Edema is swelling that is triggered by extra fluid which has become trapped in the tissues of the body. Edema may be the effect of any underlying medical problem, different drugs as well as pregnancy.
Identifying the cause and treating the underlying reason for edema is the major method of its control.
Any individual should see their primary care physician if any symptoms or signs of excessive swelling or edema occurs.
Immediate medical attention should be sought if the individual has any symptoms or signs of edema or excessive swelling in the lungs – known as pulmonary edema. Excessive swelling or edema happens when the minuscule blood vessels of the body known as capillaries, seep fluid.
There are some cases of swelling where the edema is a symptom of an underlying medical problem that is more serious.
This condition creates scarring of the liver that restricts liver functioning, causing deviations in the chemicals and the hormones that manage the fluid in the body, and increases stress inside the portal or large blood vessel that carries the blood from the spleen, intestine and pancreas to the liver.
When either one or both of the lower chambers of the heart lose the ability to pump blood effectively – as happens with congestive heart failure – the blood can start backing up in the ankles, legs, as well as the feet, causing edema or excessive swelling. If an individual has kidney disease, the kidneys are not able to remove enough sodium and fluid from the blood. Injury to the tiny blood vessels of the kidneys known as glomeruli that normally filters waste and excess water from the blood may trigger nephrotic syndrome. CVI or chronic venous insufficiency is a medical problem where the veins as well as the valves in the veins of the legs are damaged or weakened to the point where they cannot pump adequate blood back to the heart. This edema is quite serious and occurs when there is excess fluid in the tissues surrounding the lungs. For the physician to make a determination on what is causing the edema, the individual will need to have a physical exam with medical history.
Diuretics may not be suitable to treat edema in some individual, especially thoses with chronic venous insufficiency or in most women who are pregnant. This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment. Patients often ask me if there is a non-medical, “natural” remedy for malar bags and eyelid Festoons. While some people have an family genetic predisposition to Malar Mounds and eyelid Festoons, most people develop them as a result of sun damage to the fragile skin in the lower eyelid and cheek region.
Once we understand this, we see that the best way to improve malar bags and eyelid Festoons is to rejuvenate the skin layers in this region.
Another medical non-surgical way to somewhat reduce Malar Mounds and eyelid Festoons involves the use of medical products to improve the skin.
In my life, I’ve often heard the phrase “there’s no such thing as a free lunch,” which I interpret to mean that getting real results in life takes real effort and work. Daily use of sunblock can protect your face from worsening sun damage in general and Malar Mounds and Festoons specifically, and the use of Retin-A can also be helpful to improve the skin to a slight degree.
Lymphedema : When there is excess of fluid accumulation in the lymph vessels it may cause swelling. Finally, it can be due to side effects of any drugs of calcium channel blockers and antidepressant medicines.
Apart from swelling in the ankles or legs, there may be moderate to severe pain while walking or moving the legs. You can keep your legs in the elevated position (above the heart) for facilitating easy blood flow.
In case of minor foot injury and sprain, you can use ice packs or wrap the foot with compressions.
Your doctor will first identify the underlying cause of swelling in the feet before giving treatment. Doing exercise and physiotherapy can help the person to overcome various causes of swelling. Early detection of Charcot neuroarthropathy is critical for preventing the bone and joint destruction associated with later stages, but symptoms that mimic other conditions can make a differential diagnosis difficult. Newer theories have emerged that more accurately describe the pathogenesis of this condition.
CN will be seen primarily in the diabetic population; however, keep in mind that any disorder that causes neuropathy can predispose an individual to the development of CN. Individuals with CN in the acute phase will typically present with a red, hot, swollen foot.4 Edema and erythema are usually present, and unilateral presentation is more common than bilateral presentation. Temperature changes will be noted in the affected limb, which has been verified by limited thermographic study.23 Recording the skin temperature differential between limbs on the initial presentation and all follow up visits may help the practitioner determine staging and progression of CN, but to our knowledge, a study has not been performed to confirm this.
Chronic phases of CN will present with a temperature that is more similar to the unaffected contralateral limb. A number of differential diagnoses may preclude the practitioner from immediately diagnosing CN.
Infection such as cellulitis, septic arthritis, or osteomyelitis can usually be rejected as a differential diagnosis if an open ulceration is not present and traumatic inoculation did not occur.25 Laboratory studies including complete blood count (CBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) should be completed. Deep venous thrombosis (DVT) will present with an enlarged limb and will be seen in a patient experiencing a hypercoagulable state as a result of genetics, surgery, age, immobilization, medications, or metastatic disease.
