What is the cause of bilateral foot and ankle edema?

Differential Diagnosis for Bilateral Foot and Ankle Edema

Single Most Likely Diagnosis

• Chronic Venous Insufficiency: This condition is a common cause of bilateral foot and ankle edema, especially in individuals with a history of prolonged standing, obesity, or previous venous thrombosis. The edema results from the inability of veins to return blood to the heart efficiently, leading to fluid accumulation in the lower extremities.

Other Likely Diagnoses

• Heart Failure: Edema in the feet and ankles can be a sign of right-sided heart failure, where the heart is unable to pump blood effectively, leading to fluid buildup.
• Nephrotic Syndrome: A condition characterized by excessive loss of protein in the urine, leading to low albumin levels, which can cause fluid to leak out of blood vessels and accumulate in tissues, including the feet and ankles.
• Liver Cirrhosis: Cirrhosis can lead to fluid retention and edema due to hypoalbuminemia and portal hypertension.
• Hypothyroidism: Although less common, hypothyroidism can cause edema due to the accumulation of mucopolysaccharides in the skin and other tissues.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although DVT typically presents unilaterally, it's crucial not to miss this diagnosis, as it can lead to pulmonary embolism, a potentially life-threatening condition.
• Lymphoma or Other Malignancies: Certain cancers can cause edema by obstructing lymphatic or venous return.
• Superior Vena Cava Syndrome: Obstruction of the superior vena cava can lead to edema in the upper body but can also affect the lower extremities if the obstruction is significant.

Rare Diagnoses

• Lipedema: A rare condition characterized by the abnormal growth of fat cells in the legs, leading to swelling and edema.
• Fabry Disease: A genetic disorder that can cause edema, among other symptoms, due to the accumulation of a particular type of fat in the body's cells.
• Sarcoidosis: A condition that can cause inflammation and edema in various parts of the body, including the feet and ankles, although this is less common.