Causes and treatment of swollen legs (oedematous leg)

Swollen legs – a symptom that may signal illness

In this article, I go through all the possible causes of swollen legs – from minor injuries to serious internal diseases – and in each case I explain what to do and which of my detailed guides you should read next.

First step when you have an oedematous leg

If the swelling has appeared recently, your first task should be to find out what is causing it! If you want to protect your health, see a doctor as soon as possible and ask for an examination.

Treatment can be effective once the cause of the swelling has been identified. Treatment works best when it is matched to the cause.

There are many possible causes of swollen legs. Let us review them – and also how the necessary steps differ!

The “simpler” causes of swollen legs

• In some cases, the cause of an oedematous leg is obvious. For example, if you twist your ankle, you know what caused it, and the swelling is temporary. It will disappear on its own sooner or later (provided there is no fracture).
• Injuries (strains, sprains, dislocations, ligament tears and bone fractures) almost always cause swelling as well. This may have two causes. First, small blood vessels torn during the injury bleed and form a haematoma. Second, blood flow towards the injured area increases. This is useful for protection (pathogens could enter the body through the wound, so an “army” of white blood cells arrives to prevent this). Blood flow also brings substances that support healing and regeneration. More fluid than usual therefore reaches the injured area, causing swelling.
• Lack of movement (a full day of sitting or standing at work, a long car, bus or plane journey) can cause swollen legs even in a healthy person. The edge of the sock leaves an indentation above the ankle. This is the easiest type of swelling to resolve – it quickly disappears with exercise, walking, jogging or cycling.
• Arthritis – the area around the affected joint(s) is swollen, warm and painful, movement is difficult and the area may be red.
• Rheumatoid arthritis – a common autoimmune form of arthritis characterised by inflammation, swelling and pain in the joints.
• Arthrosis: a painful condition caused by wear of the joint cartilage, which may involve swelling around the joint.
• Gout: an acute attack triggered by uric acid crystals usually appears after heavy eating and drinking. The joints of the foot, especially the big toe, become swollen and very painful.
• Knee bursitis: a bursa is a fluid-filled sac with a slippery surface. It acts as a cushion between bone and muscle or tendon and helps movement. Inflammation causes swelling and pain, most often at the back of the knee.
• Infections (e.g. erysipelas, cellulitis): bacteria such as streptococci or staphylococci enter the skin. The skin becomes red and warm, and the affected area rapidly spreads. It soon becomes tender, and pain and fever develop. Details are available in the guide Erysipelas – a bacterial infection of the skin.

General medical treatment

• A fracture must be immobilised (put in a cast).
• After an accidental injury, rest the swollen joint, apply ice, bandage it (compression) and elevate it.
• In the case of an infection, the important step is to start medical treatment (antibiotic therapy) as soon as possible.
• If a new inflammatory process appears, see a doctor. Treatment must be based on the examination and matched to the disease.
• If the pain or inflammation is longstanding (arthritis, arthrosis), you do not need to rush to the doctor every time the pain worsens, as this will not help. In this situation, you can treat your symptoms at home with physiotherapy methods, as discussed with your doctor. Ask your doctor which method or combination of methods you should use.

More serious causes of swollen legs – when is an examination important?

After an ankle sprain, it is usually clear what caused the swelling. However, a range of diseases may first appear as swollen legs. This is why you should take new swelling seriously and have these conditions ruled out through medical examinations.

In the following sections, I go through the most common more serious causes. I link each one to a detailed guide with specific advice for home care.

Oedematous legs as a medicine side effect

Swollen legs may be an unwanted side effect of some prescription medicines. The most common causes are heart medicines called calcium-channel blockers (amlodipine, nifedipine). Non-steroidal anti-inflammatory medicines, such as aspirin and ibuprofen, and some medicines for diabetes can also cause swelling. The oedema-causing side effect of hormone medicines containing oestrogen or progesterone (contraceptives), as well as some antidepressants, has been known for a long time.

What to do if a medicine causes side effects

• Consult your doctor and ask whether the medicine can be replaced with a preparation that has a different mechanism of action.
• Choose another method of contraception.

Pregnancy and varicose veins during pregnancy

During the last third of pregnancy (the third trimester in medical terminology), the growing baby presses on the blood vessels running near the uterus. This compresses them and makes blood flow more difficult. As a result, the legs may swell.

