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Edema / Swollen Legs

 

Leg swelling also known as edema is a noticeable increase in the volume of fluid in the skin and tissue which causes pressure, discomfort, and pain. This swelling may be accompanied by skin changes like eczema, bruising, blisters, and drainage. Many people first notice this swelling around their ankles when they remove their socks at the end of the day.

 

Your body has a lymphatic system and a vascular system that work together to deliver oxygen and nutrients to your cells. These systems remove waste products and fluid that accumulate at a cellular level and fight against infection. When these systems are faulty or become damaged, blood and lymph fluid accumulate in the legs and this leads to swelling, discomfort and pain.

 

What Can Cause Leg Swelling

• Medical Conditions: Heart Disease, Heart Failure, Thyroid Disease, Cancer, Liver Disease, and Kidney Disease can cause swelling.

• Medications: Medications may cause leg swelling and fluid retention. Your pharmacists can determine if your medications may cause swelling.

 

• Prior Treatments: Lymph node biopsies, cancer surgery, radiation therapy, trauma, or surgery can cause limb swelling.

 

• Immobility: Conditions like stroke, fracture, arthritis, and failing health that limit mobility may result in limb swelling.

 

• Venous Disease: Reversal of flow (reflux) in the venous system alters the balance between the vascular and lymphatic systems and leads to leg swelling. Deep vein thrombosis and late complications of DVT—Post Phlebitic Syndrome may present as swelling.

 

• Lymphatic Disease: Lymphatic disease can lead to leg swelling. This may be congenital, with onset at birth, adolescence, or early adulthood or acquired as a result of damage from surgery or radiation therapy. In other countries the most common cause of lymphedema is infection.

 

• Infection: Cellulitis (infection of the skin and subcutaneous tissue) damages the lymphatics. Minor trauma or infection may trigger the development of lymphedema.

 

Evaluation

Evaluation for swelling includes a medical history, physical exam, and a duplex ultrasound. With this information a medical strategy can be developed.

 

For minor swelling that resolves with a good night’s rest and no underlying venous or medical problems appear, Conservative Care Treatments such as exercise, elevation, compression, weight management, changes in diet, etc. may be all that is needed. For more severe swelling that does not respond to conservative care, more diagnostic testing may be helpful.

 

In addition to a duplex ultrasound of the legs other test may be ordered. These tests include a nuclear medicine lymphoscintigraphy to evaluate the lymphatic system for flow patterns.

 

Treatment For Leg Swelling

 

• Any underlying medical conditions should be treated.

 

• Medications that contribute to swelling should be changed if possible.

 

• Conservative Care measures should be instituted as well (visit the Conservative Care Resource Center for more details on conservative care).

 

• If the swelling is not controlled, a referral to an Occupational or Physical Therapist for lymphedema evaluation and management should be made. Once the swelling is controlled, any underlying venous reflux should be corrected.

 

For most lymphedema patients the condition can be treated and controlled but not cured. If medical conditions, medications, or venous disease are the cause of the swelling it may improve with correction of these conditions. Since cellulitis may trigger swelling, at the first sign of infection medical attention should be sought.

 

The primary treatment for chronic lymphedema and leg swelling is treatment by an Occupational or Physical Therapist certified in the management of lymphedema. Manual lymphatic drainage massage opens the lymphatic channels and encourages normal lymph flow. This is usually combined with multi-layered compression wrapping to treat the swelling and maintain a healthy fluid balance in the soft tissue of the legs. Once stabilized, graduated compression hose should be worn daily. In some patients a pneumatic compression device can be used at home to help control the swelling.

 

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Swollen leg, edema

 

Swelling in the leg