Swelling of the legs is abnormal and should be evaluated by a vein physician specialist if it occurs more than occasionally after a long day of sitting or standing. Pain or tenderness in the legs associated with swelling is an especially important reason to seek evaluation. While some of the causes of leg swelling may be minor self-limiting conditions, others require very urgent medical care to reduce the likelihood of major complications or death. Untreated leg swelling may lead to other complications such as infection, poorly-healing wounds, or clots in leg veins. It is not uncommon to meet patients who are treated for swelling with fluid pills where the best treatment is to address vein disease.
The most common failure of diagnosis occurs due to a venous ultrasound study which is performed in a manner to rule out clots, known as deep vein thrombosis, in the deep veins of the legs and does not evaluate for failure of one-way valves in the leg veins (venous insufficiency). It is common for patients with chronic leg swelling to be told that the ultrasound is “normal” or “was negative for clot” while failing to test for treatable venous insufficiency.
Some of the causes of leg edema due to elevated venous pressures include:
- Venous insufficiency, a failure of one-way valves in the veins,
- Deep vein thrombosis, clots obstructing venous flow back to the heart,
- Chronic obstruction of veins in the leg or pelvis due to previous deep vein thrombosis
- Failure of the calf muscles to pump venous blood out of the legs due to stroke, venous injury, arthritis limiting ankle motion, or inactivity.
Chronic leg swelling may also be due to states that result in generalized body fluid expansion which may be more apparent in the legs due to the effect of gravity such as:
- Congestive heart failure
- Other forms of heart disease
- Lung disease
- Liver disorders
- Kidney disorders
Cellulitis, infection of the skin and fatty tissues of the leg may cause swelling with pain and tenderness. Pain from cellulitis may be very severe or may manifest as tenderness and mild pain with faintly pink to bright red skin. ‘Cellulitis’ not responding to treatment with common antibiotics or that which lingers for years and months may not be cellulitis at all but rather vein disease.
Treatments are directed at the underlying cause of the swelling and may include:
- Weight loss
- Treatment of venous insufficiency by removing or sealing shut the leaking veins with minimally-invasive techniques
- Treatment of blood clots
- Treatment of cellulitis (infection),
- Treatment of heart failure; kidney, liver, intestinal, or hormonal disorders
- A trial of stopping possible causative medication