Diabetes toes hurt, what it really means

A person who experiences diabetes toes that hurt should be aware that the pain indicates serious nerve damage; this is one of the leading causes of amputations in a diabetic. A new study shows that there has been a sharp increase in the numbers of people who are having a toe affected by high blood sugar; the lower limbs take a very severe beating from high blood sugar; it is an issue which must be taken seriously.  In this post we will look at why diabetes affected toes hurt and what you can do about it.  

 

 

Those very small blood vessels

 

A very recent study from University of Iowa department of orthopedics and rehabilitation revealed that there has been an increase in the number of diabetic partial toes amputations by about 25%; this is a tremendous number of people who have been affected. The need for the removal of the toe was due to the fact that a spreading gangrene could have resulted in the need to remove the foot or the whole leg.  When diabetes toes hurt it means nerve damage, the thin nerve fiber which should protect the nerve is being damaged.  This pain is usually in the toe, fingers, foot, legs and hands. This nerve damage is called Glove and Stocking because of the areas that are affected

 

 

 

 

 

 

The picture below shows a nerve damage leading not only to pain but also to discoloration, blood sugar in excess is a poison in the body. There is no other illness today which is as damaging to the kidney, liver, heart and eyes such as high blood sugar. 

 

 

 

 

Dr. Phinit Phisitkul, assistant clinical professor at the University of Iowa department of orthopedics and rehabilitation

 

"Patients with diabetes have to do their best to control their blood sugar. They need to seek care from their primary care doctor, get treatment, and discuss potential surgeries [like tendon release] to help improve their feet,” said Dr Phistkul

 

 

When diabetes toes hurt: The doctor speaks of the need to get that nasty excessive blood sugar out the body

 

There is a European diabetes foot diet report that has been shown to save the foot from surgery and save the limb. The diabetic foot diet is used in 10 countries, including the United States, to naturally stop diabetes toes that hurt by healing the nerve fiber.  The report now includes the Type 2 diabetes reversal diet, both reports are now included together to get a normal blood sugar and cure the foot problems.

 

 

Read both reports, Click here   Revere Diabetes Foot pain Report now read in 10 Countries

 

 

 

 

 

 

 

Why Diabetes Leg Cramps should alarm you

Diabetes leg cramps are a very common night time complication and danger it does signal danger. It is possible for people to experience this muscle difficulty in the daytime but for the majority this is not the case. In this post we will discuss why the diabetic experiences these muscle spasms and what diabetes leg cramps actually signal. Each year more than 50,000 diabetics are forced to have a leg removed due to high blood sugar damaging the lower limb.

 

 

 

High blood sugar’s devastating affect on the legs

 

The cause of diabetic muscle cramp is due to the excessive blood sugars affect on the nerves, circulation and muscle. High blood sugar damages the cells of the body in many different ways and this is why the illness is so difficult to treat, often the illness actually causes reduced blood flow to the lower extremities, this reduced blood flow is often responsible for muscle tightening.  Diabetes leg cramps signal much more serious underlying complications, artery blockage in the lower limbs is common in diabetics and this means big trouble. Diabetic are at much higher risk for heart disease and stroke much of this is related to clogged arteries in the legs  Peripheral artery disease( clogged leg arteries) affects almost  30% of diabetics, take cramps in the legs seriously.

 

Nerve damage

 

Diabetic muscle cramp has a direct relation to diabetic nerve damage (called neuropathy).

We don’t often think about nerves when we think about muscles but the nerves are involved in the muscle switching and contractions which occurs under the skin.  High blood sugar is a damaging illness which should not be ignored, the diabetes muscle cramps are just one more symptoms of artery blockage or nerve damage The body will fight of the symptoms of high blood sugar as long as it can, if you do not act soon you risk being one of the 50,000 diabetics who experience lower limb amputations. Over 80% of amputations from high blood sugar could have been avoided had people acted in time.

 

A European diet created specifically for the diabetic legs has been reversing diabetes leg cramps pain, swelling and clogged arteries without surgery in over 10 countries.

