My foot has been swollen for 10 years. Is this normal?

Dr Flo,

I have had a swollen foot for close to 10 years.

Apart from the discomfort of the occasional feeling of tightness, I have not had any pain over the years. However, lately I have started feeling slight pain in my knee and hip joint. What could be the problem?

Rebecca

Dear Rebecca,

Oedema refers to accumulation of excess fluid under the skin or in between the tissues. It can happen in the feet, around the ankles, the legs, hands and arms, and even in other spaces within the body like around the brain, the heart, the lungs, and in the abdomen. It may be acute, developing quickly, and also resolving over a short period of time.

This can be caused by spraining an ankle, infection, a blood clot, a bee or wasp sting, allergic reactions, and kidney or heart failure. It can also be chronic, developing over time and lasting for a long time. This can be caused by problems with blood flow, or drainage of lymphatic fluid, heart failure, kidney disease, liver disease, thyroid disease, low blood level or a tumour in the pelvis.

In your case, where there is painless chronic oedema of one foot, the most likely causes are poor blood flow in the veins, poor drainage of lymphatic fluid (lymphoedema) or a swelling in the pelvis e.g. fibroids, or a tumour. If the swelling usually reduces at night, then it is more likely to be from poor blood flow in the veins.

Please consider visiting a doctor to do a Doppler ultrasound – this is a scan that checks the blood flow in the veins. If this is normal, you may consider a pelvic ultrasound to make sure there are no swellings/tumours in the pelvis. Treatment involves wearing compression stockings to improve blood (or lymphatic) flow, increased leg exercises and elevating the feet. Also avoid prolonged sitting or standing at one place. Pneumatic (air) compression devices can be used in some cases.

If there’s a tumour in the pelvis, it should be attended to. In some women, especially those aged between 20 and 30, the cause may not be any of the above. If that’s the case for you, then the management is elevating and exercising the legs, reducing your weight if you are overweight and reduction of salt intake. Also avoid taking too many fluids. 

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Dr Flo,

Just before my menses come to an end, I feel a dull pain on my lower left abdomen.

Is it cause for alarm?

Worried Lady

Dear Worried Lady,

Period pain occurs on both sides of the pelvis or in the middle. If the pain is on one side, it might suggest an abnormality in the shape of the uterus. It might also be due to endometriosis. Abnormalities in the shape of the uterus are inborn, and some can be corrected surgically, if need be.

Endometriosis means that there is endometrial tissue (the tissue lining the inside of the uterus, responsible for your periods) outside the uterus, e.g. on the ovaries, fallopian tubes, bladder, intestines, the lining of the pelvis, or anywhere else in the body. This tissue, wherever it is, still responds to the normal monthly cycle of hormones, and “bleeds” when there is bleeding from the uterus. Endometriosis can be quite painful. The symptoms depend on where this tissue is, so if it is on the left side of the pelvis, you might have pain on the left side of your abdomen during your periods. To diagnose either of these issues, you will need a pelvic exam by a doctor and a pelvic ultrasound. If any abnormality is found, you will be advised on the next course of action. If not, then pain killers and warm compresses, like a hot water bottle, can help manage the pain. 

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Dr Flo,

I have been a career handball coach for 25 years. Recently, my Achilles tendon ruptured, but it was operated on successfully. I have a few worries about this, though:

1. What causes the ruptures?

2. How long will it take to heal completely?

3. Will I be able to walk properly again, leave alone play actively?

4. Is there a danger of rupturing the other foot or the same foot again? Yours in pain,

Coach Pere

Dear Coach Pere,

The Achilles tendon is a band of fibrous tissue that connects the muscles at the back of the leg, the calf muscles, to the heel. It is useful in walking, running, jumping and pointing your toes. It can be injured quite easily, and if there is a complete tear through the tendon, it’s called a rupture.

Achilles tendon ruptures occur more commonly in people who play sports, because of increased physical activy that involves rapid speeding up, slowing down or pivoting. It can also occur in people with flat feet, in those who wear high heels a lot, or after taking steroid medication, or some antibiotics (flouroquinolones) for a long time. It is more common in men over the age of 30. The length of time it takes to recover is dependent on several factors like your age, your health status and the severity of the injury. It usually takes several weeks to several months to heal. You should be able to walk properly again with time; however, do not engage in your previous level of physical activity until there is no more pain when you walk, jog, sprint or jump, and the injured leg is as strong as the “normal” one and it can move as freely as the “normal” one. It is possible to injure the same tendon again, if you engage in physical activity too soon, before it heals completely. After it heals, it is possible to injure or rupture either or both Achilles tendons, the same way you got the rupture the first time.

As you recover, some measures you can take include resting the leg, elevating it and using a heel lift to protect the tendon from stretching further. Physiotherapy that includes stretching and strengthening exercises also helps.