What can I do about swollen legs and ankles?

DEAR DOCTOR K:

Why are my legs and ankles swollen? What can I do about it?

DEAR READER:

In yesterday’s column, I answered the first part of your question. I explained the different causes of leg and ankle swelling (edema) — some not serious, and others very serious.

Today I’ll explain what your doctor needs to do to diagnose the cause of the edema, and what you and your doctor can do to reduce the swelling.

Among the serious causes of leg and ankle swelling are diseases of the heart, lungs, liver, kidney and thyroid. If your symptoms and physical examination suggest the possibility of any of these conditions, your doctor will order various diagnostic tests.

  • Blood tests can help diagnose heart failure, severe lung disease, kidney disease, low protein levels in the blood and underactive thyroid — all causes of leg and ankle swelling.
  • Urine tests can help diagnose kidney disease.
  • A chest X-ray can help diagnose both heart disease and lung disease.
  • An electrocardiogram (EKG or ECG) can also help diagnose heart, lung and kidney disease.

The treatments for leg and ankle swelling depend on the cause. For most causes, you can take several steps that will help greatly:

  • Reduce your salt intake. Extra salt in your diet tends to hold water inside your body. Particularly if you are diagnosed with heart, lung or kidney disease, avoiding salt is very important — and entirely in your control.
  • Avoid drinking too much fluid. Normally it’s healthy for men to drink 13 cups of water-containing beverages per day, and women 9 cups. (That is, it’s healthy depending on what the “water-containing beverage” is.) However, if you have leg and ankle swelling, cut back from that number. But don’t forget about reducing salt: It is more important in reducing swelling than cutting back on fluid.
  • Elevate your legs. Almost regardless of what’s causing your leg and ankle swelling, elevating your legs will help because it offsets the downward tug of gravity. That tug is keeping water in the blood and in the space between your cells from returning to your heart. (But if you are short of breath at rest, and elevating your legs makes that worse, don’t elevate them — and talk to your doctor.)
  • If you’re pregnant, avoid lying on your back, as that causes the baby and uterus to press down on the veins from your legs, which makes it harder for water in the legs to return to the heart.
  • Compression stockings can help reduce leg and ankle swelling, particularly if your swelling is caused by disease of the veins in your legs.
  • Diuretic pills (“water pills”) help the kidneys eliminate extra water.

No matter the cause, protect any area affected by edema from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns in areas that have edema take much longer to heal and are more likely to get infected.