 

 

See here  

 

European diet for Diabetes leg pain saves the legs in over 10 countries

 

 

 

 

 

My diabetes leg pain is bad, the urgent message

 

 

“My Diabetes leg pain is bad” this was the message that we received yesterday from one of our many readers. Pains in the legs are one of the horrible consequences of living with the illness, it is absolutely necessary that more people become informed of the ways in which the lower limbs suffer when blood sugar is high.  In the middle of this very serious diabetic epidemic are the causalities of the illness, one of the consequences which does not getting enough publicity is lower limb aches. “My diabetes leg pain is bad” was the cry from our reader, when someone comes to the realization that their situation is bad it usually means that they have waited too long to address the situation.

 

What to do?

 

Before we discuss what to do, we will discuss what is happening to the leg; it is a very dangerous situation.

 

Excessive blood sugar has a very negative affect on the circulation, this dilemma leads to the removal of thousands of people’s legs each year due to excessive blood sugar. High blood sugar is a poison in the system, as time goes by the damage is often irreversible. 

 

My diabetes leg pain is bad

 

High blood sugar often causes the arteries in the legs to become chocked off (blocked); this can be a very dangerous situation.

 

 PAD (Peripheral artery disease) is common in diabetics; PAD is when the arteries become clogged.

 

 

For the diabetic pins/needles, tingling and numbness or other pains are a stark warning.

 

Excessive blood sugar is destructive and particularly damaging to the arteries in the legs.

 

Data from the Framingham Heart Study revealed that 20% of patients with PAD had diabetes, but this probably greatly underestimates the prevalence, given that many more people with PAD are without symptoms.  Diabetes and artery blockage are linked.

 

The surgery to repair diabetes blocked arteries cost over $5,000 dollar and usually involves the insertion of a stent to keep the arteries open.

 

 

Get the right diet to avoid surgery

 

Diabetes leg pain is serious and should be addressed immediately with diet!

 

There is a diabetes leg pain diet from Europe which is now used in more than 10 countries including the United States; it has been helping people save the legs with diet alone.

 

See here    diabetes leg pain

 

 

 

 

Foot Hurts and Diabetes, what you must do

 

 

It is a very common ailment, the foot hurts and this is often related to diabetes. One of the sad consequences of the worldwide diabetic crisis is the revelation that many people are losing their limbs to the illness. One of the major factors in regards to increased amputations (surgical removal of the limb) is the fact that millions are unaware that they are living with high blood sugar. When the foot hurts it is a signal that blood sugar is damaging the nerves in the limb.  

 

 

Why the feet suffer more

 

The reason that the feet suffer so greatly when a person has high blood sugar is due to the fact that there are very many small blood vessels in the foot which are easily damaged.  Excessive blood sugar ruins the circulatory system, and this in turn can lead to amputation of the lower limb. Nerve damage is not easily repaired, it is crucial that any pain in the feet receive immediate attention.

 

Because of long-term nerve damage, people with diabetes face up to a 25 percent lifetime risk of amputation, according to current research.  When the foot hurts and a person has pre or full diabetes it can be a very strong warning sign which should not ignored.

 

 

The Center for Disease Control estimates that there are more than 30 million people worldwide who are not aware that they are diabetic; often the symptoms of the disease are ignored. Diabetes is one of the most damaging illnesses; the excessive blood sugar should be removed naturally from the body with diet not drugs.  Dizziness, thirst and other symptoms should not be ignored. Not addressing the illness swiftly is the reason many are in danger of lower limb nerve damage. Numbness, pain, tingling, pins and needles are all signs of the nerve damage, this is the consequence of excessive blood sugar.  Blood sugar in excess is a poison, it is crucial that people understand the power of this enemy and how it destroys the body.  There is not one organ in the body which is not affected by high blood sugar, the liver, kidneys and heart all suffer under this illness. When the foot hurts, it is always a sign; it is a very important warning from your body for action.  80% of people who had a leg, foot or toes removed could have save the limb had they acted in time. When the foot hurts it is a message to you from your body.

 

Researchers in Europe have been saving the feet with a very specialized diet created to stop the pain and nerve damage from high blood sugar. The diet is now used regularly by thousands in 17 countries to save the feet and avoid surgery.

 

See Here Diabetes feet swollen

My feet hurt and I have diabetes

A question from one of our thousands of readers stated “My feet hurt and I have diabetes what does this mean”. One of the more dangerous complications of living with high blood sugar is the damaging effects that the illness has on the lower limbs, each year thousands in the Unites States, England and much of the world have to face the prospect of losing the lower limb. “My feet hurt and I have diabetes”, if you are one of the thousands who are experiencing diabetic foot pains it is crucial to address the problem quickly in order to avoid permanent nerve and tissue damage.

