SPOTTERS MEDICINE
PEDAL EDEMA
🔹 Definition:
Pedal
edema refers to accumulation
of fluid in the interstitial tissue of the feet and ankles, causing visible
swelling. It may be unilateral or bilateral, pitting or non-pitting,
and can indicate systemic or local disease.
🔹 Types:
1.
Pitting Edema:
Leaves an indentation when pressed
o Seen in cardiac, renal, hepatic,
or nutritional causes
2.
Non-pitting Edema: No indentation on pressure
o Seen in lymphedema, hypothyroidism
(myxedema)
🔹 Common Causes:
🔸 Cardiac Causes:
- Congestive Heart Failure
(especially right-sided failure)
- Constrictive pericarditis
🔸 Renal Causes:
- Nephrotic syndrome
- Acute or chronic kidney disease
- Glomerulonephritis
🔸 Hepatic Causes:
- Liver cirrhosis →
hypoalbuminemia → decreased oncotic pressure
🔸 Nutritional Causes:
- Severe protein deficiency (e.g.,
Kwashiorkor)
- Malnutrition, alcoholism
🔸 Endocrine:
- Hypothyroidism → myxedema
(non-pitting edema)
🔸 Local Causes:
- Deep vein thrombosis
(unilateral)
- Varicose veins
- Cellulitis or trauma
- Lymphedema
🔸 Iatrogenic/Drug-induced:
- Calcium channel blockers (e.g.,
amlodipine)
- NSAIDs, corticosteroids
- Pioglitazone (in diabetics)
🔸 Pregnancy-related:
- Normal in late pregnancy
(mechanical pressure)
- May be pathological in pre-eclampsia
🔹 Clinical Evaluation:
- History: onset, duration,
bilateral/unilateral, associated symptoms (dyspnea, oliguria)
- Physical Exam: pitting vs non-pitting,
temperature, tenderness
- Check for systemic signs: heart failure, renal or liver
disease
🔹 Investigations:
- CBC, renal function, liver
function, electrolytes
- Urine protein (for nephrotic
syndrome)
- ECG, echocardiogram (for cardiac
causes)
- Thyroid function tests
- Doppler ultrasound (for DVT or
venous insufficiency)
🔹 Treatment:
- Depends on cause
- Diuretics (furosemide) for
fluid overload
- Salt and fluid restriction
- Treat underlying heart, kidney,
or liver disease
- Compression stockings in
varicose veins
- Elevation of legs,
physiotherapy
🔹 Complications:
- Skin breakdown, cellulitis
- Ulceration
- Impaired mobility
- Venous thrombosis in immobile
patients
🔹 Prognosis:
- Good if underlying cause is
identified and managed early
- May become chronic in cases like
heart failure or lymphedema
DR.C.GANESAN
M.D.,
PROFESSOR OF
MEDICINE
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