Well’s criteria can be utilized to determine those most at risk for DVT.28, 29 In this system, +1 point is given to those most at risk, such as those with cancer, paralysis or immobilization of more than three days, tenderness along course of deep veins, leg swelling, pitting edema, prior DVT, and collateral superficial veins. Gout is the result of deposition of monosodium urate crystals within a joint; it typically occurs in the first metatarsophalangeal joint but can present in any joint of the foot. Ankle sprains are one of the most common injuries presenting to the emergency department, second only to knee injuries.
Septic arthritis is potentially one of the most dangerous differential diagnoses on this list to miss.
Diagnosis should be made quickly through an accurate and thorough clinical exam, and definitive treatment should not be delayed while waiting for laboratory results to be completed. The Eichenholtz classification system is the one most frequently utilized when evaluating neuroarthropathy.
Early changes, such as those associated with stage 0 Charcot, can reliably be observed with triphasic bone scan.
It can still be difficult to differentiate infection from arthropathy based on MRI evaluation alone, as bone edema and osteomyelitis can have a similar appearance.38 It is, therefore, important to carefully evaluate MRI studies for subtle differences that can lead to a correct diagnosis.
It is important to remember that infection will be caused by contiguous spread from ulceration or surrounding cellulitis; osteomyelitis in the absence of these entities is extremely rare. Cellulitis will be seen as a low signal in the soft tissues surrounding the bone on T1-weighted images and hyperintensity seen on T2-weighted images. FDG-PET (2-fluoro-2deoxy-glucose positron emission tomography) scanning offers some very distinct advantages over MRI in relation to Charcot neuroarthropathy. PET scans have another distinct advantage in that patients with metal implants can be reliably evaluated with this technique without complicating artifacts to obscure views, which can occur with MRI. FDG PET is rarely utilized clinically in the diagnostic workup of Charcot neuroarthropathy today.  Limitations of this imaging modality include its significant expense, which can range from $2,000 to $8,000 depending on the institution.
Although many confounding differential diagnoses exist, Charcot arthropathy can be relatively simple to diagnose if the practitioner has an understanding of the condition and a high index of suspicion. Although treatment of CN is beyond the scope of this article, it is worth noting that if a practitioner comes across an individual with suspected CN, implementing non-weight bearing status is of utmost importance. Download this FREE eBook to see how foot pressure data contributes to more efficient treatment and better outcomes. A 38 year-old professional fisherman presents to your emergency department after returning to shore from a 3 week trip. Consider possible underlying causes — trauma, surgery, ENT or systemic infection, diabetes mellitus, and immunosuppression.
Erythromycin ointment qid — for corneal exposure and chemosis if there is severe proptosis. Periorbital (or preseptal) cellulitis is a soft-tissue infection of the eyelids that does not extend past the orbital septum posteriorly. Mortons Neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd?3rd and 3rd?4th metatarsal heads). Orthotics and corticosteroid injections are widely used conservative treatments for Morton’s neuroma. A viral rash is any type of skin rash brought about by the presence of an underlying viral infection. Viral rashes are also usually accompanied by other symptoms indicative of a viral infection, such as fever, headaches, and body pains. Viral rashes are most effectively resolved once the viral infection itself is treated, but most viruses are self-limiting and are simply given time to heal and disappear on their own.
Rosacea is a skin condition marked by redness with plaques or papules (pimples) hence the term acne rosacea.
The exact cause of rosacea is unknown despite certain triggers being common to most patients. The characteristic redness of the skin seen in rosacea is due to increased blood flow through the superficial blood vessels as well as an increase in the number of vessels at the affected area (increased vasculature).


Elevated levels of certain immune compounds and skin enzymes may be contributing factors to the disease process in rosacea. Very light skinned people do have tendency to flush or blush easily which is not necessarily due to rosacea.
Easily triggered by sun exposure, emotions, hot or cold, alcohol, spicy foods and cosmetics. The features of the pre-rosacea phase persists even as the condition progresses to other phases. Corticosteroids should only be used for a condition known as rosacea fulminans (pyoderma faciale) which resembles severe rosacea. Surgical measures are also not curative but can help reduce the cosmetic impact and improve some of the symptoms of rosacea. Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis.