High blood sugar is a very damage illness, as the excess sugars are allowed to invade the bloodstream the nerve endings experience damage, this can lead to the removal of the foot or leg if the situation is not reversed.. Some people with nerve damage have no symptoms at all but for others the first symptoms are often numbness, tingling, or general painful discomfort. Symptoms start slowly and become progressively worst, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Nerve damage can cause a lifetime of problems and should be address immediately. If you have diabetes and your feet hurt it is a sign that nerve damage has begun.

Symptoms can involve the sensory, motor, and autonomic-or involuntary-nervous systems. In some people, mainly those with focal neuropathy, the beginning of the painful condition may be sudden and very severe.

High blood sugar can cause the blood vessels to narrow and this is how the circulation can become blocked, the decreased oxygen supply from narrowed blood vessels can cause swelling or other painful conditions, it should be strongly stated and understood that nerve endings are destroyed in the presence of excessive sugar in the blood. Many diabetics must face amputation of the foot or leg.

The root cause of high blood sugar comes from insulin resistance, this is mainly due to our modern day processed food supply which causes inflammatory diseases like obesity.

If you have diabetes and your feet hurt it is extremely important to reverse the condition before permanent nerve damage occurs. There is some good news, there is a diet that has been reversing diabetic foot problems, the painful condition stops and the nerve damage reversed, it is a specialized diabetic foot diet that is used in Europe, it is now used in 10 countries

CLICK HERE  European diet saves the feet of diabetics in 10 countries

Can High blood sugar cause foot swelling? Yes

Living with high blood sugar is extremely dangerous and it can cause foot swelling and other health complications. There is an epidemic of type 2 diabetes that has been sweeping much of the World, the United States, Asia, Africa and Europe have all been experiencing record number of cases of diabetes. The World Health Organization states that over 350 million people worldwide suffer from diabetes. High blood sugar can cause foot swelling, this condition know as edema can be a warning sign of heart troubles and may result in the loss of the foot.

In healthy people the hormone insulin creates energy to the cells from sugar but this is not the case in diabetics, the person with diabetes has the sugar flood the bloodstream and this is where the health complications begin. As the sugar floods the bloodstream it causes damage to the organs of the body, the limbs are also effected due to circulation blockage. Swollen limbs from excessive sugar in the blood leads to blood vessel deterioration and blockage.

Diabetic feet swelling is the collection of fluid in the feet, ankles and legs. Extra consideration is needed for people who have edema and diabetes. It can occur in one or both lower extremities.
Damage to capillaries or increased pressure can cause capillaries to leak fluid into surrounding tissues and result in high blood sugar swelling.



Note: Diabetic medications like Actos, Avandia and others are dangerous and can also cause feet to swell! Diabetic Medications are linked to heart disease and swelling of the limbs. Drugs  side effects such as swelling can indicate that the medication is effecting the heart negatively. Diabetic Medications are linked to heart attack.


Reversing the foot problems naturally and drug free

A study at Imperial College London revealed that the foot damage can be reversed if caught in time. Dr Eszter Vamos said they had expected to see long-term complications of diabetes rising to some extent because the number of people diagnosed with the condition had increased. It is clear that high blood sugar can cause foot swelling.

"But at the same time there is very strong evidence that with a multidisciplinary team approach you can prevent up to 80% of the amputations. Said Dr. Vamos

SEE HERE    Diabetes foot swelling

Why are my Feet Blue with Diabetes?

Those who have diabetes and are experiencing discoloration such as blue feet must take this extremely serious. What does it mean when there is skin color changes in the foot due to high blood sugar? The answer lies in the circulation., high blood sugar can cause extreme damage to the lower limbs. One of the more alarming signs of trouble is diabetes blue feet, discoloration signifies damage to the circulation which can result in the removal of the foot if the damage persist.

