lymphatic system. The lymphatic system serves three primary purposes:
- Draining excess tissue fluid: It balances the fluid in the blood and the tissues. This is known as fluid homeostasis
- Fighting infection: It provides immunity by assisting the body’s immune defence against foreign bodies, such as bacteria and removing toxins.
- Absorbing fats: It absorbs lipid nutrients from the intestine and transports them to the blood.
Think of the lymphatic system as a transport and drainage system with interconnecting channels to help deliver and remove products out of the body by processes of natural detoxification such as urinating and sweating. A disruption to the lymphatic system can, in the long term, undermine its ability to drain fluid properly. As a result, excess fluid can build up in parts of the body. There are 2 classifications for lymphoedema:
1) Primary lymphoedema – a genetic developmental problem of the lymphatic system
2) Secondary lymphoedema – caused by damaging etiological factors affecting the lymphatic system which can or cannot be reversed.
Etiological factors for lower limb swelling:
Sudden Onset
- Unilateral onset could be caused by a blood clot (DVT) and is associated with pain. Get checked out immediately.
- A ruptured Baker’s/ Popliteal Cyst can also cause unilateral pain and swelling, but is more in the calf. Get checked out immediately.
- Injury e.g. ankle sprain or strain
- Infection, over-reactive response to insect bite or verruca acid treatments
- Surgery
Common Insidious Onset
- Standing or sitting in the same position for too long e.g. long flights – muscles are inactive, can‘t pump body fluids back up toward the heart.
- Pressure and restriction from tight garments or jewellery
- Temperature changes – too hot, or too cold
- Eating too much salty food which causes fluid retention – causes fluid to leak into interstitial tissue spaces
- Being overweight – decreases blood circulation, increases ankle pressures
- Pregnancy, hormonal fluctuations
- Poor diet e.g. too much salt intake
- Medication
Chronic Long Standing
- Immobility from paralysis
- Renal and congestive heart failure
- Diabetic foot complications e.g. Charcot Foot
- Chronic venous insufficiency e.g. varicose veins
- Cancer/ cancer treatments destroying lymphatic nodes
It is important to have a balance of lymphatic fluid for health. One of the main controls of water is to balance the concentration of blood serum proteins. Low levels of blood proteins can result in fluid retention. A loss of serum proteins may be caused by kidney, liver or thyroid diseases, malnutrition, excessive bleeding, chronic draining wounds and excessive burns.
When does oedema become lymphoedema?
When the oedema does not go away, nothing seems to help address the underlying cause, and there is little to no soft pitting, this is the general answer. A patient usually has a swollen ankle(s) for a long time, with poor lymphatic drainage and function, resulting in an imbalance of blood serum proteins and water. The high protein content can cause secondary complications such as tissue and skin hardening over time.
Facts about lymphoedema:
- There is a family history of the condition in 20% of cases.
- In the early stages of the condition, swelling may be unequal on each side of the body.
- Direct pressure to the skin causes no pain. Legs may feel heavy and ‘tight.’
- Limbs do not bruise easily.
- Increased infection risk (Cellulitis) can affect both sexes at any age.
- Stress does not cause lymphoedema, but it can cause weight gain, which is a contributing factor.
- Causes physiological stress, which can have an impact on mental health and well-being.
- Weight gain can be caused by antidepressants. oedema
- Skin changes caused by dermatology, such as thickening, splitting, blistering, and ulceration
- Aspirating or draining fluid can aggravate the condition.
- Diuretics and water tablets are ineffective in treating chronic lymphoedema.
Prevention and Treatment of Oedema
The goal of secondary lymphoedema treatments is to reduce swelling to normal or near-normal levels by utilising remaining healthy lymph vessels and other lymphatic pathways. Maintaining the skin’s health. It is a check-box approach in which one does everything possible:
- Drinking plenty of water to maintain proper lymphatic function
- Wear compression socks or stockings, but make sure they fit properly. Tight clothing can cause circulatory problems.
- When flying, wear flight socks.
- Soak the feet for at least 15 minutes in cool water with Epsom Salts.
- Raise the feet above the heart on a regular basis, and raise the end of the bed.
- Calf muscles that are active act as a pump to move fluids up the leg.
- Losing weight if you’re overweight
- Eating a healthy diet and watching your salt intake. Avoid a low-protein diet.
- Consume foods high in water content, such as courgettes and cucumbers, to keep your body hydrated for longer.
- Massage of the feet by best foot massager for large feet
- Lymphatic drainage massage by a professional
- Consume more potassium-rich foods. Bananas, for example, can help to reduce water retention.
- Magnesium supplements can help with muscle activity.