An effect of nephrotic syndrome is lower levels of albumin in the blood leading to accumulation of fluid that often leads to edema. To answer this question, we need to first understand what the underlying causes are of malar bags and eyelid Festoons. We often don’t appreciate how the sun, in small doses over our lifetime, affects our skin in general and the eyelid and cheek region specifically. I can do this surgically with my Laser RESET Festoons treatment, which causes the skin to renew itself in a healthier, younger and more attractive state. One such product is Tretinoin (commonly known as Retin-A), which has been proven to help create new collagen in the skin. Along a similar vein, the idea that the difficult-to-treat medical condition of Malar Mounds and Eyelid Festoons can be addressed with a non-medical natural remedy is enticing to contemplate, but at this point in time it isn’t very realistic.
But by far the most effective way to completely improve Malar Mounds and eyelid Festoons is though surgical and laser treatments like my RESET treatment.
This happens when there is inadequate supply of blood that is moving upwards from the legs to the heart.
For some people, swelling happens in the evening indicating retention of salt and heart failure.
Some people will be comfortable while sitting but feel intense pain while walking or moving their legs. Clinical photograph of Charcot foot demonstrating foot and leg edema after removal of an Ace bandage.
A neurovascular, or French, theory8,14 suggests that autonomic neuropathy leads to increased blood flow, resulting in a “washing out” of the bone with subsequent osteopenia, resorption, and fracture. A triggering traumatic event in the face of neuropathy results in inflammation.  Pro-inflammatory cytokines such as interleukin IL-1b and tumor necrosis factor alpha (TNF-a) are released.
Clinical photograph of bilateral lower limbs demonstrating increased foot and leg edema on the left side, consistent with Charcot neuroarthropathy.
Although CN can occur within any joint of the foot, the midfoot is the most common location.19 A study by Herbst 20 found that 50% of Charcot cases occurred in the midfoot, 28% in the hindfoot, 19% in the ankle and 3% in the forefoot. Temperature differences between limbs will return to zero when the acute phase of CN is complete. Testing is simple and involves the application of the monofilament wire to various locations on the plantar and dorsal aspects of the foot. Infection, or osteomyelitis, is one of the main alternative diagnoses and is one of the most difficult to differentiate.
This patient will experience pain in the posterior leg when pressure is applied to medial and lateral aspects of the calf. Those suffering from hypertension are three times more likely to develop gout.  Thiazide diuretics, stress, surgery, infection, pneumonia, stroke and myocardial infarction have all been implicated as potential triggers.
Weightbearing lateral radiograph demonstrating Charcot dislocation of the Lisfranc joint with dorsal subluxation and increased soft tissue edema. A patient with an ankle sprain will present with a history of trauma, which can potentially be the inciting event for the development of Charcot neuropathy. Eichenholtz developed a series of three radiographic stages to describe the progression of change within the neuroarthropathic foot .33 Stage 1, termed the “stage of development”, is characterized radiographically by fragmentation of articular cartilage and subchondral bone. An individual in stage 0 will present with an acute, red, hot, swollen foot and bounding pulses.
Some studies even indicate that abnormalities could be seen with a technetium-99 bone scan months before clinical or radiographic abnormality becomes apparent.34 Uptake will be noted in all three phases. The benefits of MRI over plain radiographs include a more rapid determination of bone stress injury, which typically precedes fracture in these individuals and can lead to diagnosis at the stage 0 phase. Infection is favored as the diagnosis if sinus tracts, subchondral cysts, bone marrow abnormalities that are diffuse in nature, or erosions of the bone are noted.
Lateral subluxation of metatarsal bases 2-5 with fracture at 2nd metatarsal base and slight medial dislocation of medial Lisfranc joint; obliteration of Lisfranc joint space. Osteomyelitis will more commonly be seen in areas that are typically prone to ulceration such as the digits, metatarsal heads, calcaneus, and malleolus. PET scans can differentiate infection from CN on the basis of glucose metabolism; infection will result in a higher uptake of glucose, which can be measured. Ring PET has been found to be more reliable than hybrid (dual head gamma camera) PET in at least one study,39 since the resolution of ring PET scans is higher than hybrid PET scans. Ionizing radiation exposure and limited availability of this technology outside of a tertiary care setting are also limitations that can preclude its routine use. When a diabetic, insensate individual presents without an open ulceration and has a red, hot, swollen foot (especially the midfoot) with bounding pulses, Charcot arthropathy should be at the top of the practitioner’s list of differential diagnoses.
The patient should be placed in a posterior splint or total contact cast and given crutches or a wheelchair to ensure that no additional pressure is applied to the foot. Over the past week he has had progressively worsening left eye symptoms and is now feeling quite unwell.
