Sometimes our legs or feet become swollen and feel uncomfortable. This is known as oedema and it happens when fluid in our lower legs or feet has trouble returning back up through the body.
Chronic oedema, regardless of the cause, is a build-up of fluid in the tissues of the body that has lasted more than 3 months. This causes swelling of the affected body part. The lymphatic system would usually work to remove this fluid and along with it, various toxins that the body needs to excrete via the kidneys. If the oedema does not completely resolve overnight or with elevation, this indicates lymphatic failure, or lymphoedema. All chronic oedema is related to failure of the lymphatic system. Lymphoedema can lead to changes in the skin and deeper tissues. It can also lead to infection (cellulitis). Lymphoedema in the lower limbs is commonly related to chronic venous insufficiency.
What can cause legs and feet to swell?
‘Venous’ is anything related to our veins. Swelling often happens when our veins are not working as well as they should. Blood is pumped from our heart to the rest of our body through our arteries and returns to our heart through your veins. Blood is then propelled back to our heart by our heart pumping. Our leg and foot muscles help this along by circulating blood as you walk and move your ankles.
Our veins contain one-way valves that stop the blood falling back towards your toes. These valves can become weak or damaged. When this happens, our veins become swollen (varicose veins) that blood is forced into the tissue of your skin making it swell and overburdening the lymphatic system.
What does oedema look like?
What is lymphoedema?
Legs and feet can also become swollen if we have problems with our lymphatic system. This is known as lymphoedema. The lymphatic system can be thought of as a waste disposal system that takes tissue fluid and waste products away from the tissues around your skin, fat, muscle and bone. Once the tissue fluid is inside the lymphatic vessels, which are just under the surface of our skin, it becomes known as ‘lymph’. Lymph is then transported in one direction by larger and deeper lymphatic vessels. Lymph moves when we are active and when we breath deeply, so any physical activity helps the lymph vessels work better and prevent or reduce any swelling. Being active is an essential part of treatment.
There are many causes of lymphoedema. Some people may be born with a tendency to develop it. It is more likely to occur in those who are overweight, inactive, who have problems with their veins or who have had cancer treatment involving surgery or radiotherapy in the pelvis or lower limbs. Some joint surgery may also damage lymphatic vessels and contribute to development of lymphoedema.
Here’s a short film to explain “What is Lymphoedema?”.
Swelling in the lower legs can also be caused by right-sided congestive heart failure. This is known as cardiac oedema and also causes shortness of breath and weight gain. It is important that cardiac oedema is considered if you are being treated for these symptoms, and before you are prescribed compression therapy. However, if you have a cardiac problem you may also have other problems, such as lymphoedema which must be treated.
Getting your swollen legs and feet diagnosed
If your legs or feet are swollen, make an appointment at your GP practice, who will be able to diagnose or exclude conditions such as cardiac problems. The GP may refer you to a nurse responsible for caring for patients with venous leg problems or a lymphoedema clinic.
When you see the nurse or doctor, they should:
- Ask about your symptoms and how long you have had problems
- Examine your lower legs from toe to groin
- A Doppler ultrasound may form part of this assessment. This test measures the blood pressure in your ankle and compares it to the pressure in your arm to see if you have problems with the blood supply to your lower leg. You may have to come back to have your Doppler test on another day or at another clinic but if done, you should have this test within a few weeks of your first appointment.
You might also be offered some other tests to check for other health problems such as diabetes and anaemia that can affect your legs.
Your GP Practice may refer you to a specialist lymphoedema clinic or to your local hospital if they think you may have problems with your veins or arteries.
Treatment – what treatment will I be offered for swollen legs and feet?
The treatment for swollen legs depends on what has caused the swelling.
Compression therapy (support bandages or socks)
If your legs or feet are swollen because of venous insufficiency or lymphoedema and there are no problems with the blood supply to your legs or feet, then you are likely to require compression therapy. Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling and healing or preventing sores or ulcers. You may need to be seen by a lymphoedema or other specialist for specialist measuring and fitting of compression
There are lots of different types of compression therapy so ask your nurse to find something that is right for you. Your legs may feel uncomfortable at times in compression stockings or bandages. This is often towards the end of the day when your legs can become more swollen. This can be relieved by elevating your legs for a good amount of time and stretching your ankles and calf muscles and wiggling toes can also help. You may have been experiencing pain in your ulcer before compression treatment. We would advise that you continue with any pain relief you may have been prescribed. Compression stockings or bandages should not increase pain. If your pain increases or becomes severe, contact the nurse or doctor who prescribed them.
Healthcare advice for swollen legs and feet
There are some lifestyle changes you can make to help reduce your swelling:
- Maintain a healthy weight
- Be as active as you can. Aim to take light to moderate exercise such as swimming or walking for about thirty minutes at least three times a week. Being active while wearing compression is particularly effective. Even if you have limited mobility, there are things you can do that will help to reduce swelling. Refer to the British Lymphology Society EveryBodyCan pages for ideas and information
- Avoid standing for a long time – keep your feet and legs moving as much as you can. Try lifting up one heel at a time to stretch your foot arch or rock back on your heels but make sure you can hold on to something to avoid any falls
- Try to avoid sitting for long periods with your legs down, put your feet up – elevate your legs above your heart. It is also helpful to do foot and ankle stretches to help the circulation of blood and lymph
And please remember the following:
- Swollen tissues are easily damaged, so take care to protect your skin from injury, scratches, insect bites or sunburn
- Lymphatic failure increases risk of infection, so keep your skin clean by washing and careful drying, especially between the toes daily and applying a non-perfumed moisturiser to keep the skin supple
- If signs of infection occur, e.g. redness, more swelling, pain, and feeling fluish, seek medical advice immediately
Further reading around swollen legs and feet
This helpful guide was written for those who develop lymphoedema following cancer treatment, but provides useful advice, regardless of the cause.
Accelerate We have a clear vision at Accelerate – Our vision is to boldly transform chronic wound and lymphoedema care. And we do this by developing and increasing access to world-class treatments and thinking in chronic wound and lymphoedema care. We're based in East London but can accept national referrals from your GP / specialist to our world-class centre where we pioneer and trial experimental new treatments for chronic wounds, lymphoedema and mobility challenges.
The British Lymphology Society (BLS) is a dynamic and innovative body providing a strong professional voice and support for those involved in the care and treatment of people with lymphoedema and related lymphatic disorders, including lipoedema.
Find out more on the British Lymphology Society website
Lymphoedema Support Network (LSN) is a national UK charity which provides information and support to people with lymphoedema.
020 7351 0990
Find out more on the Lymphoedema Support Network website
The Lindsay Leg Club Foundation Promoting and supporting community based treatment, health promotion, education and ongoing care for people who are experiencing leg-related problems - including leg ulcers and other wound care issues.
Find out more on the Lindsay Leg Club Foundation website
NHS Choices the official NHS website, which provides vital information and support about leg and foot signs and other symptoms.
Call 111 - for non-emergency medical advice
Find out more on the NHS Choices website
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