- Avoid hot baths as well as traditional saunas and steam rooms. Direct heat is a problem. Saunas with infrared technology can be beneficial.
- Reduce your alcohol consumption because it causes dehydration and can impair liver function.
- Steroids, unless medically prescribed, can cause swelling.
- Avoid crossing your legs for an extended period of time.
- Increasing protein levels in the blood
- In mild to moderate conditions, taking diuretics to flush out excess fluid
Excellent Foot Care for Swollen Feet
It is critical to maintain the health of swollen feet because many secondary problems can be avoided. An oedematous foot requires the same level of attention as a diabetic:
- Wear well-fitting footwear with adjustable fastening
- Every day, apply a 10% Urea general purpose foot cream to your feet, ankles, and lower legs.
- Reduce the likelihood of skin infections. Use anti-fungal topical skin products, for example, to reduce your chances of getting Athlete’s Foot.
- Don’t go outside barefoot.
- If you have pain in your lower limb joints, consult a podiatrist about your biomechanics. Increased fluid retention is caused by musculoskeletal problems. A special insole or shoe can help with gait.
- Keep your nails short and consult a podiatrist if you are having difficulty cutting them.
- Professionally remove all callouses and corns. Avoid using medicated corn plasters. Cellulitis can be caused by heel splits!
- Use insect repellent where there is a high risk of being bitten. Mozzies are obsessed with ankles!
- Use a high factor sunblock when out in the sun.
- All cuts and abrasions should be treated right away with an antiseptic cream, and the area should be kept clean.
- When possible, elevate the affected limb above the level of the heart; if this is not possible, use a foot stool. Up is preferable to down!
- Compression socks with open toes are better for reducing pressure on the nails and toes.
- Avoid unnecessary blood pressure checks, blood draws, and injections in the affected limb. Additional trauma and post-inflammatory tissue swelling may occur. Because of fluid dilution, local anaesthetics will not work.
If the oedema does not seem to be going away and is getting worse, seek medical attention. It could be because of medication or another easily resolved issue. The injection of coloured dye will trace lymphatic movement and identify any existing or potential blockages.
Lymphoedema Complications That Aren’t Desired
Complications are more common in people who do not seek medical help and are disobedient. Possible complications include:
- Skin ulcerations – As skin ages, it becomes thicker and less supple, and when stretched, it can lose its integrity as a protective barrier.
- Cellulitis is a skin infection. Cellulitis is a bacterial infection that affects the deeper layers of skin as well as the fat and soft tissue layers beneath the skin.
- Lymphangitis is an inflammation of the lymph vessels that is usually caused by a Streptococcus bacterial infection.
- Immune System Impairment – A weakened immune system and poor overall health can result from a deficient lymphatic system.
If lymphoedema is diagnosed, the following treatments can help reduce swelling in people with mild to moderate lymphoedema:
Other Lymphedema Therapies
- Intermittent Sequential Pneumatic Compression Therapy – Lymphatic drainage suits, which massage and squeeze fluid up the legs, can be purchased.
- Standing on an oscillating vibration plate can help activate muscles and increase blood flow and lymphatic drainage.
- Kinesio Taping – K- Tape is commonly used to aid in fluid drainage during the acute stage of an injury to reduce oedema; it can also be used as part of lymphoedema management because it stimulates cutaneous blood and tissue fluid flow.
- Drug Therapy – Although drug therapy has limited benefit for lymphoedema, new drugs, such as ketoprofen, are being clinically tested. Ketoprofen has been shown to improve skin elasticity and health.
- Low Level Laser Photodynamic Therapy – Clinical studies have shown that using low level laser red light energy to reduce swelling by improving circulation and lymphatic drainage. Red light energy from a laser, such as the Erchonia XLR8 or PL Touch, works at the cellular level.
- Surgery – While advancements in re-routing lymphatic drainage systems are being made, they are still in their infancy. The primary goal of surgery is to preserve tissue viability. If there are blocked or faulty leg valves that are contributing to the oedema, surgery can be beneficial.
There are diagnostic tests, such as MRI and CT scans, that can determine if there is a blockage or a problem with the lymph nodes. A lymphoscintigraphy test can also be used to diagnose a problem; a radioactive dye is injected into the lymphatic system, and a nuclear scanner is used to detect any blockages.
Conclusion
A multi-targeted approach should be used to successfully treat oedema and lymphoedema. It makes sense to include as many of the preventative measures and treatments as possible. A proactive approach to treating and managing oedema or lymphoedema will allow the individual to live a normal and healthy life. A person’s quality of life should not be hampered by puffy ankles. The sooner an individual with recurrent or persistent ankle oedema seeks treatment, the better the outcome; otherwise, the ‘elephant has bolted,’ but all is not lost.
