What is the treatment for swollen ankles with pedal edema?

Question

Hello doctor,

I went for a run a few days back, after which I developed pitting edema with swollen ankles. I had been on Hydrochlorothiazide and steroids for a few weeks with no change. My blood and other tests were done, including chest X-rays and ECG. However, my condition is not improving. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I went through your query and understood your concern. I have checked your reports (attachment removed to protect the patient's identity). Lipids show elevated cholesterol. Urinalysis was okay, but it had some ketone bodies. These changes are more typical of a condition known as nephrotic syndrome. Some of the causes of this disorder include diabetes and systemic lupus. Steroid use can also cause swelling in ankles. However, I have a few questions. Do you have a history of diabetes or high blood pressure? Are you still taking steroids? Did you get remarkable shortness of breath or dizziness before?

Kindly follow up with the answers. Thanks and regards.

Answer 2

Hello,

Welcome back to icliniq.com.

I saw the picture you attached (the attachment was removed to protect the patient's identity).

It shows the presence of pitting edema. The fact that you do not possess symptoms like shortness of breath or dizziness rules out the possibility of a heart condition. Patients with leg swelling with underlying heart conditions are usually associated with other symptoms such as those mentioned above. In your situation, the culprit is most likely the steroid you used for arthritis. Steroids very often retain water in the body. In your situation, I suggest you talk to your physician and gradually reduce the dose of the steroids, and repeat urinalysis in the coming days because of elevated cholesterol levels. This will rule out nephrotic syndrome. The nephrotic syndrome usually presents with high cholesterolemia, albumin in urine, ankle or face swelling, etc. Initially, albumin levels might not be affected until later on. The best approach to your situation is to tell your physician about the swelling. As for your heart, there is nothing to worry about. I also suggest you reduce your salt intake.

I hope this has helped you. Thanks and regards.