Article written by Diabetic Sock Club an American owned small business
focused on the health benefits of proper foot care for those living with diabetes.

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When should I be worried about sock marks on my legs?

Although one may not give their feet much thought regarding their health, they are just as vital as any other part of the body, and wearing socks is the best way to prevent unwelcome foot issues.

Your feet benefit from the comfort, protection, humidity management, and temperature regulation socks offer. By placing a layer between your foot and the shoe, socks reduce friction and shield you from blisters. To provide comfort, modern socks also have padded soles. In addition, specialized medical socks are available to encourage appropriate support, safety, and comfort, improving one's foot health (and overall wellness).

However, you've probably seen that your socks occasionally tend to leave a reddish imprint on your ankles. This is because when the elastic bands restricting socks from falling rub against the skin, socked legs may develop markings.


When should I be worried about sock marks?


You shouldn't notice any ridges or depressions in your skin when you take off your socks. However, if it occurs once or twice, it can indicate that the elastic holding the socks up is too tight. But, if you notice these indentations on your leg frequently, your body may be trying to warn you of a more serious issue. In such a case, you should be concerned about these marks.

Pressure marks are typically more apparent when someone has lower leg peripheral edema or swelling. The swelling could be minor and go away on its own, or it could be more persistent and be caused by an underlying medical condition. These could be the reasons socks produce marks on the legs.

  • Water retention
  • A person's socks may create marks on their legs due to water retention. Water retention-related swelling is typically not harmful. However, it makes you puffy or swells your hands, feet, or face.

    Long periods of standing or sitting can result in lower leg edema, which can cause symptoms including tight shoes and sock markings. Menstruation is another time when it can occur. However, water retention often resolves independently, so a person does not need to seek treatment.

  • Dehydration
  • Water levels must be maintained because water makes up most of the human body. Dehydration results from not getting enough water to drink, and this further damages your blood vessels. Damaged veins may develop tiny leaks that allow fluid to accumulate in the tissue around them.

    Most fluid retention occurs in the tissues of your feet and ankles, which results in scarring. In addition, your body may suffer from dehydration if you have sock imprints on your ankles.

  • Pregnancy 
  • Pregnancy can cause swelling, especially in the legs, ankles, feet, and fingers. Usually, it gets worse later in the day and as your pregnancy progresses. It can be painful, but swelling that develops gradually is typically not hazardous to you or your baby.

    Swelling can occasionally indicate preeclampsia, but there are other situations when it could be a sign of something more serious. Preeclampsia is a pregnancy condition that is thought to be brought on by the placenta's inability to mature normally due to a problem with the blood vessels that supply it. It's possible to experience high blood pressure with preeclampsia. 

  • Venous insufficiency
  • The inability of the veins to carry blood from the heart to the feet and back is referred to as venous insufficiency. In addition, veins have more difficulty delivering blood to the heart as they deteriorate over time.

    The veins' tiny valves may malfunction. Due to the blood pooling in the legs, fluid is forced into the surrounding tissues from the blood vessels. Foot and ankle edema may result from this disorder.

  • Varicose veins
  • Your veins in the legs can't adequately transport blood back to your heart when they weaken. The result is painful swelling due to blood backing up in your leg veins. One of the conditions that cause varicose veins is this one. If you frequently develop sock markings, your body may be trying to tell you that your veins are preventing blood from returning to your heart.

    Veins that are big and swollen are known as varicose veins. Usually, they affect the legs and feet. The National Health Service (NHS) of the United Kingdom lists the following additional symptoms:

    • swelling ankles and feet
    • legs that ache or feel heavy
    • burning and throbbing in the legs
    • muscle cramps in the legs, especially during bedtime
    • dry and itchy skin over the vein
    • High blood pressure or hypertension

    Any discomfort you experience after taking off your socks, such as swollen or painful feet, may be caused by hypertension or a high blood pressure problem. In most cases, patients with edema do not experience pain, although they do experience severe discomfort. In these circumstances, fluid retention, or excess fluid formation in the lower feet, results in inflammation.