Consult your doctor! This is particularly important if the swelling extends beyond your legs and appears higher up, for example around your eyes – swelling of this kind has a more serious cause!

Compression massage, meaning a lymphatic drainage device, can be used safely. A gentle 10–15-minute treatment, which you can repeat 2–3 times a day, may relieve the swelling. Details are available in the guide Varicose veins during pregnancy – when pregnancy really is the cause.

Varicose veins and chronic venous insufficiency

Varicose veins usually develop slowly in people who work standing or sitting, or who get little exercise.

A feeling of “heavy legs” is the first sign of varicose vein disease. The veins slowly widen, thicken and become tortuous. Blood pools in the veins instead of flowing back towards the heart. A tight, painful feeling and swollen legs develop. The first warning sign is when your sock “cuts into” your ankle.

If venous insufficiency is neglected, it can lead to serious complications such as deep vein thrombosis or a venous ulcer (a wound that does not heal).

What you can do to help yourself

• Wear compression stockings. This may slow the progression of the oedema.
• During work, exercise your legs thoroughly every half-hour, walk around and tense your leg muscles.
• Exercise regularly! At least 45 minutes of walking, slow jogging or cycling every day is needed to refresh the muscles, improve your venous and lymphatic circulation and reduce your symptoms.
• If you cannot exercise for some reason, use a muscle stimulator. The device creates contractions in the leg muscles similar to walking, effectively improves circulation in the legs and may contribute to reducing oedema.
• You can also use a lymphatic drainage device. A 15–20-minute treatment may “squeeze” stagnant blood and lymph out of the limb, quickly relieving the feeling of heavy legs.

Read my detailed guide to learn, for example, about ways to treat varicose-related swollen legs at home: Varicose vein disease: causes, symptoms and treatment

Deep vein thrombosis and thrombophlebitis

One of the first symptoms of thrombophlebitis (superficial vein inflammation) and thrombosis (deep vein inflammation) is a swollen leg, especially a swollen lower leg. As a layperson, you cannot determine which condition is present, so see a doctor immediately. This is essential if you notice painful swelling in your leg and the skin above it is warm, red or bluish.

In superficial thrombophlebitis, a blood clot forms in veins close to the skin. This is less risky than deep vein thrombosis, in which a blood clot forms in a deep vein between the leg muscles.

What to do in acute thrombosis or thrombophlebitis

• Do not exercise at all – if there is a blood clot, muscle movement may push the thrombus onwards and lead to an embolism!
• If you notice these symptoms, see a doctor without delay – preferably call an ambulance, but do not walk there under any circumstances!
• Do not attempt any home device treatment for these conditions, as it may worsen the symptoms. At this stage, treatment must be medical.
• Your next treatment step will only be needed about 3 months after the acute phase begins, when the final, lasting condition after acute deep vein thrombosis has developed.

The detailed clinical background – including the difference between superficial and deep vein forms, symptoms, diagnosis and the urgent treatment protocol – is available in the guide Thrombosis – when your vein becomes blocked.

Post-thrombotic condition (post-thrombotic syndrome)

Post-thrombotic syndrome (PTS) is the most common late complication of deep vein thrombosis (see the previous section). Acute thrombosis must not be treated at home, but symptoms appearing 3–4 months after thrombosis can – and should – be treated.

Thrombosis means that a blood clot blocks a vessel. Over several weeks, the clot changes, attaches firmly to the vein wall and is partly absorbed. In most cases, however, recovery is not complete: residual symptoms should be expected, because the vein wall and venous valves are permanently damaged and venous return remains impaired.

Main symptoms of PTS

• persistent swelling (especially on the previously affected side, more noticeable by the end of the day);
• a feeling of tightness and heavy legs;
• brownish-purple-red discolouration of the skin (haemosiderin deposition);
• dry skin, later lipodermatosclerosis (a hard, inflamed area of skin);
• in severe cases, a chronic venous lower-leg ulcer that heals slowly.

What can you do at home?

If you want to avoid serious complications such as lymph leakage, wounds or ulcers, you need regular treatment. The main treatment is daily regular walking and cycling. Electrical stimulation of the lower-leg muscles or compression massage may be used as additional treatment. The foundation is lifelong, personalised compression therapy (a correctly fitted compression stocking).