What causes the discoloration

Diabetes damages blood vessels and ruins the circulation, the illness decreases the blood flow to the lower limbs. Poor circulation weakens bone, and can cause disintegration of the bones and joints in the foot and ankle. High blood sugar constricts blood vessels producing damage to the nerves. The blood vessels are dependent on oxygen rich blood for proper circulation, the lack of proper circulation is where the diabetic loses the limb. When the foot turns color it s a sign that the circulation is being choked off, the blood vessels are narrowing and oxygen rich blood is being restricted. Diabetes blue feet are a sign of the circulation being choked off, this very dangerous situation can become worst, a slight cut can turn into a quick infection that does not heal, the end result may be the loss of the foot.

Many are needlessly losing the lower limbs to the illness.

Many diabetics are needlessly losing a leg or a foot to the illness, doctors in the United Kingdom reported this week that over 8,000 amputation could have been avoided had the diabetic addressed the illness immediately, if you are experiencing any limb discoloration it is a sign that the damage to the circulation is getting worst, it is crucial to confront the illness immediately.

80% of amputations could have been avoided

A study at Imperial College London revealed that the foot damage can be reversed if caught in time. Dr Eszter Vamos said they had expected to see long-term complications of diabetes rising to some extent because the number of people diagnosed with the condition had increased.
"But at the same time there is very strong evidence that with a multidisciplinary team approach you can prevent up to 80% of the amputations. Said Dr. Vamos



There is some good news from Europe, a diabetic diet created for diabetic neuropathy (limb nerve damage) has been reversing the foot circulation problem (diabetes blue feet) it is now used in over 10 countries

See here Stop Diabetes blue foot

What to do about Diabetes swollen feet

Diabetes swollen feet is a sign of a very serious circulation problem resulting from high blood sugar, it cannot be understated that excess glucose in the bloodstream is a literal poison to the organs of the body. The numbers of foot amputations has increased greatly over the last 10 years in the United Stated and Europe, diabetes swollen feet signals that an excess of glucose(sugar) is damaging the cells(circulation) of the the lower limbs; it is this condition that causes thousands each year to lose a limb to this very serious illness.

Below the ankle amputations increasing

The phenomenon of foot amputations from diabetes is increasing incredibly in Europe and the United States, recent statistics over the last decade reveals that below-ankle amputations doubled to more than 2,000, and major amputations increased by 43 per cent in England, the situation is worst in the United States. Type 2 diabetes accounts for 90 per cent of cases and is caused by the body not responding properly to insulin or not producing enough. The illness impairs blood flow to the extremities, resulting in nerve damage. Diabetes swollen feet also know as “edema” must not be ignored, it is crucial to address the situation immediately to save the foot.

Excessive blood sugar is a poison to the body

When excess blood sugar lives in the bloodstream it has a damaging effect on the nerves and circulation, this is the cause of the loss of arms, legs and feet to diabetes. The medical term for nerve damage from excess glucose in the bloodstream is “diabetic neuropathy”, in a person with a normal blood sugar level glucose enters the cells and is used for energy, but this is not the case in diabetics. Diabetics have cells that do not receive the glucose into the cells, the sugar floods the bloodstream instead of entering the cells. When glucose floods the bloodstream it causes nerve and organ damage, this is what causes diabetes swollen feet. It must be noted that diabetic medications such as Actos can also cause swelling in the feet, the medication has been linked to heart attack. Diabetic medications can cause just as much harm as the illness. The most important thing is the reversal of the diabetic foot condition.

80% of amputation could have been avoided

Dr Eszter Vamos of Imperial College London said they had expected to see long-term complications of diabetes rising to some extent because the number of people diagnosed with the condition had increased.

The doctor makes it clear like thousands you can save the foot

"But at the same time there is very strong evidence that with a multidisciplinary team approach you can prevent up to 80 per cent of the amputations.

There is some good news, there is a Specialized European diet that has been reversing diabetic foot problems in over 10 countries, foot problems are reversed naturally, stopping the nerve and circulation damage, it is now used in over 10 countries

See Here Diabetes swollen feet

Why do diabetics lose their toes? A warning

Why do diabetics lose toes or the foot to high blood sugar? High blood glucose is a poison in the body that effects the limbs, each year there are literally thousands of people who must experience having a limb removed due to living with high blood glucose. The extremities are often very heavily effected by diabetes. We received a question from a reader “Why do diabetics lose their toes”, in this post we will explore how the illness effects the feet and can cause a person to lose the limb.

