There is a post in the Pilon Fractures Suck! group that says, "I was pressing on my skin last night and noticed a small section felt like playdough. I kept pressing, and it didn't spring back like it would normally but remained indented," so I thought it might be helpful to write here about what pitting edema is and how to manage it.
What is pitting edema?
Pitting edema is a type of swelling where pressing on the skin leaves a small dent, or "pit," that takes a few seconds to go away. It happens when extra fluid builds up in the tissues under your skin.
Pitting edema can be caused by things like staying immobile for too long, inflammation from your injury, or problems with the body's ability to drain excess fluid properly.
What is the fluid exactly?
The "fluid" that builds up in edema is primarily interstitial fluid, the liquid that normally surrounds cells in the body to deliver nutrients and remove waste.
In edema, this fluid accumulates excessively in the tissues, which can cause swelling as the body struggles to reabsorb or move the fluid effectively.
Under normal conditions, interstitial fluid moves into the lymphatic system and veins, where it is filtered and returned to the bloodstream. This constant movement maintains a healthy balance of fluids in the body.
You can see the pitting edema I have in the top of my foot post-ORIF.
Types of edema
There are several types of edema.
Pitting edema: This type leaves a temporary dent when you press on the swollen area. It's often caused by fluid buildup due to injury, poor circulation, or prolonged immobility.
Non-pitting edema: Unlike pitting edema, non-pitting edema doesn't leave a dent when pressed. It's often linked to the diagnosis of lymphedema or thyroid issues.
Peripheral edema (extremity edema): Swelling occurs in the lower extremities, like the legs, feet, or ankles. Extremity edema is common after injuries or prolonged sitting and may also result from heart disease or kidney disease.
Pulmonary edema: This occurs when fluid builds up in the lungs causing shortness of breath.
Cerebral edema: Swelling in the brain due to injury, infection, or other conditions.
Macular edema: Swelling in the retina of the eye, often associated with diabetes or eye conditions.
For pilon fractures, peripheral or pitting edema is most common.
Causes of pitting edema
Pitting edema occurs when excess fluid builds up in the tissues under your skin, leading to swelling that leaves a temporary dent when pressed.
Common causes include:
Injury or surgery: An injury, like a pilon fracture, or surgery can lead to inflammation and fluid retention in the affected area.
Immobilization: Staying in one position for too long can reduce circulation and cause fluid to pool.
Heart problems: Conditions like heart failure can make it harder for blood to circulate properly, leading to fluid buildup.
Kidney issues: When the kidneys can't remove excess fluid efficiently, it can accumulate in the body, causing edema.
Liver disease: Conditions like cirrhosis can affect the production of proteins needed to maintain fluid balance, leading to swelling.
Lymphatic system problems: When the lymphatic system isn't draining fluid effectively, it can cause localized swelling.
Medication side effects: Some medications, like steroids, calcium channel blockers, or anti-inflammatory drugs, can lead to fluid retention and pitting edema in patients.
Pregnancy: Hormonal changes and increased fluid volume during pregnancy can cause edema, especially in the legs and feet.
Diagnosing pitting edema
You can check for pitting edema at home using the "press-and-check" method. Gently press your finger into the swollen area for a few seconds and see if a "pit" remains after you remove your finger. If the pit takes a while to go away, it might be pitting edema.
While this method can help you monitor changes, a healthcare provider can confirm the cause of the swelling and rule out more serious conditions, like an infection or blood clot.
Grading scales for edema
The most common grading scale for edema is based on the depth of the "pit" left after pressing on the swollen area and the time it takes for the pit to disappear.
1+ Mild Edema
Slight indentation, about 2mm deep.
The pit disappears almost immediately.
Symptoms include minimal swelling, often not noticeable.
2+ Moderate Edema
Indentation of 4mm.
The pit disappears within 10-15 seconds.
Symptoms include moderate swelling that may be noticeable but not painful.
