When Should I See a Doctor About Leg Swelling?

While swelling in your legs, or ankles and feet may be caused by hormonal fluctuations, dietary choices, and medication, most instances are due to vein disease. Left untreated, it can develop into lymphedema or progressive skin deterioration possibly leading to an ulcer around the ankle.

At Vascular Vein Centers, with our seven locations in Central Florida, our providers cover your leg health needs with experience, compassion, and care. That’s why we’ve compiled this helpful guide to edema (swelling) in your legs and/or feet, and when it’s time to have it evaluated further.

Diagnosing edema 

When you come in for your appointment, we will examine your legs for signs of edema and get a careful history of other conditions and medications you are taking. Your legs may appear puffy, and your skin appears shiny, especially if you have been standing for long periods. If you have edema, you will notice a persistent depression around the ankle bone late in the day. Early in the day, there may be no swelling. Usually it occurs late in the day when you have been on your feet a lot.

Swelling causes inflammatory fluid to pass into the surrounding tissue. At first, this may be subtle and hardly noticeable but as time goes on it gets worse and the tissue and skin become firm, stiff, brittle, discolored (pinkish or brown) and fragile. An ulcer can occur, or lymphedema with swelling of the foot can result.

Lymphedema results when lymph vessels, which lie adjacent to veins, are scarred, and cease to function. Swelling becomes firmer, extends down into the feet and toes and is much harder to control, often making regular shoes difficult to wear, especially dress shoes. Once swelling has gone into the feet and toes, it cannot be eliminated using compression, elevation, or diuretics but it can be decreased.

Not all cases of edema are serious or require emergency care. Edema can sometimes be a side effect of medication or in pregnancy with hormonal fluctuations and as a result of the gravid uterus pressing on the pelvic veins- resisting blood return from the legs. Edema can also be a sign of more serious conditions like kidney, liver, and heart disease. The most frequent cause of lower leg swelling by far is vein disease. Untreated, it can develop into lymphedema or progressive skin deterioration leading to a risk of an ulcer over years.

Leg swelling is the result of gravity, dependency, and the distance from the heart. To efficiently return blood from the legs, a person needs veins that have normal valves and calf muscles that are functional.

Factors that affect these are:

• Inheritance- the walls of the vein are weak and dilate over time
• Pregnancy- causes veins to dilate making the valves incompetent due to retained fluid and the gravid uterus pushing down on the pelvic veins resisting outflow.
• Menstrual periods- fluid retention causes veins to dilate
• Overweight (Obesity)- tendency to walk flat footed not engaging the calf muscle and increased pressure from the abdomen resisting outflow from the legs
• Jobs with long periods of standing or sitting- swelling because of the prolonged force of gravity without active calf pumping
• Long trips- prolonged dependence without calf pumping
• Deep Vein Thrombosis/clot (DVT)- Blockage in the veins obstructing outflow

The above causes can be a problem by themselves but when two or more are acting together, the problem of swelling can be compounded.

Treating edema

When edema is not a sign of a more serious health condition, it can usually be controlled with simple lifestyle changes, like avoiding prolonged sitting or standing, leg elevation when possible, wearing compression garments when up for prolonged periods or traveling, weight control and exercise, especially in water. 

The keystone to treatment of leg swelling is medical grade, graduated compression socks, stockings, or wraps to assist the calf pump and keep fluid in the vascular space blocking the “leak”.

The greatest impact on controlling the swelling of vein disease is treating the underlying vein problem. This is best accomplished using laser ablation or VenaSeal medical adhesive to eliminate the source veins; and Varithena or regular foam for closure of the branch varicose veins. These procedures can be done with very little discomfort or risk and recovery is usually overnight.

For more information on treating edema, call our office nearest you, or make an appointment online today.

Author

Samuel P. Martin, MD, FACS Founder and Medical Director at Vascular Vein Centers