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Questions for Dr. Kennedy
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Swolling ankles and overall swelling of both feet
Posted by: Pat
Date: March 4, 2000 2:59 AM

I have been plagued with chronic swelling of both feet for the past 3-4 years. The swelling in the beginning was minimal and began with pain on both the bottom and top portion of my feet. Recently I've experienced an annoying tingling in both feet, which causes me to constantly "stomp" down on them to make the tingling go away. I've been examined by orthopedic doctors, I've had a test which x-rayed the veins in my legs, and no cause was found for the swelling. When I rest my feet at night, the swelling is reduced somewhat, but returns the following day. I went to the E.R. out of frustration and the doctor told me I was suffering from veinous insufficiency. He said there was no cure. He just looked at my swollen feet and did not order any tests or medication. Any advice would be appreciated. Could the tingling be caused my poor circulation? If so, is there any medication I can take? Currently, I'm taking Venistat, which is supposed to promote healthy circulation. I haven't observed any improvement.

Swolling ankles and overall swelling of both feet
Posted by: Ron Kennedy, MD
Date: March 4, 2000 2:01 PM

Swelling below the knees is called "dependent edema" which means water in the body is collecting at the lowest point - usually due to gravity - it is being pulled to that location. If such a person were bedridden, for example, the fluid would collect on the side of the body usually in contact with the bed, the most "dependent" part. What this means is that fluid is not staying inside cells but is going to the space between cells. It has a differential diagnosis (meaning it could be any of these) as follows (in the order of frequency): (1) calorie overload (overeating), especially of carbohydrates such as sweets, bread, pasta, potatoes, rice, (2) kidney disease, (3) heart disease, (4) venous insufficiency. In the case of venous insufficiency the effect is not due to "dependency" but rather to the fact the venous system has lost its tone and veins have enlarged in size thus rendering part of the one way valve system unable to prevent flow of blood backward. Therefore fluid escapes from the capillary system into the space between the cells due to backward pressure. Each of these conditions has proper treatment, but first you need proper diagnosis, then you must be in the hands of a doctor experienced in that type of problem. In the case of kidney disease, you best see an internal medicine doctor, in the case of heart disease a cardiologist for diagnosis, but usually a nutritional medicine doctor for actual treatment, in the case of calorie overload a doc who practices nutritional medicine, and in the case of a venous problem, a sclerotherapist. All docs are not of equal skill, and some have not a clue about the differential diagnosis of your problem and this is a real problem for consumers of medical services. From this discussion you may have an idea yourself of what the problem is and can use the Find A Doctor function (yellow tab, upper left) of this web site to get started. Good luck.



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