Leg Swelling

General Information
Swelling of the lower legs is common at any age and even more so in older people. Edema of this sort, called dropsy, occurs with heart failure, but many other possible causes exist besides failing heart function. Many of these causes are temporary and are not life threatening. A few herald more serious health problems or can lead to complications that can be serious and disabling.

Edema represents the accumulation of excess fluid in the tissues but outside the arteries and veins. The most common cause of edema is gravity.

Some tissue fluid is present in all of us. The system that removes this fluid and returns it to the blood circulation is just able to keep up with fluid formation under ordinary circumstances and at usual levels of activity. This system depends in part on the muscular contraction of the leg muscles against the veins and the tissue spaces to help pump this tissue fluid back into the circulatory system. If there are limits on exercise and mobility, excess fluid can accumulate by gravity in the lowermost portion of the body. Physicians often speak of this as dependent edema because it goes to the most dependent (lowest) portions of the body.

This is really the familiar story that all of us have experienced when taking a long automobile or airplane trip. With this prolonged inactivity, enough swelling of the feet and ankles develops to prevent our getting our shoes back on after the trip. With resumption of activity, this accumulation of fluid rapidly resolves and the edema disappears. In elderly patients who are bedridden or chair-bound for long periods, this edema can worsen. It can develop to the point at which there is sufficient swelling to lead to secondary complications.


Important Points in Treatment
Changes in position, particularly elevation of the feet, can move this fluid accumulation and lessen the possibility of complications. Often when the fluid moves it may find a location where the edema is less apparent, but the fluid accumulation remains. This is particularly true in people who lie down without turning over for long periods. Fluid that may have accumulated in the legs while they were sitting or standing flows into the back. With the distribution over a larger area, the edema is somewhat less apparent. The fluid nonetheless continues to be present. It is better to promote the removal of the fluid than it is to shift the fluid from one area to another.

Even limited exercise can resolve the edema. Your tolerance for exercise plus the guidance of your physician will help establish safe limits for exercise. Although levels of exercise to acquire physical fitness may need to be extreme, those necessary to promote the removal of edema fluid may be much less strenuous.

If there is only limited opportunity for exercise, your physician may add the use of diuretic drugs and restriction of salt (sodium) intake to help limit the formation of edema. Overtreatment can occur, leading to kidney dysfunction. Therefore, the use of diuretic drugs must be carefully controlled. Indiscriminate use may precipitate complications.

In addition to the use of diet and drugs, the use of support stockings or hose can help restrict the accumulation of fluid in the legs. These must be carefully fitted and continually adjusted to prevent complications that can be associated with these tight-fitting garments.

Heart disease and liver disease also may cause edema. Heart failure is a well-recognized cause of edema and is commonly the first thing that comes to a physician’s mind when an individual has swollen legs. Treatment involves improvement of heart function to permit it to work more effectively as a pump, with modifications in salt and water intake to reduce the load on the heart. Impaired liver function may change the blood composition enough to cause the accumulation of tissue fluids. Certain drugs, particularly steroids and reproductive hormones, also may be associated with fluid retention.

Varicose veins and other forms of peripheral vascular disease that cause an impediment to good venous circulation may permit the accumulation of tissue fluids more rapidly than they can be carried back into the circulation. Many individuals have had thrombophlebitis (inflammation in the veins) and impairment of their circulation. Because of this inflammation, they have a residual problem of the easy accumulation of edema fluid.

These problems can be cumulative. In elderly patients in whom heart failure plus minimal venous slowing plus inactivity may all occur, the combination of these effects may result in the production of prolonged edema even though each individual problem might not be serious enough to cause edema on its own.

Leg and ankle swelling may be caused by problems other than simple fluid accumulation. Infections of the legs or feet cause swelling, just as infections anywhere in the body do. It is also possible for fractures or cracks to appear in bones subjected to unusual stress. These silent fractures also may cause tissue swelling to occur.


Notify Our Office If ...

• You have swelling or edema in the legs or ankles. Report the occurrence of swelling of the legs when you visit your physician.