The attack on the circulation

Diabetes has a powerfully negative effect on the circulation, excess glucose in the bloodstream causes damage to the cells of the body. Diabetes affects the micro-circulation, the large arteries and occasionally the large and small veins, by causing vessel wall hardening. The degree of stiffening produced is linked to its duration. The ability of the person with high blood sugar to distribute blood is affected, especially during increased blood flow. As we can see, diabetes is a horrible illness that causes the loss of the circulation, this can also cause chest pain,heart attack and removal of the leg. Why do diabetics lose their toes? The circulation problems lead to swellings,pain and numbness, all which may result in the removal of the foot or leg.

Save your own foot

One of the starkest statements about reversing high blood sugar complications came from Liaquat University of Medical and Health Sciences Dean Prof Memon. “People with diabetes need to take an active part in their own care” Not taking charge of the illness is what too many people with high blood sugar are not doing. Over 80% of people who lost a leg to diabetes could have saved the leg. The answer to the question, as to, why do diabetics lose their toes is due to the fact that the poison high levels of blood sugar damages the circulation. The circulation damage can lead to swelling,sores and possible gangrene. The loss of feet,fingers and legs to diabetes can be avoid but you must take an active part in the reversal of the illness. 

There is some good news, there is a diet that has been reversing diabetic foot problems, the swollen feet get help and are reversed, it is a specialized diabetic feet diet that is used in Europe, it is now used in 10 countries

See here Diabetes Foot Pain

What can help Diabetes swollen Feet

Diabetes swollen feet must be rectified quickly, it is necessary to receive help before permanent nerve damage occurs in the foot. There has been an increase in amputations due to an explosion of high blood sugar over the last 2 decades; researchers in the United States, UK and India have all reported a startling increase in the numbers of people who are losing a foot to the illness. When it comes to nerve damage from high blood sugar immediately help is crucial to prevent the loss of the foot. Diabetes swollen feet are a sign of nerve and circulation damage.

The Centers for Disease Control report that the number of diabetes-related lower limb amputations have increased by over 227 percent between 1980 (33,000) and 2003 (75,000). This is a tremendous number of people who have had to have the leg or foot removed; the numbers afflicted over the last 5 years are even scarier with a rise over 300%. It is very important to monitor the circulation when a person has a high blood sugar, diabetes effects the circulation in a horrible way; the excess blood glucose causes edema (swelling) in the extremities. Diabetes swollen feet are a sign that your circulation has been negatively effected by the illness.

"Among all the complications from diabetes, amputation can be the worst," said Dr. Craig Walker, of the Cardiovascular Institute of the South, in Houma, La

"Amputation affects a person's quality of life drastically, from mobility to self-image. It is also associated with a decreased life expectancy”

Diabetes causes the blood vessels to narrow and this chokes off the circulation, the decreased oxygen supply from narrow blood vessels causes swelling (edema) and sadly for many the loss of the limb. It is crucial to get help for diabetes swollen feet.

The root cause of diabetes comes from insulin resistance; this comes from our modern day food supply (highly processed food chemicals in the food)

There is some good news, there is a diet that has been reversing diabetic foot problems, the swollen feet gets help and are reversed without surgery.  It is a specialized diabetic feet diet which is used in Europe and is now used in 10 countries to stop the painful condition.  See Here Diabetes feet swollen

 

Why Diabetes feet swelling is a crucial warning

If you have diabetes and are experiencing feet that are swelling it is a very dangerous sign that you are in danger of losing the foot. High blood sugar is a poison in the bloodstream and causes the death of the cells and organs of the body. Over 300 million worldwide are losing the battle against glucose in their bodies, it is crucial to address the illness swiftly to save you organs and limbs . Diabetes feet swelling is one of the first signs that you are in danger of losing the foot. After edema comes the discoloration as the picture above illustrates.

The rise in diabetic complications

Some of the more scarier problems that have been observed by medical professionals are the many thousands who are experiencing complications from living with high glucose in the bloodstream. Glucose is good and when you are healthy it goes into your cells giving you energy but this is not the case with those who have high blood sugar, the glucose floods the bloodstream instead of going into the cells. The cells are resistance and will not accept the glucose, this glucose flooding is a poison in your bloodstream. Diabetes feet swelling is a very serious warning that circulation damage from the glucose flood in your bloodstream is occurring.

