Team AckoSept 18, 2023
If you’re someone who spends long hours standing at work or has been diagnosed with heart or kidney problems, you’ve probably seen Leg Swelling (LS) first hand. LS is a commonly encountered complaint that can affect the entire leg or be restricted to a specific part like the ankle, calf, or thigh. There are many causes for LS. It can be an isolated symptom or be associated with other problems depending on the underlying cause. It’s best to let the doctor decide how serious the condition is and decide the ideal management. Read ahead to get an overview of this medical issue so that you can understand it better..
Leg Swelling is primarily caused by one of these two mechanisms.
Fluid accumulation and buildup in the leg
Injury or inflammation of the structures of your leg
The causes of Leg Swelling are classified based on these mechanisms.
Clinically this is referred to as peripheral edema. In this condition, Leg Swelling is usually associated with a feeling of heaviness and tightness of skin. In severe cases, this can hamper daily activities and cause difficulty in walking.
Sometimes, when you press on the skin for a few seconds, it leaves a depression. This is known as pitting edema. Some of the most common causes for this condition are:
Dependent edema: This refers to LS that you develop when you leave your legs hanging for too long (during travelling, sitting for too long, or prolonged standing). This is not a serious issue and is relieved by keeping the leg elevated, walking, and performing calf exercises.
Pregnancy: In the later stages of pregnancy, the enlarged uterus can compress on the veins returning from the leg resulting in the slowing of blood flow away from the leg which causes edema.
Heart Disease: LS is a sign of Heart Failure. It is usually associated with shortness of breath, palpitations, breathing difficulties on lying down, chronic cough, and sometimes with abdominal distension, transient loss of consciousness etc.
Liver Disease: There are many causes for liver failure, including alcoholism, infections, autoimmune causes, etc. Liver failure causes a decrease in the amount of protein (albumin) in your blood. This can cause edema. Increase in the pressure in the veins of the liver (portal hypertension) also causes edema.
Kidney Disease: Kidney failure (both acute & chronic) can cause LS. A condition called nephrotic syndrome, which can commonly be seen in children can result in generalised edema throughout the body, particularly in legs, hands, and face. The mechanisms behind this are varied; to put it shortly, kidney dysfunctioning causes defective filtering of the blood which can cause increased sodium levels, or decreased protein levels in the blood.
Drug-Induced: Several medications can cause Leg Swelling because of increased fluid retention. This includes painkillers like ibuprofen and naproxen, and medicines like beta blockers.
Issues with the blood vessels of the legs: Conditions like chronic venous insufficiency (where the veins stop functioning adequately), Deep Vein Thrombosis (blood clot in the deep veins of your leg), Thrombophlebitis, etc., can all cause stagnation of blood which can result in swelling of the affected leg.
Lymphedema: The lymphatic system is a part of the immune and circulatory systems, and any blockage in the lymph vessels can cause edema of the legs, referred to as lymphedema.
Any direct injuryto the leg resulting in fractures, sprain, ligament tears, tendon injury and ruptures can present with swelling of the affected area. Depending on the extent of the injury, it can be localised just to the site of injury, or it can involve the entire limb.
There are some inflammatory conditions that affect the joints in the lower limb which can also produce swelling, such as:
There are also infective conditions that can cause Leg Swelling, such as:
Cellulitis (infection of the skin and subcutaneous tissues)
Abscesses in the leg
Infection of the bone (osteomyelitis)
Depending on the cause, there can be many features associated with Leg Swelling such as:
Breathing difficulty, palpitations, shortness of breath while lying down, and transient loss of consciousness (with heart disease).
Jaundice, swelling of the abdomen, tiredness & lethargy, upper abdominal pain, disorientation, vomiting, mood changes (with liver disease).
Redness, severe crampy calf pain, swollen veins in that region (with deep vein thrombosis).
Excruciating pain in case of any injury or infection. Always look for any overlying ulcer or pus discharge.
Now that we know that there are so many reasons for Leg Swelling to develop, the next step is to figure out which one is the specific cause. Luckily, we now have access to a wide range of investigations to help us do just that.
Blood tests such as complete blood count, liver function test, renal function test, etc.
X-rays to check for fractures
Ultrasonography to examine organs and check for soft tissue swelling
MRI or CT scan as required to check for injuries
Echocardiogram to evaluate heart function
Fibroscan to check for liver involvement
Doppler studies to assess blood flow in the legs
Your doctor may advise a combination of some or all of these tests to evaluate Leg Swelling. However, before that it is very important to ensure that you give an accurate history to your doctor. Make sure to tell them about any medications you are taking and any patterns you may have noticed regarding when the swelling increases.
The treatment of Leg Swelling involves diagnosing and fixing the underlying problem. There are multiple treatment modalities available for each of those conditions.
In general, if you have dependent edema while travelling or standing for too long, the following measures are helpful:
Elevate the legs (in sleeping position) using a couple of pillows under your legs, as well as while you are sitting by resting the feet over a small stool.
Using support stockings or compression bandages at night to decrease swelling (check with your doctor if it is safe for you to use these for a prolonged period).
Walking, calf exercises, heel raise exercises all stimulate the calf muscles which act as a peripheral pump to send back blood from the veins to the heart and thereby reducing the pooling of blood.
Consult your doctor if you have Leg Swelling at the earliest to ensure early diagnosis and a proper care plan to minimise the complications of the specific causes.
I feel my legs are swollen every day when I get back from work. Is this normal?
In case of jobs involving prolonged standing or sitting with the legs hanging, it is common to develop Leg Swelling. Ensure to support your legs and back well while sitting.
What can be done to avoid Leg Swelling in pregnancy?
Some common steps to avoid Leg Swelling in pregnancy include drinking enough water, resting with the legs elevated, resting on a pillow, doing light exercise such as walking, etc. Consult your doctor in case the swelling causes any difficulties.
Can wearing tight shoes cause Leg Swelling?
Yes. wearing shoes that are too tight or don’t fit well can affect the circulation of blood in the feet. This can cause Leg Swelling.
Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions. Leg Swelling is written as LS in this article on a few occasions.
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