3+ Severe Edema
Indentation of 6mm.
The pit lasts more than 1 minute.
Symptoms include significant swelling with possible discomfort.
4+ Very Severe Edema
Indentation of 8mm or deeper.
The pit lasts 2 minutes or more.
Symptoms include extensive swelling that may interfere with movement or indicate a serious underlying condition.
Non-pitting edema
Swelling that doesn't leave an indentation when pressed.
Symptoms include firm, thickened skin often associated with lymphedema or thyroid disease.
These scales help healthcare providers determine the severity of the edema and guide treatment. For pilon fracture patients, regularly monitoring edema and noting changes in severity is crucial for recovery.
Elevation: Keep the limb above heart level to encourage fluid drainage.
Movement and exercise: Gentle activity can improve circulation and reduce swelling.
Compression: Wear compression socks or wraps to prevent buildup of fluid.
Dietary adjustments: Reduce salt intake to minimize fluid retention and stay well-hydrated.
Home remedies
Cold compress: Applying a cold pack can reduce inflammation and swelling.
Massage: Gently massaging the swollen area can help move excess fluid.
Medical treatments
Medications: Diuretic therapy(water pills) may be prescribed to patients with edema to get rid of excess fluid.
Physical therapy: A therapist can guide you in safe exercises to restore mobility and circulation.
Compression devices: Medical-grade pneumatic compression devices can provide targeted relief. Pneumatic compression device treatment uses inflation and deflation cycles to provide dynamic pressure, whereas normal compression devices (like compression socks or wraps) provide static pressure.
Addressing the underlying cause
Injury recovery: Proper care for a pilon fracture, including managing inflammation and avoiding prolonged immobility, can help reduce edema.
Chronic conditions: Conditions like heart, kidney, or liver disease may require specific treatments, such as medication or dietary changes, to manage edema.
Infections or clots: Treating infections with antibiotics or addressing blood clots with anticoagulants is critical if these are causing swelling.
Managing pitting edema during pilon fracture recovery
Managing pitting edema during pilon fracture recovery involves a mix of home care and medical advice.
The R.I.C.E. method—Rest, Ice, Compression, and Elevation—is a great starting point. Rest allows healing, ice reduces inflammation, compression supports the area, and elevation helps drain fluid.
Gentle physical activity and physical therapy are also important to improve circulation and prevent the accumulation of fluid.
Staying hydrated and cutting back on salt can reduce swelling from fluid buildup.
If needed, your doctor might recommend compression garments or diuretics to help manage more severe cases of pitting edema.
What happens if you don't treat pitting edema
If pitting edema isn't treated, it can lead to complications.
Skin damage: Prolonged swelling can cause the skin to become stretched, thin, or cracked, increasing the risk of infections like cellulitis.
Chronic swelling: Untreated edema can progress to chronic lymphedema, where the swelling becomes permanent due to scarring of the lymphatic vessels.
Tissue damage: The buildup of fluid can reduce oxygen and nutrient delivery to tissues, potentially leading to ulcers or non-healing wounds.
Organ strain: In cases of severe or systemic edema, untreated fluid buildup can strain the heart, lungs, or kidneys.
Preventing pitting edema
Preventing pitting edema during pilon fracture recovery starts with healthy habits and being attentive to early warning signs. Elevating your leg whenever possible helps fluid drain efficiently, while gentle movement or physical therapy supports circulation and prevents fluid buildup. Compression stockings can also provide added support to reduce swelling. Keep an eye on your symptoms, and act quickly if you notice unusual changes.
When to seek medical attention
Red flags include severe pain, redness, warmth, or swelling that suddenly worsens, which could mean you have an infection, a blood clot, or another complication. If you notice any of these symptoms, contact your healthcare provider right away.
When you talk to your doctor, clearly describe your symptoms, including when they started, any changes you've noticed, and any activities or treatments that might have affected the swelling to help them determine the best course of action.
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