Definition
Oedema is the accumulation of excess fluid in the tissues of the lower limbs, leading to visible swelling of the ankles, feet, and sometimes legs. It may be temporary and benign or a sign of an underlying medical condition.
Causes
Localized (peripheral) causes
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Prolonged standing or sitting
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Injury or surgery to the foot/ankle/leg
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Infection or inflammation (cellulitis, arthritis)
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Venous insufficiency
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Deep vein thrombosis (DVT)
Systemic causes
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Heart failure
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Kidney disease (nephrotic syndrome, chronic kidney disease)
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Liver disease (cirrhosis)
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Hormonal changes (pregnancy, menstrual cycle)
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Hypothyroidism
Drug-induced
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Calcium channel blockers (e.g., amlodipine)
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NSAIDs
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Corticosteroids
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Hormone replacement therapy (oestrogen)
Risk Factors
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Age over 60
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Sedentary lifestyle
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High salt intake
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Obesity
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Chronic diseases (heart, kidney, liver)
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Varicose veins
Pathophysiology
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Increased capillary hydrostatic pressure (e.g., in heart failure, venous insufficiency)
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Reduced plasma oncotic pressure (low albumin in liver/kidney disease)
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Lymphatic obstruction (lymphoedema)
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Increased capillary permeability (inflammation, allergic reactions)
Clinical Features
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Pitting swelling (indent remains after pressing skin) in most causes
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Non-pitting swelling in lymphoedema or hypothyroidism
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Heaviness or discomfort in affected limb
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Skin tightness, shiny appearance
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Associated symptoms depending on cause: shortness of breath (heart failure), pain/redness (DVT), fatigue (kidney/liver disease)
Diagnosis
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History: onset, duration, symmetry, associated symptoms, medication history
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Physical examination: pitting vs non-pitting, unilateral vs bilateral
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Blood tests: kidney, liver, thyroid function, albumin
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Urinalysis (proteinuria in nephrotic syndrome)
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Echocardiogram (heart failure)
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Doppler ultrasound (DVT, venous insufficiency)
Treatment
General Measures
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Leg elevation above heart level when resting
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Compression stockings (unless contraindicated, e.g., in severe arterial disease)
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Reduce salt intake
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Regular walking and calf muscle exercises
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Avoid prolonged standing or sitting
Treatment of Underlying Cause
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Heart failure: diuretics, fluid restriction, cardiac medications
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Kidney disease: treat cause, control blood pressure, diuretics if indicated
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Liver disease: manage cirrhosis, diuretics, low sodium diet
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Venous insufficiency: compression therapy, vein surgery if required
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DVT: anticoagulation therapy
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Injury/inflammation: RICE (rest, ice, compression, elevation)
Medications (examples for adults)
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Furosemide: 20–40 mg orally once daily; may increase gradually as needed
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Spironolactone: 25–100 mg orally once daily in liver-related oedema
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Compression therapy: Graduated compression stockings, 20–40 mmHg
Complications
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Skin breakdown, ulcers
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Infection (cellulitis)
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Reduced mobility
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Chronic venous insufficiency
Quick-Reference Clinical Chart — Oedema
| Feature | Details |
|---|---|
| Definition | Fluid accumulation in tissues of lower limbs |
| Common causes | Prolonged standing, venous insufficiency, heart/kidney/liver disease, DVT, medications |
| Symptoms | Swelling, heaviness, pitting/non-pitting, skin tightness |
| Risk factors | Age, sedentary lifestyle, high salt diet, obesity, chronic disease |
| First-line treatment | Leg elevation, compression stockings, reduced salt intake, mobility |
| Drug therapy (adult dose) | Furosemide 20–40 mg PO daily; Spironolactone 25–100 mg PO daily (cause-dependent) |
| Investigations | Blood tests, urinalysis, echocardiogram, Doppler ultrasound |
| Prognosis | Good with treatment of underlying cause; recurrence if risk factors persist |
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