    Blood circulation is hampered by high blood pressure, promoting fluid retention. When blood pressure spikes, the body responds by accumulating fluid in the soles of the feet.

  • Congestive heart failure
  • This disorder prevents the heart from adequately pumping blood throughout the body. As a result, blood might accumulate in some bodily areas when your heart cannot circulate it.

    One or both of the heart's lower chambers quit effectively pumping blood when it suffers from congestive heart failure. Blood may pool in the legs, ankles, and feet, leading to edema. The stomach area may swell as a result of congestive heart failure. Other signs include:

    • exhaustion 
    • breathlessness
    • swollen ankles and legs
  • Kidney disease
  • Swelling in the legs and around the eyes are side effects of kidney disease. Wastes and extra fluid are removed from the circulation by your kidneys and expelled in the urine. Dangerous fluid, electrolytes, and toxins can accumulate in your body when your kidneys lose their filtering capacity.

    Moreover, a diminished renal function might result in salt retention, which can enlarge your ankles and feet. The kidneys' inability to efficiently eliminate water and salt from the body causes this edema.

    Thus, swelling in the lower limbs may be a symptom of heart illness, liver disease, or persistent leg vein issues.

  • Liver disease
  • The word for liver scarring is cirrhosis. It may happen as a result of different liver diseases. However, many people may be unaware they have cirrhosis. This is due to the possibility that symptoms may not appear until the liver has suffered severe harm.

    Individuals who do exhibit early symptoms could go through the following:

    • lethargy
    • weakness
    • low appetite
    • unusual weight loss
    • nausea
    • vomiting
    • mild discomfort or pain in the upper right side of the abdomen

    The lower legs, ankles, and feet can swell when liver function declines. This is because the usual blood flow through the liver is slowed by cirrhosis. As a result, the vein that carries blood to the liver is under more pressure. Then, the abdomen and legs swell. In addition, edema, or fluid buildup in the legs, and ascites, or fluid buildup in the belly, can be brought on by increased pressure in the portal vein.

  • Lung conditions
  • Swelling can be caused by lung diseases such as chronic obstructive pulmonary disease (COPD), especially in the legs, feet, and ankles (known as peripheral edema)—fluid retention results from COPD's impact on your heart and lungs, affecting your circulation. Your activity may be restricted and made uncomfortable by the swelling. With COPD, leg edema may develop gradually. After a while of walking or sitting with your legs dangling down, it's typically more evident.

    If peripheral edema is caused by severe COPD, in addition to classic symptoms like puffiness of the feet, ankles, and lower legs, itching of the feet and legs, or indentation of the swelling from your socks and shoes, you may also experience other symptoms, such as:

    • difficulty breathing during daily activities
    • wheezing
    • coughing
    • fatigue
    • lightheadedness, especially during exertion
    • Lymphedema

    A chronic illness called lymphedema develops when the lymphatic system is harmed due to the accumulation of lymph fluid within the body, producing tissue swelling. Lymph nodes act similar to a drain in your sink. Fluid cannot flow if the drain is blocked.

    Swelling can happen everywhere; however, it typically occurs in:

    • legs
    • arms
    • face
    • genitals
    • neck
    • oral cavity
    • chest wall

    The accumulation of lymphatic fluid in the body makes the illness visible to medical professionals.

  • Side effects from medication
  • Some medicines might induce edema in the lower legs. Certain antidepressants and blood pressure drugs can cause uncomfortable foot swelling.

    Several forms of contraception, particularly estrogen-containing birth control tablets, might alter a woman's hormonal balance and result in water retention and leg edema. Your feet may swell up, and removing your socks leaves sock marks with swelling. Hormone changes can cause inflammation. The following medicines also produce swelling:

    • corticosteroids
    • nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation, such as ibuprofen (Advil)
    • opioids
    • calcium channel blockers
    • diabetes drugs like rosiglitazone (Avandia), pioglitazone (Actos)
    • anticonvulsants like gabapentin (Neurontin)
    • antidepressants
    • proton pump inhibitors
    • voriconazole (Vfend), an antifungal
    • medications for Parkinson's disease: pramipexole (Mirapex)

    How can you reduce these sock marks?


