What is the treatment for hand and feet swelling?

Treatment of Hand and Feet Swelling

The treatment of hand and feet swelling requires a combination of non-pharmacological and pharmacological approaches tailored to the underlying cause, with elevation of the affected extremities, compression therapy, and appropriate medications being the cornerstones of management. 1

Assessment of Underlying Cause

Before initiating treatment, it's essential to determine the etiology of the swelling:

• Osteoarthritis: Look for joint pain, stiffness, and bony enlargements
• Diabetic foot complications: Check for ulcers, infection, or neuropathy
• Vascular insufficiency: Assess for skin changes, temperature differences
• Erythromelalgia: Evaluate for burning pain with redness and warmth
• Edema from other causes: Consider cardiac, renal, or lymphatic origins

Non-Pharmacological Management

First-Line Approaches

1. Elevation of affected extremities:

   • Elevate hands and feet above the level of the heart
   • Implement regular elevation periods throughout the day 2
   • For feet: elevate legs while sleeping using pillows

2. Compression therapy:

   • Compression gloves for hand edema
   • Compression stockings for foot/ankle edema
   • Ensure proper fit to avoid circulation compromise

3. Heat application:

   • Local application of heat (paraffin wax, hot packs) especially before exercise 1
   • Heat therapy has strong recommendation (77% on VAS scale) for hand swelling

4. Exercise regimen:

   • Range of motion exercises
   • Strengthening exercises
   • Gentle active movement to promote circulation 1

For Specific Conditions

• For hand osteoarthritis:

  • Splints for thumb base OA 1
  • Orthoses to prevent/correct lateral angulation and flexion deformity

• For diabetic foot swelling:

  • Offloading devices for ulcer prevention
  • Total contact cast or removable walker for neuropathic plantar ulcers 1

Pharmacological Management

Topical Treatments

• Topical NSAIDs:

  • First choice for localized swelling with mild to moderate pain 1
  • Apply to affected areas 3-4 times daily
  • Safer than oral NSAIDs due to minimal systemic absorption

• Capsaicin:

  • Effective for pain associated with swelling 1
  • Apply 3-4 times daily

Oral Medications

1. Paracetamol (Acetaminophen):

   • First-line oral analgesic (up to 4g/day)
   • Preferred for long-term use due to safety profile 1

2. NSAIDs:

   • Use when paracetamol is inadequate
   • Lowest effective dose for shortest duration
   • Consider GI and CV risk factors 1
   • For patients with increased GI risk: use with gastroprotective agent or COX-2 inhibitor
   • For patients with increased CV risk: avoid COX-2 inhibitors

3. Diuretics:

   • For edema unresponsive to conservative measures
   • Furosemide 20-80mg once or twice daily 3
   • Titrate dose based on response
   • For elderly, start at lower doses

Special Considerations

For Erythromelalgia

• Aspirin 325mg daily, particularly effective for secondary erythromelalgia due to myeloproliferative disorders 4
• Avoid excessive cooling measures (limit ice/water immersion to 10 minutes, 4 times daily maximum) 4
• Maintain optimal indoor humidity (30-50%) and temperature (20-24°C) 4

For Diabetic Foot Complications

• Assess for peripheral arterial disease
• Consider revascularization if toe pressure <30 mmHg or TcpO2 <25 mmHg 1
• Treat infections promptly with appropriate antibiotics 1

For Infection-Related Swelling

• Obtain cultures before initiating antibiotic therapy when possible 1
• For superficial infections: oral antibiotics targeting S. aureus and streptococci
• For deep infections: parenteral broad-spectrum antibiotics 1

Monitoring and Follow-up

• Regularly assess response to treatment
• Monitor for complications of therapy (e.g., NSAID-related GI issues)
• Use reliable measurement tools to quantify changes in swelling:
  • Figure-of-eight technique with tape measure (highest evidence quality) 5
  • Water volumeter for accurate volume assessment

When to Refer

• Persistent swelling despite appropriate treatment
• Signs of severe infection or ischemia
• Suspicion of underlying systemic disease
• Need for surgical intervention

Pitfalls to Avoid

• Treating symptoms without identifying underlying cause
• Prolonged use of NSAIDs without monitoring for adverse effects
• Neglecting elevation and compression as first-line treatments
• Failing to recognize signs of compartment syndrome or deep infection requiring urgent intervention

By following this algorithmic approach to hand and feet swelling, clinicians can effectively manage symptoms while addressing underlying causes to improve patient outcomes.