Causes and Treatment of Leg Swelling (Edema)

First steps when you have an edematous leg

If the leg swelling has appeared recently, your first task is to find out what's causing it. To do yourself a favor, see a doctor as soon as possible and ask for an evaluation!

Treatment can only be effective when the cause of the swelling is known. Therapy is most effective when it is targeted to the underlying cause.

There are many possible causes of leg swelling. Let's go through them and the different actions each one requires.

Simpler causes of leg swelling

• Sometimes the cause of the swollen leg is obvious. For example, if you sprain your ankle you know what caused it and the swelling is usually temporary — it will go away over time (unless there is a fracture).
• Injuries (strain, sprain, dislocation, ligament rupture and bone fracture) almost always cause swelling for two reasons.
  First, small blood vessels ruptured at the time of injury lead to bleeding and a hematoma.
  Second, blood flow to the injured area increases. This brings immune cells to protect against infection and also delivers substances that promote healing and regeneration. More fluid arrives at the injury site than usual, causing swelling.
• Lack of movement (all-day sitting or standing work, long car, bus or plane trips) can cause leg swelling even in a healthy person. The sock edge can leave a dent above the ankle. This is the easiest to fix — with body movement: walking, jogging, or cycling the swelling usually disappears quickly.
• Arthritis – the area around the affected joint(s) is swollen, warm, painful and difficult to move, sometimes red.
• Rheumatoid arthritis – a common autoimmune form of arthritis characterized by inflamed, swollen and painful joints.
• Osteoarthritis: painful condition due to wear of joint cartilage, which can be accompanied by swelling around the joint.
• Gout: acute attacks caused by uric acid crystals, often after heavy eating/drinking; joints of the foot (especially the big toe) become swollen and very painful.
• Knee bursitis (inflammation of the bursa): a bursa is a fluid-filled sac that cushions between bone and muscle or tendon and helps movement. Its inflammation causes swelling and pain, most often at the back of the knee.
• Infections (e.g., erysipelas, cellulitis): when bacteria such as streptococcus or staphylococcus enter the skin, the skin becomes red, warm and the infection rapidly spreads. The area becomes tender, painful and fever may develop.

General medical treatment

• A fracture must be immobilized (cast).
• For traumatic injuries, rest the swollen joint, apply ice, use a bandage (compression) and elevate the limb.
• For infections, start medical treatment (antibiotic therapy) as soon as possible.
• For newly appearing inflammatory conditions, see a doctor and treat according to the diagnosis.
• If the pain or inflammation is chronic (arthritis, osteoarthritis), you don't need to rush to the doctor every time the pain increases as that won't help. In these cases, follow what you and your doctor have agreed on and you can use home physiotherapy methods. Consult your doctor about which method or combination to use.

More serious causes of leg swelling

While a sprained ankle makes the cause of swelling clear, there are a number of diseases where leg swelling may be the first sign. These are the conditions for which you should take early edema seriously and have medical tests to rule out the following.

Leg swelling from medication side effects

Some prescription medications can cause unwanted leg swelling. Most often calcium channel blockers used for the heart (amlodipine, nifedipine) are responsible. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, and some diabetes medications can also cause swelling. Hormonal drugs containing estrogen or progesterone (birth control pills) and certain antidepressants are known to have edema-causing side effects.

What to do if a drug is causing the swelling

• Talk to your prescribing physician and ask if the drug can be changed to one with a different mechanism of action.
• Choose a different method of contraception if relevant.

Pregnancy

In the last third of pregnancy (the third trimester), the growing baby can press on blood vessels near the uterus. This compresses them and makes blood flow more difficult, which can lead to swelling in the legs.

Consult your physician! This is especially important if the swelling is not limited to your legs but spreads upwards and, for example, appears around your eyes — such edema can be due to a more serious cause.

Compression therapy, that is, using a compression therapy unit, can be used safely. With gentle 10–15 minute treatments (which you can repeat 2–3 times a day) you can reduce swelling.

Varicose veins and chronic venous insufficiency

Varicose veins most commonly develop slowly in people who stand or sit a lot at work or due to lack of exercise.