He reports a history of double vision but now he has trouble seeing anything out of his left eye. What causative organisms are usually responsible for this condition in the different settings in which it can occur?
What are the clinical features of this condition, and how is it distinguished from the goggle-eyed fisherman’s diagnosis? The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease (5th edition). Rosena€™s Emergency Medicine: Concepts and Clinical Practice, 7th edition (2009) Mosby, Inc. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. Our Team, headed by Mike Cadogan & Chris Nickson, consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand.
In addition to traditional orthotic arch supports, a small foam or fabric pad may be positioned under the space between the two affected metatarsals, immediately behind the bone ends. In most cases, the root source of a rash can be determined according to the nature of the symptoms that are present, but in cases wherein the doctor is unable to identify the type of virus causing the condition, the rash is simply considered to be non-specific and is treated as a generic type of skin rash. The rashes can however be helped through topical remedies such as anti-itch creams and antihistamines in order to control the redness and itching. However, rosacea should not be confused with acne vulgaris that is commonly seen in teens as it is a different condition altogether. The main features of rosacea is inflammation, abnormality of blood flow through the cutaneous (skin) blood vessels and overgrowth of tissue over time.
The sensitivity of rosacea sufferers to heat may also account for the increased blood flow on the surface of the skin. The latter is evident by the higher risk of developing the condition when there is a family history of rosacea.
Treatment with medication at most limits the severity of the condition and reduce the symptoms for a short period of time.
However, lifestyle factors including dietary change should revolve around avoiding trigger factors. By addressing the root cause of the problem, I am able to restore the skin to a better state. Wearing sunblock on all parts of your body exposed to sun on a daily basis prevents further sun damage to the skin and in turn prevents worsening of lower eyelid Festoons and Malar Mounds.
You need to consult your doctor if there is excess of swelling with headaches, abdominal pain and nausea.
Sometimes, there may be injury in the ligaments which is holding the ankle when it is stretched beyond limit. Certain allergic reactions, varicose veins and using contraceptive pills may also cause swollen feet.
He will suggest you to wear support stockings if your problem is due to venous insufficiency.
Virchow and Volkmann challenged the French idea and proposed a neurotraumatic, or German, theory suggesting that individuals with neuropathic changes undergo a traumatic event, which progresses to an inflammatory response.14,15 The insensate foot fails to respond or feel pain as a “normal” individual’s foot would.
These factors are known to stimulate RANK-L (receptor activator of nuclear factor kappa-B ligand) which induces maturation of osteoclasts.


This diagnostic tool may allow the clinician to assess whether to transition the affected foot from acute therapy, such as total contact casting, into more conservative, chronic therapies, such as CROW walkers or protective diabetic footwear with custom bracing or custom molded inserts.
Radiographs will show evidence of bony consolidation and sclerosis will be resolving.  Significant deformities may be present, depending on the effectiveness of treatment (if any) prior to evaluation. Fracture, cellulitis, deep venous thrombosis (DVT), gout, ankle sprain, and septic joint are also differential diagnoses that can usually be ruled out with an adequate history and physical examination.
Points are tallied and a high probability of DVT is associated with a score of more than 3, moderate probability if the score is 1 or 2, and low probability if a 0 score is obtained. Sprains will present with tenderness to the medial or lateral ligamentous areas that house the ankle joint. Infected joints are usually monoarticular and severely painful, and will present similar to gout. Joint aspiration with synovial fluid analysis for gram stain and culture are performed in order to tailor antibiotic coverage. If osteomyelitis is suspected, osteomyelitis indium 111 labeled or HmPAO scan can be obtained. Diagnosis is determined by low signal intensity on T1 weighted images within the bone itself. In the presence of infection, a more localized involvement and cortical breaks are visualized.27,36,37 Localized abscess formation can also be seen as a contiguous source in osteomyelitis. Ring FDG PET offers a higher sensitivity and specificity in differentiating Charcot foot from infection when compared to MRI results.
Time will tell if this diagnostic modality’s usage will increase but certainly it may be, pending future improvements in cost effectiveness, accessibility, and increasing awareness and education of practitioners. Multiple diagnostic tools are now available to help differentiate CN from osteomyelitis, including MRI and FDG- PET. Protecting the limb will prevent further breakdown of the neuroarthropathic joint and allow the healing process to begin.
Sur quelques arthropathies qui paraissent dependre d’une lesion du cerveau ou de la moelle epiniere.
High rate of Charcot foot attacks early after simultaneous pancreas-kidney transplantation. Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle.
Difference in presentation of charcot osteoarthropathy in type 1 compared with type 2 diabetes. Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density.
