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lower extremity edema
Etiology:
1) unilateral edema
- popliteal cyst (Baker's cyst)
- tears of the medial head of the gastrocnemius
- deep vein thrombosis (DVT)
- chronic venous insufficiency
- degenerative joint disease
- Charcot foot
- medial meniscus medial horn tear
- trauma, surgery
- lymphatic obstruction
2) bilateral edema
- generally of systemic origin (also see edema)
- heart failure
- pulmonary hypertension
- obesity hypoventilation syndrome
- cirrhosis
- nephrotic syndrome
- pharmaceuticals
- Ca+2 channel blockers
- especially amlodipine, felodipine, nifedipine
- gabapentin, pregabalin
- NSAIDs
- hydralazine
- clonidine
- minoxidil
- carbenicillin, amantadine
- androgens (testosterone), estrogens, progestins
- glucocorticoids
- aromatase inhibitors, tamoxifen
- alpha-blockers, beta blockers, hydralazine, diazoxide
- phenothiazines, thioridazine, lithium
- reserpine, guanethidine, MAO inhibitors
- thiazolidinediones (pioglitazone)
- insulin
- dopamine agonists
- bromocriptine, pramipexole, ropinirole
Clinical manifestations:
- bilateral edema
- pedal edema, pitting edema
- painless
- periorbital edema suggests thyroid disease
- orthopnea or paroxysmal nocturnal dyspnea suggests heart failure
Laboratory:
- urinalysis
- serum creatinine
- serum albumin
- serum transaminases
- serum sodium, serum potassium
- thyroid function testing
Management:
- bilateral pedal edema & bilateral lower extremity edema in general
- conservative measures:
- sodium restriction
- leg elevation
- weight reduction
- compression stockings
- specific measures for specifc etiologies
- see venous stasis & venous stasis dermatitis
Related
deep vein thrombosis (DVT)
gastrocnemius muscle tear
Morrant Baker (popliteal) cyst or pseudothrombophlebitis syndrome
osteoarthritis (OA)
venous stasis; venous hypertension
General
peripheral edema
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16,
17, 19. American College of Physicians, Philadelphia 1998, 2009,
2012, 2015, 2021
- O'Brien JG, Chennubhotla SA, Chennubhotla RV.
Treatment of edema.
Am Fam Physician. 2005 Jun 1;71(11):2111-7.
PMID: 15952439