A feeling of "heavy legs" is the first sign of venous disease. Veins slowly dilate, thicken and become tortuous. Blood pools in the veins instead of returning to the heart. Tension-type pain and leg swelling develop. The first warning sign is when your sock starts to cut into your skin.

If venous insufficiency is neglected it can lead to serious complications such as deep vein thrombosis or venous ulcers (non-healing wounds).

What you can do to help yourself

• Wear compression stockings; this can slow the increase of edema.
• During work, exercise your legs thoroughly every half hour: walk around and contract your calf muscles.
• Exercise regularly! At least 45 minutes of daily walking, slow jogging or cycling is needed for the muscles to refresh venous and lymphatic circulation and reduce symptoms.
• If you cannot exercise for some reason, use a muscle stimulator. The device produces contractions in the leg muscles similar to walking, effectively improving circulation in the legs and helping reduce edema.
• You can also use a compression therapy unit; a 15–20 minute treatment can "squeeze out" pooled blood and lymph from the limb, quickly relieving the heavy-leg feeling.

Read this article of mine where you can find home treatment methods for varicose vein–related leg swelling: Causes, symptoms and treatment of varicose vein disease

Deep vein thrombosis and thrombophlebitis

Thrombophlebitis (inflammation of superficial veins) and thrombosis (deep vein clot) often present with a swollen leg (especially the calf). As a layperson you cannot determine which it is, so seek medical attention immediately. If you notice a painful swollen area on your leg and the skin over it is warm, red or bluish, seek urgent care.

In superficial thrombophlebitis, clots form in veins near the skin surface; this is less dangerous than deep vein thrombosis, where a clot forms in a deep vein between the muscles.

What to do in acute thrombosis or thrombophlebitis

• Do not perform any physical exercise — if there is a clot, muscle movement may dislodge it and cause an embolism!
• If you notice the mentioned symptoms, seek medical help immediately — call an ambulance if possible, and do not walk!
• Do not try any home mechanical treatments in these conditions, as they may worsen the symptoms. Treatment in such cases must be medical.
• Your own interventions will only be considered about 3 months after the acute phase begins, when the final and lasting condition after deep vein thrombosis becomes apparent.

Post-thrombotic condition

While acute thrombosis must not be treated at home, the symptoms that appear 3–4 months after thrombosis can be addressed.

Thrombosis means a blood vessel is blocked by a clot. Over a few weeks the clot changes, becomes attached to the vein wall and partly dissolves.

In the vast majority of cases full recovery after thrombosis does not occur; residual symptoms must be expected. The main symptoms are persistent swelling, a feeling of tension, brownish–bluish–reddish discoloration of the skin and skin dryness.

If you want to avoid serious complications such as lymph leakage, wounds or ulcers, you need regular treatment.

The main therapy is regular daily walking or cycling.

To supplement this, electrical stimulation of the calf muscles or compression therapy can be used.

Read this article of mine about home treatments for the residual condition after thrombosis (persistent leg swelling): Home treatment of the post-thrombotic condition

Heart failure

Heart disease can cause edema. If the heart's contractions are weak it cannot pump blood effectively, so fluid gradually accumulates in the legs. Common symptoms of congestive heart failure include shortness of breath, fatigue and a dry cough.

Edema of cardiac origin requires medical treatment.

What you can do to help yourself

• Wear compression stockings to slow the progression of edema.
• Exercise regularly, adjusted to your capacity. Walking or slow cycling moves the muscles and improves venous and lymphatic circulation, reducing swelling.
• If you can no longer exercise and you do not have a pacemaker, use a muscle stimulator. The device produces contractions in the leg muscles similar to walking and effectively improves leg circulation, helping to reduce edema.

Kidney disease

In kidney disease the kidneys do not function properly, so water and waste that should be excreted remain in the body. Fluid accumulates and causes swelling in the legs and sometimes the arms.

Symptoms of kidney disease can 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.

Lymphedema

If all the previously listed causes of leg swelling have been ruled out, then what remains may be lymphedema.

This is a condition in which the swelling is due to disease or damage of the lymphatic system. Because lymph cannot return to the circulation, swelling (most commonly of the leg) develops. It can also affect the arm, trunk or face.

Read my articles about lymphedema and home treatment options for lymphedema: Treatment of lymphedema at home