What causes leg and ankle swelling?

DEAR DR. DONOHUE: My legs, ankles and feet get really swollen, and I mean really. During the day, if I slip my shoes off, I can’t get them back on. What can I do to take down the swelling? I’m not on any medicine, and my health is good. I haven’t seen a doctor in quite a while. — M.M.

ANSWER: The swelling you have is called edema. You need some background information to understand why it happens. Fluid constantly (and normally) leaks out of the circulation to bathe all body cells, tissues and organs. It returns to the circulation by way of lymphatics, vessels that act like suction hoses to vacuum up lymph fluid and return it to the circulation.

Many things can cause an excessive leakage of this fluid. One big cause is congestive heart failure. The failing heart can’t pump much blood with each beat. Blood backs up into the circulation, and fluid leaks out to swell the legs, ankles and feet. Medicines often can strengthen the heart, and other medicines can get rid of too much fluid.

Liver and kidney diseases also bring fluid retention and edema formation. A clot in a leg vein can swell the leg, ankle and foot, but this just about always happens to only one leg.

Salt retention causes the body to hold onto fluid, and the circulation is overwhelmed by it. That extra fluid leaks out and brings on edema.

One somewhat innocuous cause is sitting too long or standing in one place too long. Gravity pulls fluid from the circulation.

All of this is my way of telling you that you must see a doctor to find the exact cause. You can’t get the appropriate treatment without knowing the cause. However, you can do some things on your own that will reduce the swelling. Cut back on salt. It makes the body hold onto water. Elevate your legs as often as you can. Don’t sit for long periods. Get up and walk around. Leg muscle contractions push fluid out of the feet and legs.

The booklet on edema and lymphedema (a variant of edema) explain this phenomenon and how it’s treated. Readers can order a copy by writing: Dr. Donohue — No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have heard from several sources and have seen in magazines that cell phones are suspected of causing brain cancer. Is this true? If it is, shouldn’t there be a nationwide alert? I would think that the government would see to it. — T.R.

ANSWER: The link between cell phones and brain cancer has been investigated for decades without a definite association being made. Many of the studies have been inconclusive, and some have been outright contradictory. Newer studies have raised the issue again, but no clear relationship has been demonstrated. Some say that it is wise to limit the use of cell phones, especially for children. It is children who could be at greater risk.

On social grounds, it wouldn’t hurt to limit cell phone time. Some children use these devices so often and so constantly that they appear to have one grafted to their ear.

DEAR DR. DONOHUE: I have a bone spur on my heel. It is very painful. Can you tell me what I should do to get rid of it? What causes bone spurs? — H.B.

ANSWER: A bone spur is an icicle-shaped piece of bone that juts off many bones. Usually, some irritant causes it to form. In the case of a bone spur on the heel bone, plantar fasciitis is the biggest cause. The plantar fascia is a sling of tough tissue that arises from the heel and fans out to the base of the toes. Fascia inflammation is a common foot disorder. Anti-inflammatory drugs, heel pads and well-cushioned shoes can rid you of pain. The spur isn’t the cause of the pain. Inflammation of the plantar fascia is. If these simple measures fail to cure the pain, you’ll have to see a doctor for more-invasive treatment, like a shot of cortisone.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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