Excess Glucose in the blood destroys the circulation

The numbers of people losing arms,fingers,toes and legs to diabetic levels of high glucose has increased 300% in the last 10 years according to the Center for Disease control in the United States. Swelling in the limbs is called “Edema” and it often signals damage is also happening to the heart valve, the circulatory system is holistic and if one part is effected usually the whole is suffering. Heart disease from high glucose is common because as we stated earlier high glucose is a poison in the bloodstream. Diabetes feet swelling is a very crucial warning that the circulation and nerves are being damaged, if you do nothing you may be one of the many who had to have the foot removed. There is some interesting news from Europe, a diabetic diet created for diabetic neuropathy (nerve damage) has been reversing the high glucose foot complications without medications, it is now used in over 10 countries  

See here Diabetes feet swollen

What does it mean to have diabetes and swollen feet? Trouble

Diabetes with Swollen feet signals major circulation problems, many have lost a foot to this illness, it is imperative that extreme attention be paid if the foot starts to swell. High blood sugar has become a worldwide crisis and the numbers of people who are suffering the consequences are huge, feet swollen from diabetes can be a very serious sign of circulation trouble and heart damage.

Edema

Edema is a condition where fluid floods the tissues of the body, this can be a serious complication of high blood sugar and it can be the beginnings stages of losing the foot if the condition is not reversed. Edema is strongly related to the condition of the heart and is linked to high blood sugar. A high blood sugar level means that the bloodstream is being flooded with a poison high level of glucose, it is this extreme amount of glucose that damages the organs of the diabetic body. Each day the diabetic experiences a glucose pounding in the cells of the heart,liver,kidneys and lungs. Diabetics experience heart attacks at an increased rate, a diabetic has heart attack rates similar to a person who has already had a heart attack.

Edema related blood sugar problems is a strong warning about the condition of the diabetics heart. If you have diabetes and your feet are swollen it is a sign your heart is being effected.

The loss of the foot

As the circulation gets worst sores and ulcers often develop, the end result can be the loss of the foot. Each year doctors perform thousands of foot amputations due to ignored high blood sugar, it is important to note that many diabetic medications are linked to heart disease and foot swelling. Two diabetic medications, Actos and Avandia were recently linked to edema and heart attacks. A good circulation is crucial for the diabetic, feet that are swollen from diabetes is a sign of circulation damage and ignoring this can cost you dearly.   

The only European diet shown to reverse diabetes swollen feet without drugs, used in 10 countries See here Reverse Diabetes feet swollen

Diabetes foot swollen? This can cost you the limbs

If you have diabetes and your foot is swollen it is an extremely dangerous sign that serious damage is happening to the body part, there are many who have had to have the feet removed due to the effects of high glucose in the bloodstream. It is extremely important to address the issue swiftly to avoid the many complications which have cost many the use of their feet. A Diabetes swollen foot signals circulation troubles.  

Glucose can be extremely dangerous when in excess in the bloodstream, in a healthy person insulin causes glucose to go into the cell where it is used for energy, this is not the case of the person who has diabetic high blood sugar. The glucose which should be used in the cells actually floods the bloodstream of the person with high blood sugar, this must be understood to be a very serious situation, it is tantamount to living with a poison in the bloodstream. A swollen foot with diabetes is a sign that the glucose is choking the circulation, this can lead to discoloration, ulcers and ultimately removal.

All circulation problems involve the heart which is the major organ that helps the blood to circulate, swelling in the feet signals that the heart has probably been effected due to excess glucose circulating in the blood, diabetic routinely suffer more stroke and heart failure.

According to Doctor Min Luo, it is the damaging in the bloodstream tfrom the glucose that causes the heart to fail, The new study from University of Iowa links oxidative stress caused by diabetes to increased death risk after a heart attack

"Our findings suggest that oxidized CaMKII may be a 'diabetic factor' that is responsible for the increased risk of death among patients with diabetes following a heart attack," says lead study author Min Luo, D.O., Ph.D., a cardiology fellow in the UI Department of Internal Medicine.

It is clear that the feet are sending a serious message, heart disease is the leading cause of death in those with high blood sugar, high blood sugar ruins the organs of the body. Diabetes foot swollen is a very serious warning sign of heart troubles and circulation damage.  

 European Diabetes foot diet used in 10 countries without medications 

 See Here Reverse Diabetes feet swollen