Swollen legs generally occurs because of an abnormal accumulation of fluid in the tissues of the lower extremity. The medical term for this is venous incompetence and essentially means that the blood is getting down to your feet, but struggling to get back up to your heart.
The typical uncomplicated case of swollen legs might be a 60 year old lady whose ankles puff up late in the day. She cannot wait to kick her shoes off at night, but by morning the swelling has gone.
Although swollen legs can be quite a nuisance, it cannot be forgotten that swelling can also be a clue to certain underlying medical problems. So it is important that the cause for your oedema is checked properly. Other conditions like previous venous thromboses and heart failure are more frequently seen in older people and may contribute to leg swelling. Swelling could also be due to lymphodema (a condition where the fluid is not being adequately removed from the body) or deep vein thrombosis (DVT). DVT is characterised by swelling that happens quickly sometimes after a period of immobilisation and an associated intense amount of pain, please see your podiatrist or doctor immediately if this happens.
Who does it affect?
Venous incompetence will tend to plague us more as we get older and can be caused through pervious injury to the vein, genetic predisposition and is more common in caucasians. It is also more common in women, thought to be due to a combination of hormonal factors and as a result of pregnancy.
How does it happen?
The main veins that drain the legs are like columns of fluid with several in-built valves that work like muscles to squeeze around the columns and force the fluid from your feet back to your heart. If the valve is not working well enough, it has even more trouble circulating the fluid because it is fighting against gravity. So the more that you’re on your feet, the more fluid will accumulate around your ankles and the worse it will get as the day goes on, but in the morning when you’ve been lying flat all night and the fluid is not falling to your ankles with gravity, you have no problems.
What are the symptoms?
Along with the swelling, you may notice that it is typically worse towards the end of the day. Symptoms will be magnified in the hot weather or after sitting still for a long period of time, e.g. on an aeroplane. If the pressure on the main vein is large enough, the fluid can diffuse into the tissues and push itself into the little surface veins so they can be seen just under the skin, the larger veins to form varicose veins (the vein becomes swollen and bulbous), and small bruise like marks (haemosiderin deposits) may appear on your lower legs. As the condition worsens, the legs can burn and become itchy (a dermatitis called venous stasis dermatitis), the lower third of the leg may become hardened (liposclerosis – it can look like an inverted champagne bottle) and the area may be prone to breakdowns of the skin (ulcers).
How do I treat Venous Incompetence?
It’s a good idea to se someone to make sure that this is what the problem is.
- Use gravity. At the moment the valve around the vein is struggling to help with circulation when it has to push the blood up against gravity. So, put your feet up and allow gravity to help the valve circulate the fluid back to your heart.
- Calf muscle exercises. The calf muscle is a great pump and will assist the valve to force the blood back to your heart. Walking is a great way to activate the calf muscle or even up and down on your toes whilst sitting at the dinner table.
- Medication. Speak to your GP about whether you would be suitable for some diuretic medication which can help extract some of the fluid from your system.
- Support stockings. These stockings place a mild pressure from the ankle up the leg to force the blood upwards. However, they should only ever be used once we can ensure that there is enough blood coming down to your feet. You should make sure that you consult with your Podiatrist to check this.
- Take care of your skin. If the skin is taught from the pressure and itchy from the dermatitis you can be prone to breakdowns of the skin (ulcers). Ensure a moisturiser is used to keep the skin integrity intact and if the dermatitis flares up a topical cortisone cream can help to settle the area.
- Surgery. A consultation with a Vascular Specialist for more extensive testing about what options you may have. You will need to discuss this firstly with your GP who will refer you to the Vascular Specialist should this be an option for you.
Tags: ankles, compression stockings, swelling, venous incompetence
