Patients often get worried if they develop even a little swelling in their lower legs and/or ankles because they think it is an indication of something serious. It can be, but it often isn’t.
Swelling in one leg
If swelling in one leg or ankle is associated with redness and tenderness, this can be an indication of cellulitis, a bacterial infection of the skin and underlying soft tissues, requiring elevation, heat and antibiotics.
If the swelling does not involve signs of infection, it can be due to a deep vein thrombosis — a blood clot. This can be life threatening because a piece of clot can break off and go to the lungs, causing a potentially life-threatening pulmonary embolus. “Blood thinners” (anticoagulants) are indicated for this condition. Prolonged immobilization, such as surgery or a long plane trip, is a risk factor for blood clots. If it occurs out of the blue, a workup should be done to see if you have a genetic clotting disorder — where your blood clots more easily than it should.
Blood clots in the legs can lead to chronic venous insufficiency, with persistent swelling in the affected leg. Skin ulcers are sometimes a complication of this condition. Sometimes, there can be redness and swelling associated with chronic venous insufficiency, which is hard to differentiate from infection.
Swelling in both legs
If the top of your socks leaves a small indentation, don’t worry about it. If your lower legs, ankles and/or feet seem swollen, press hard with your finger over your lower shin or ankle, and if it leaves a significant dent, you have edema — fluid in the soft tissues just under the skin.
Rarely, edema can be caused by serious conditions such as heart failure, kidney failure or liver failure. In most cases, though, it is due to venous insufficiency: The heart pumps blood out through your arteries with each contraction. The blood returns to your heart passively through veins, aided by muscle contractions when you walk. There are valves in the veins to prevent backflow. Due to genetic factors or aging, the valves can wear out, so the blood backs up in the veins of your legs. The increased pressure associated with this leads to fluid leaking out of the veins into the subcutaneous tissues in your legs. Elevation and elastic stockings can help.
Other conditions that can cause edema are:
• High sodium (salt) intake.
• Certain medications such as pioglitazone (Actos) used to treat diabetes, and high doses of calcium channel blockers such as amlodipine used to treat high blood pressure.
• Diuretics such as hydrochlorothiazide or furosemide (Lasix) can be useful for edema caused by heart failure, but usually not for other causes.
Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email firstname.lastname@example.org.