Many medical conditions remain poorly understood, various theories and hypotheses posited to explain the disease process. An example might be fibromyalgia or chronic fatigue syndrome. Other problems are so multi-factorial and complex, we have some ideas about how they develop but impacting the course of the disease has been challenging. Coronary artery disease is one illustration of this. In contrast, there are afflictions well understood, yet a successful, effective remedy has eluded our grasp.

Perhaps the best representative of such an entity might be swelling of the lower leg. Medically, a general term for swelling is edema. Perhaps the most remarkable facet of lower extremity edema is its frequency. A large percentage of the adult population suffers from some degree of swelling of the ankle and lower leg. To some extent, this is a testament to the constant pull of gravity, always present, always at work, pulling the fluids of the body downward.

Do you know a senior? Does an acquaintance have high blood pressure, or perhaps kidney disease? Do you have some family member who underwent surgery for cancer? How about an adult with a family history of vein disease? These are all examples of medical conditions associated with swelling of the lower leg. But these are just a small sampling; many varied and disparate disease entities can produce a build-up of fluid in the lower legs.

Some individuals initially notice something as subtle as their socks feeling tight. But for a large percentage of the population, swelling is a daily occurrence, causing the limb to feel heavy. Hosiery leaves an indentation (although this is not cutting off circulation; the sock is just pushing some of the water out of the tissues). Edema of the legs rarely produces acute symptoms or significant pain. Understandably, it may be uncomfortable and also may keep you from moving freely. Shoes may become tight and can even lead to blisters or irritation of the skin.

Edema in the legs means the tissues or blood vessels in your legs are holding more fluid than they should. This can happen if you simply spend a long day on your feet or sit for too long. It is affected by the use of tight, restrictive clothing. The consumption of excessive salt when you have hypertension can produce increased leg edema. It may also be a sign that you’re overweight or aren’t getting enough exercise. But it may indicate the presence of a more serious medical condition.

Likely the most common type of leg swelling is lymphedema, which involves dysfunction of the lymphatic circulation, an extensive system of tiny tubes found throughout the body. Lymphedema results from the inability of the lymphatic circulation to perform one of its basic functions, the removal of water and protein from the tissues. This occurs when the lymph channels are blocked, a result of many different situations like the trauma caused by surgery.

A discussion of lower leg swelling can be divided into swelling of one leg versus swelling of both. They each have different sources and are associated with differing complications that may result. Without question, the greatest concern with swelling of just one leg is a blood clot in the deeper veins of the leg. The term applied is that of a Deep Vein Thrombosis (aka DVT), which can lead to a blood clot traveling to the lungs.

This is called a Pulmonary Embolism and it can be deadly. When a DVT develops, the sufferer will often experience a heaviness in the leg, acute pressure and significant pain, usually in the calf. When a clot forms in the superficial veins (thrombophelebitis), there are rarely any concerns about the clot traveling.

The function of the veins in the leg is to bring blood back up to the heart, fighting gravity the entire way. They are able to achieve this through the action of valves which prevent blood from flowing back down.

Unfortunately, many people develop incompetent valves that allow retrograde flow, meaning blood tends to collect in the leg, resulting in leakage into the tissues, skin included. One of the substances leaking out contains iron, which stains the skin a brownish color. With continued deposition over time, the skin is poisoned. The skin becomes, essentially, diseased, leading to the leakage of fluid from the skin. This may start as pin-point openings but can progress to large, open, draining ulcers. Not exactly socially appealing, as you might expect.

Swelling of both legs is most common. As mentioned, multiple causative factors may be at play. This may be produced by poor kidney function, causing more fluid to be retained by the body. Long-term kidney disease means this vital organ is not working properly to filter water and waste material from your blood. This allows fluid to build up. Once again, gravity comes into play, causing the swelling in your legs.

Yes, the list of possible factors contributing to leg swelling is extensive. Congestive heart failure is a commonly made diagnosis. It means your heart is too weak to pump all the blood your body needs. Again, it leads to fluid buildup, especially in your legs (as well as shortness of breath and coughing). Many medications carry the unwanted side effect of increased fluid retention. Some common examples include many heart medications (especially the calcium channel blockers), aspirin, metformin and many other diabetic meds, various anti-inflammatory drugs, and some anti-depression pharmaceuticals.

How does one go about treating this all-too-common condition? Some fairly simple methods can help to reduce the severity of the edema, but a cure for many of these causes is not available. Predictably, exercise is beneficial. When sitting for long periods, like on a plane trip, it is helpful to contract the calf muscles repeatedly. Get up and walk periodically. Elevation is a recommendation every sufferer has heard.

Probably the treatment most often prescribed is that of compression stockings. Make no mistake about it: compression of the limb is the most effective means of reducing the amount of fluid in the tissues. But are these stockings the best way to achieve this? Is there another example in medicine where a prescription is so rarely followed? The rate of compliance with this therapy is horrendous. Invariably, these torture devices are uncomfortable, if not downright painful. And those most often affected with chronic lower leg edema are seniors, who generally don’t have the physical strength to put them on. So, although effective as a method of treatment for this problem, compression stockings are an abject failure.

Fortunately, ingenious design has produced a new alternative. A recent development is a sleeve, worn on the lower leg. This garment produces the desired effect through the use multiple elastic strings attached to a series of Velcro tabs. The sleeve, when maximally opened, is quite expansive and thus easy to don. The zipper is first used, but provides little compression, meaning it is easy to do. This is where the work-horse, 4 pairs of elasticized Velcro tabs, are harnessed. Opposing tabs are pulled away from each other producing the compression. A simple but effective calibration system allows one to reproduce the same amount of compression each and every time.

Daily swelling is a problem for so many people, and not just seniors. Yet few successful options exist other than elevating your feet all day…..and that doesn’t provide for a very good quality of life. Now we have the Velcro-tab compression sleeve as an option. Talk to a lower extremity physician to see if this is right for you, because, when it comes to chronic swelling, it’s really about management. As a rule, there’s nothing that’s truly curative. Finding the cause of your swelling is not always possible but is worth investigating. Swollen legs are generally not conducive to increased activity levels, and that means poorer cardio-vascular fitness. Now we are talking about more than “just” quality of life: this is an issue of health and well-being.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.