    Although sock markings are not harmful, very obvious ones may indicate that your ankles and feet are swollen.

    You may take broad steps to reduce minor peripheral edema or swelling in people with sock markings on their legs because of specific factors or underlying diseases. 

    • Massaging the feet, ankles, or legs. Edema can be treated by massage by removing extra fluid from the body.
    • Reduce your salt intake. Sodium helps balance fluids inside and outside cells by binding to water.
    • Increase water intake.
    • Manage healthy body weight.
    • While sitting or lying down, elevate your feet on a cushion above the level of your heart so that gravity forces the fluid out of your legs rather than into them.
    • If you're standing or sitting for an extended period, take frequent breaks and elevate your legs whenever possible.
    • Put pressure on your legs by using compression stockings to prevent fluid buildup. Compression stockings without a prescription are available online.
    • Keep your clothing, shoes, and socks loose-fitting.
    • Exercise the calf muscles. Blood can't collect in your leg and travel into the soft tissue. Thus contractions help flow blood through your veins.

    These can be tried in addition to specialized therapies for the illness causing your edema. Remember that a person's condition, age, and general health will all affect the specific treatments they receive.


    How is this peripheral edema diagnosed?


    Yet again, an underlying issue may contribute to swelling in your feet and ankles. Your doctor can determine the reason for your leg swelling from your medical history and physical examination, but tests are frequently necessary to make the correct diagnosis.

    Depending on the organ being assessed, a test is selected.

    • Blood tests, which assess the function of your heart, liver, kidneys, and most other organs, as well as your albumin level
    • Urinalysis, which evaluates kidney function
    • Chest X-ray is an imaging test that examines your lungs and heart.
    • electrocardiogram, another test to examine your heart's function
    • Echocardiogram is an imaging test that helps your doctor assess your heart.
    • ultrasound, an imaging test to help diagnose DVT and abdominal mass (ascites)
    • An Abdominal CT scan is an imaging test that allows your doctor to check for an abdominal mass.

    When to see a doctor


    The fact that socks leave a mark on the legs might not indicate a severe medical issue. However, it can occasionally happen due to prolonged standing, pregnancy, or airplane travel.

    Yet, frequent swelling can indicate a more serious issue.

    A significant illness or a less severe condition both have the possibility of causing peripheral edema. Treatments are available in both situations to reduce the edema and stop subsequent problems. However, if swelling in the hands, feet or other body parts occurs regularly, a person should consult a doctor.

    If additional symptoms, such as elevated blood pressure or blurred vision, appear along with the swelling, they should also seek medical care. A physician can identify the underlying cause of the swelling and suggest an appropriate course of action.

    Schedule a visit with your doctor to check on your health and have any required tests performed.

    1 comment

    • Dear Friends:

      I learned from a Podiatrist friend, in the 1970’s, to wear only leather insoles – and only cotton socks which now are increasingly difficult to locate. I was very happy to find your socks.

      For the past few years I have had foot and ankle edema, which I had assumed was due to my age and circulatory or kidney problems related to that. More recently, I learned that what I have is probably lymphedema, related to surgery many years ago which involved removal of inguinal lymph nodes.

      I find that your socks still leave me with slight circular indentations from the elastic – and some swelling below that. Perhaps you might develop a new sock with looser elastic. Of course, they would tend to fall down, so I wonder if you could modify them by incorporating a few (six?) vertical “ribs” of more rigid (thicker?) cloth which would help them stay up.

      I look forward to your reply.

      Sincerely,

      Ariel José Thomann, M.D.

      Ariel José Thomann, M.D.

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