You can find the detailed clinical background and complete home-treatment protocol for the residual condition after thrombosis in the PTS section of the thrombosis pillar article.

Related symptom pathways

The clinical picture of PTS may include several symptoms that are also discussed separately:

• Reddish-brown pigment spot on the lower leg – often the first visible sign of PTS (haemosiderin);
• Venous lower-leg ulcer with muscle stimulation – the most serious late consequence of PTS.

Swollen legs caused by heart failure

Heart disease may cause oedema. The heart's contractions are weak, so it cannot circulate blood around the body properly. Fluid therefore slowly accumulates in the legs. Common symptoms of congestive heart failure include breathlessness, fatigue and a dry cough.

Oedema of cardiac origin requires medical treatment.

What you can do to help yourself

• Wear compression stockings. This may slow the progression of the oedema.
• Exercise regularly, according to your capacity. During walking or slow cycling, the muscles stimulate venous and lymphatic circulation and reduce swelling.
• If you are no longer able to exercise and do not have a pacemaker, use a muscle stimulator. The device creates contractions in the leg muscles similar to walking, effectively improves circulation in the legs and may contribute to reducing oedema.

Swollen legs caused by kidney disease

In kidney disease, the kidneys do not work properly, so water and waste products remain in the body. Fluid accumulates and causes swelling in the legs and sometimes the arms as well.

Symptoms of kidney disease may include fatigue, shortness of breath, nausea, thirst and bleeding.

If kidney disease is suspected, do not start self-treatment. See a doctor as soon as possible! There is no home medical device that can be used for kidney disease.

Lymphoedema

If all the causes of swollen legs listed above have been ruled out, then “nothing else remains” except lymphoedema. This is a condition in which swelling is caused by disease or damage to the lymphatic system. Because lymph cannot return to the circulation, swelling usually develops in the legs. It may affect the arm and can also appear on the trunk or face.

Characteristic clinical signs of lymphoedema include swelling of the foot on the affected side as well as the lower leg, a positive Stemmer sign (the skin at the base of the second toe cannot be lifted into a fold), and swelling that does not completely disappear even when the limb is elevated.

Detailed medical background: Lymphoedema – forms, causes and stages. Home-treatment protocol: Treating lymphoedema at home. Stage-specific guide: Lymphoedema stages (ISL 0–3). For arm swelling after breast cancer surgery (BCRL), see the separate clinical protocol: Arm swelling after breast cancer (BCRL).

Lipoedema (fat oedema) – predominantly female leg swelling

Lipoedema is one of the most common, yet most frequently misdiagnosed, causes of swollen legs in women. It is a chronic, symmetrical and abnormal accumulation of subcutaneous fatty tissue, typically affecting the hips, thighs, calves and upper arms. It occurs almost exclusively in women and often begins in connection with hormonal life stages (puberty, pregnancy or menopause).

Typical signs include:

• symmetrical, bilateral accumulation of fat on the hips, thighs, calves and upper arms, while the waist remains slim;
• the feet and backs of the hands remain unaffected – the “cuff sign”;
• tender skin that bruises easily;
• resistance to dieting: weight loss reduces the waist and abdomen, but has little effect on the hip-thigh-calf region;
• symptoms begin or worsen after childbirth or hormonal changes.

If these symptoms apply to you, it is worth consulting a lipoedema specialist (lymphologist, vascular surgeon or plastic surgeon with a lipoedema practice). Detailed clinical background: Lipoedema (fat oedema): symptoms and treatment. Differentiation from lymphoedema: Lipoedema or lymphoedema? Differential diagnosis. Stage-specific guide: Lipoedema stages 1–4.

Swollen legs after exercise or due to overuse

After intense exercise, especially running, intense cycling or a long hike, swollen legs and a feeling of heaviness may be a normal part of recovery. Increased blood flow and microtrauma to muscle tissue together cause temporary fluid accumulation. It usually disappears on its own within 24–48 hours.

In athletes, pneumatic compression and cold compression (ice massage) are increasingly used in clinical practice to speed recovery. Details: Compression therapy for athletes, Pneumatic compression and muscle recovery, Regenerative ice massage – cold compression therapy.

Warning: if swelling after exercise has not disappeared after 48 hours, is painful or affects only one side, it is not a recovery phenomenon and requires medical consultation.