The use of thermography in the early diagnosis of neuropathic arthropathy in the feet of diabetics. The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus. Infection and neuroarthropathy: the utility of C-reactive protein as a screening tool in the Charcot foot. Correlations between clinical probability and Doppler ultrasound results in the assessment of deep venous thrombosis. The diabetic charcot foot: MRI discloses bone stress injury as trigger mechanism of neuroarthropathy. Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics.
Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot’s neuroarthropathy from osteomyelitis and soft-tissue infection? Preoperative imaging of Charcot neuroarthropathy in diabetic patients: comparison of ring PET, hybrid PET, and magnetic resonance imaging. If MRSA is suspected consult an infectious disease specialist and consider treatment with vancomycin. Usually, viral rashes are not serious or life-threatening, although they can be frustrating and itchy. In fact, rosacea is more common in middle aged adults compared to acne vulgaris in the teenage years. Although the disease process behind rosacea is not well understood, several findings have suggested a possible cause for the redness and inflammation. It is also postulated that the drainage of blood in the skin tissue through the veins is hampered and blood therefore pools at the site to some degree. It may not be that the mite is pathogenic but rather an immune response to the presence of these mites initiates the inflammatory response.
When the inflammation extends to the eyes, it may cause a burning irritation (ocular rosacea) which can complicate into blepharitis (eyelid inflammation) or conjunctivitis. Similarly many other skin diseases may cause redness of the skin due to inflammation and this as well should not be confused with rosacea. Albert Kligman, who was in the Dermatology Department at the medical school where I trained, The University of Pennsylvania School of Medicine. Venous insufficiency occurs when there is any problem in the valves thus leaking the blood down into the vessels of the lower legs.
Inadequate secretion of albumin can cause liver disease which can create swelling in the ankles.
If swelling is due to edema, you will be put on diuretic drugs for increasing the output of urine. As a result, continued pressure and repetitive trauma cause destructive changes within the bones and joints of the foot.
Inflammatory cycles typically result in pain, which in a sensate individual would lead to splinting to protect the limb and induce healing. Patients may not sense the wire when it touches them, which would confirm a diagnosis of neuropathy.
However, individuals with septic arthritis will present clinically with fever and additional constitutional symptoms (by comparison, systemic responses are only occasionally seen in cases of gout). Stage 2, termed the “stage of coalescence”, is characterized radiographically by absorption of debris, fusion of larger fragments, and sclerosis of bone ends. Radiographic presentation may include a simple or comminuted fracture but may also be normal in some. A referral to a foot and ankle specialist equipped to deal with this population should be made as quickly as possible. Certain viral illnesses such as chickenpox and measles include the presence of these rashes as a symptom but most viral rashes non-specific.
Although rosacea may occur in episodes where it flares up and then resolve significantly for a period of time, the condition is progressive meaning that it will get worse over time if left untreated.
This includes changes in the blood vessels of the skin, microbes and elevated levels of immune chemicals. There is also some evidence that Helicobacter pylori (H.pylori), the stomach bacteria that causes gastritis, may also play some role in rosacea.
It includes medication primarily with surgical measures for the visible blood vessels on the skin surface (telangiectasia) and rhinophyma. Using Retin-A for many years can improve the collagen and elastin levels in the skin, which can help correct a main cause of many Malar Mounds and Festoons—namely, damage to the skin over time from the sun.
Patients will describe pain that develops very acutely over a period of six to 12 hours.  Untreated, these attacks will usually resolve in three to 14 days.
Diffuse pain may be noted if significant swelling is present.  Radiographic evaluation can rule out underlying ankle fracture.
Inoculation, via direct or more commonly hematogenous extension, is necessary for infection to occur.
Because CN is primarily an articular disorder, subchondral distribution will typically be seen as well.
We don’t give Ab , only antihistamine…how to differentiate between periorbital cellulitis and local allergic reaction?
Most viral rashes can have a sudden onset and are accompanied by other symptoms such as fever and pains, but then resolve on their own after some time. The condition is more common in fair-skinned people and Caucasians but a variant of rosacea known as acne agnimata is more commonly seen in Asians and Africans. Yu stated that once fragmentation or osteopenia was noted on clinical radiographs, the condition had progressed from stage 0 to stage 1. Patients with normal sensation will relate that this condition is so painful they cannot even let the bed sheets touch their foot at night. Yu also emphasized the need to identify the individual with stage 0 in order to prevent the sequelae of undiagnosed Charcot.



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