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Should you be concerned about leg swelling?

Vein disease occurs in the legs when the valves are damaged or do not work well, and this is called chronic venous insufficiency. This causes blood to backflow and collect in the legs leading to swelling.

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A patient asked me today why her legs and feet frequently felt heavy or swollen. While heart disease and kidney problems can cause this to occur, swelling or edema in the legs (“manas”) is often not a serious health threat. Of course, if left untreated, it can become painful and disabling.

immediately consult your doctor if you experience any of the symptoms. / PHOTOGRAPH COURTESY OF scopeheal.com

Leg swelling is frequently due to a disorder of the blood vessels called veins. Veins carry blood from all parts of the body back to the heart (as opposed to arteries which carry oxygenated blood from the heart to other parts of the body). The veins have valves inside them to help keep blood moving in only one direction (toward the heart) and as blood flows toward the heart the valves open and then close to keep the blood from flowing back.

Vein disease occurs in the legs when the valves are damaged or do not work well, and this is called chronic venous insufficiency. This causes blood to backflow and collect in the legs, leading to swelling. Blood is especially likely to collect in both legs when a person sits or stands for a long time without walking, like during long car or airplane trips. The swelling usually goes away in a day or two after raising the legs overnight during sleep.

Symptoms of vein disease can include pain or a feeling of tired or heavy legs, especially at the end of the day; swollen veins (“spider veins” which are small, fine veins and are usually flat, or “varicose veins” which are larger and twisted, and can appear rope-like under the skin); swelling in the lower legs or ankles, usually at the end of the day; skin color changes (brownish discoloration that often appears first around the ankle); and open sores, also called “venous ulcers” which can occur after long-standing leg swelling, usually around the ankle, and can be painful and ooze fluid.

Chances of having vein disease can increase with a blood clot in a leg vein (deep venous thrombosis); leg injury; being pregnant, especially more than once (changes in hormone levels can weaken vein walls); and obesity.

As for varicose and spider veins, the exact cause is not known, but it is primarily a genetic condition, meaning these can run in the family. Contrary to popular belief, these swollen veins are not caused by walking in high heels, crossing your legs, standing for long periods of time or wearing tight knee-high socks, although these practices can lead to leg swelling when the valves in the veins are already weak. Varicose and spider veins are also not caused by washing your legs and feet with cold water, or washing your feet right after taking off your shoes.

There are some things you can do to reduce leg swelling:

• Raise your legs up when you can, three or four times a day, for 30 minutes each time.

• Try not to sit or stand in one place for a long time. Get up to stretch and walk around for a few minutes.

• Do exercises to point your toes and feet down and up a few times each day.

• Maintain a healthy weight.

• Avoid scratching itchy skin above varicose veins, as this may cause bleeding or open wounds.

•It is important that you do not take any medications to reduce the swelling unless instructed by your doctor. Indiscriminate use of medications such as diuretics may cause dehydration and kidney injury, as well as electrolyte imbalances that can cause an irregular heartbeat and cramps.

If other regular treatments do not work, there are procedures that can be done where the damaged veins are removed or destroyed so they can no longer fill with blood. These procedures include sclerotherapy, laser ablation or surgical ligation.

The skin over your legs may also be dry and sensitive, so wash your legs each day with a gentle cleanser and use an unscented moisturizing cream or ointment while your skin is still damp. You can also use petroleum jelly. Ask your doctor before using any other type of cream or ointment, because some can cause a rash.

And watch out for these warning signs:

Sudden onset of unexplained swelling.

Swelling in just one leg.

Swelling that does not go away in a few days.

Pain, redness or tenderness over the area of swelling, sometimes accompanied by fever.

Being short of breath.

Swelling that extends to the thighs, abdomen, arms, hands and face.

See your doctor immediately if you experience any of these warning signs as your leg swelling may be due to a more serious condition — a heart or kidney problem, an infection or a blood clot in a vein.

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