Swollen legs, also known as leg oedema, can be caused my multiple factors. These can include: -
Fluid Retention This is one of the most common causes of swollen legs. It can result from factors such as prolonged sitting or standing, high salt intake, certain medications, or an underlying medical condition.
Injury or Trauma Injuries to the legs, such as sprains, strains, or fractures, can lead to swelling as the body's natural response to inflammation.
Infection Infections, including cellulitis, can cause swelling in the leg/s. When a leg or foot is infected, the erythema (redness) will not drain from the skin on elevation of the limb. This can help in diagnosis.
Venous Insufficiency
This condition occurs when the veins in the legs have difficulty returning blood to the heart, leading to swelling. This can be particularly pronounced around the ankles. Venous return refers to the blood flow back to the heart. When the venous return in your legs is impaired, often secondary to a reduction in mobility, your legs can become swollen. Typically the swelling is squashy and does not 'pit' when you press into it. If you have 'pitting oedema' (swelling that takes some time to return to 'normal' when you push on it, or will adopt the shape of whatever surface it is leaning against, for example), this indicates a potentially bigger problem such as heart failure or kidney dysfunction and you should speak to your GP to arrange further investigations).
For the purposes of this blog post, we will just discuss poor venous return in the legs relating to lack of usage of the muscle 'pump' in the calf, which sends blood back up to the heart.
What leads to lack of usage of the muscle pump? Mostly inactivity. If you are stuck in a chair due to poor mobility, pain, or even pure idleness (!) your calf muscles are not being utilised and therefore will weaken over time, impeding their ability to pump blood against gravity back up your leg. Blood and tissue fluid pools in your lower limbs, leading to swollen legs.
Left untreated, this will affect the skin causes venous eczema - which is a risk factor for ulceration.
Lymphoedema
Lymphoedema is a condition where the lymphatic system doesn't function properly, leading to the accumulation of lymph fluid and subsequent swelling.
Heart Failure Congestive heart failure can lead to fluid retention in the legs, resulting in swelling. Typically, you will also feel breathless after activity, or even at rest, as the heart cannot pump the blood efficiently around the body. It's important to speak to your GP for a diagnosis, and to commence treatment.
Kidney Disease Chronic kidney disease (CKD) is a normal part of aging and many of us will not experience any symptoms until the CKD reaches an advance stage in later life. However, as kidney problems can cause an imbalance of fluids and electrolytes in the body, this can cause the legs to swell. Why the legs? Gravity.
Liver Disease Liver disorders can result in the accumulation of fluid in the abdomen, which will affect the functionality of other organs thereby leading to leg oedema (swelling).
Pregnancy Pregnant women often experience leg swelling due to hormonal changes and increased blood volume. This can persist once the baby is born, but should resolve with time.
Medications Some medications, such as certain blood pressure drugs, may cause leg swelling as a side-effect. It's important to discuss any side-effects to medication with your GP or specialist.
Obesity Excess weight can put pressure on the veins in the legs, leading to venous congestion. Fluid accumulates in the limbs as it cannot flow freely, leading to swollen, heavy legs.
Deep Vein Thrombosis (DVT) A blood clot in a deep vein, usually in the legs, can cause pain, swelling, and redness. This tends to affect just one leg and should be investigated as an emergency.
Treatment If the swelling is NEW it's important to speak to your GP or health professional to find out what is causing the swelling before any treatment can be commenced. You may require blood tests and/or scans.
Medication
Speak to your GP about starting on medication that can help with the swelling in your legs (diuretics, water tablets), or whether adjustments need to be made to your current medications.
Compression Hosiery
This is only appropriate if you have good arterial (blood flowing from the heart to the feet) circulation. A GP or other health professional will be able to discuss this with you. In my practice, I check everyone's circulation with Doppler ultrasound. You can read more about that here.
Compression hosiery can be prescribed by a GP or nurse, or purchased in store as flight socks (speak to a healthcare professional to check that this is an appropriate option for you).
Elevation
You may find that your legs return to normal overnight and there is no swelling first thing in the morning. This is because your legs have been elevated, which really helps with the circulation. Once you stand up, your circulation is battling against gravity again and you'll find the swelling accumulates in your lower limbs over the course of the day. Sitting with your feet up as and when you can can be really helpful.
Revitive Revitive is a natty machine that stimulates the muscles in the lower leg to help pump blood back up the legs. There is more information about how Revitive works here. The machine can be rented on a 3 monthly basis (£10 per month) here.* 3 months is the minimum amount of time the machine should be used to notice the beneficial effects.
Exercise
Gentle exercise, such as walking, activates the muscles in the back of the calves, which in turn helps to pump fluid back up the legs. There are also exercises that can be performed to help, as recommended by the Chartered Society of Physiotherapy here.
Conclusion
If you are experiencing swollen legs, it's important to consult a healthcare professional in order to be properly assessed and diagnosed. Your doctor or a healthcare professional, such as a podiatrist, can help to determine the underlying cause of the swelling and recommend appropriate treatment or lifestyle changes to address the issue.
You mustn't ignore persistent leg swelling as it could lead to more serious health problems.
*for Registered patients of Oxfordshire Chiropody & Podiatry only. Machine must be picked up from Raleigh Park Clinic, OX2 9AR.