Pitting oedema

Oedema is visible or palpable excess interstitial fluid. Pitting is an indentation that persists after finger pressure is released.

Gently press an uninjured swollen area over the shin or ankle for several seconds; release and observe the indentation.

Describe location, extent, symmetry, pain, colour, temperature and duration. Check sacral oedema in a bedbound patient.

Grades depend on examination conditions. Recording depth, persistence and extent usefully supplements an isolated grade.

Mechanisms include raised hydrostatic pressure, reduced oncotic pressure, increased permeability or impaired lymphatic drainage; several may coexist.

Recent unilateral oedema suggests thrombosis, infection or local obstruction. Bilateral oedema raises cardiac, renal, hepatic, medicine-related or venous causes.

Assess dyspnoea, orthopnoea, jugular distension, ascites, weight gain, proteinuria and stasis changes; review chronology and medicines.

Acute dyspnoea, chest pain or instability requires urgent assessment. Abrupt painful or red limb swelling warrants prompt investigation of local causes.

Lymphoedema may pit initially and later become firm. Lipoedema often spares the feet; myxoedema and a mass are different findings.

According to suspected cause: renal function, albumin, urinalysis, liver testing or cardiac assessment; suspected thrombosis warrants venous ultrasound according to clinical probability.

Pitting is a sign, not a diagnosis of heart failure. A photograph establishes neither cause, intravascular volume nor severity.

Confirm pitting, describe distribution and investigate the cause. New unilateral leg swelling and acute dyspnoea immediately change clinical priority.

• Edema - Clinical Methods - NCBI Bookshelf ↗
• Pitting Edema Causes, Grading & Treatment ↗
• Peripheral Edema - StatPearls - NCBI Bookshelf ↗
• Diagnostic approach to lower limb edema - PMC - NIH ↗
• Peripheral Edema: Evaluation and Management in Primary ... ↗

Documentary review: 2026-10-12