Leg Swelling: Common Causes and When to Be Seen

What it involves

MedlinePlus defines edema as swelling caused by fluid in the body's tissues. It usually occurs in the feet, ankles, and legs, but it can involve the whole body. MedlinePlus says slight swelling of the lower legs is common in warm summer months, especially after standing or walking a lot, and advises contacting your provider about any swelling that has no clear explanation.

Who this is for

• Patients whose ankles or legs look puffy, or whose socks and shoes leave deep marks
• Patients with swelling that keeps coming back, spreads, or comes with a quick rise in weight
• Patients with heart, kidney, liver, or thyroid conditions whose swelling has changed
• Patients who take medicines that can cause fluid buildup and want them reviewed

What to expect

• Questions about when the swelling started, whether it is in one area or all over, and what you have tried at home
• A physical exam, including pressing on the swollen area to see whether it leaves a dent
• Tests your provider thinks fit, which may include blood work, a urine test, or an EKG
• A plan that covers the likely cause, salt intake, leg position, and when to come back

What the word edema describes

MedlinePlus says the extra fluid behind swelling can cause a rapid increase in weight over days to weeks, and that swelling may be all over the body or limited to one part. It also describes two types: pitting edema, which leaves a dent in the skin after you press on it for about five seconds that slowly fills back in, and non-pitting edema, which does not. A gentle press is a simple way to tell them apart.

Causes on MedlinePlus's list

MedlinePlus lists many causes of edema, and the first two are the most ordinary: Swelling around the knee after an injury or with arthritis has its own causes, which the knee pain evaluation lists.

• Eating too much salt or sodium
• Standing or walking a lot, especially in warm weather
• Heart failure
• Kidney disease, including nephrotic syndrome
• Liver problems from cirrhosis
• Thyroid disease, poor nutrition, or too little albumin in the blood
• Pregnancy, sunburn, or lymph node problems after surgery such as a mastectomy
• Some medicines, such as corticosteroids and medicines for heart disease, high blood pressure, or diabetes

Why the heart, kidneys, liver, and thyroid come up

Because several serious conditions can show up as swelling, a visit for new or unexplained swelling looks beyond the legs. The heart failure page explains why weight and swelling are tracked, the kidney function tests guide covers creatinine, GFR, and urine albumin, and the liver function tests guide covers a liver panel. Thyroid causes are covered under thyroid care.

Tests a provider may use

MedlinePlus lists tests that may be done for swelling: an albumin blood test, electrolyte levels, kidney function tests, liver function tests, urinalysis, an electrocardiogram, an echocardiogram, and X-rays. Nobody needs all of them. Some are drawn or recorded in the office and some may be arranged elsewhere, so ask the office which applies to you. The basic metabolic panel guide explains the electrolyte and kidney numbers on a common blood panel. Cramps in the calf are a different problem from swelling, and the muscle cramps guide explains the common triggers and when repeated cramps should be checked. A foot that is swollen, warm, and red with streaks or pain may have a bacterial infection, and the athlete's foot guide lists the signs to watch for after a fungal rash.

Home care MedlinePlus describes

MedlinePlus says to follow your provider's recommendations and keep up your everyday activities. When lying down, it suggests keeping your arms and legs above heart level if possible so fluid can drain, but not if that makes you short of breath. Treatment may include avoiding salt, taking water pills called diuretics, or wearing support hose, and avoiding alcohol if liver disease is the cause. Do not start or stop a water pill without your provider. Swelling and redness at the heel is a different problem from fluid in the legs, and the heel pain and plantar fasciitis guide explains when heel swelling needs a visit.

Swelling with breathing trouble

MedlinePlus says rapid diagnosis and treatment are important in an emergency such as pulmonary edema, where fluid builds up in the lungs, and it advises against raising your legs if doing so makes you short of breath. If swelling comes with trouble breathing, call 911 instead of booking a visit. The chest pain guide lists other symptoms that should not wait. Breathing trouble on its own has a longer list of causes, which the shortness of breath evaluation sets out, including the symptoms that need 911.

Sources

• MedlinePlus — Edema
• MedlinePlus — Swelling (Medical Encyclopedia)