There are many reasons why your legs can swell. The cause of the swelling may be from a problem with your heart. Swelling may also be found in people who are overweight, consume too much salt in their diet, or have renal problems.

Another reason for leg swelling is a condition called lymphydema. In this condition the lymphatic channels do not function right and as a result of this, there is an accumulation of fluid in the leg(s). In most instances, the swelling is on top of the foot as well as the lower leg.

One of the most common causes of leg swelling is an abnormality of the venous system. This may simply be reflux related to a valve malfunctioning in the greater saphenous vein or small saphenous vein. When the valve does not function properly, there is a buildup of pressure in the venous system, which causes fluid to accumulate in the leg.

Read more about venous disease and see how valves should work.

Another reason for swelling may be related to the deep venous system. This may occur because of a previous clot or compression of the vein such as a condition called May Thurner syndrome. With this condition, there is compression of the iliac vein by the iliac artery. Many times a stent is necessary to promote normal flow in the vein.

If the swelling is caused by disease in the greater saphenous vein or the small saphenous vein, it is easy to alleviate the problem by a procedure called thermal ablation. If the problem is related to a previous clot, it is much more difficult to treat. In this instance, compression stockings, periodic elevation, and mild diuretics may be the only therapy available to you.

As of November 2012, there are no good synthetic valves available to be placed in the venous system, although work is moving forward on this.

If you have swelling in one leg, it is likely due to venous disease alone. If you have swelling in both legs, it may be related to venous disease, but you’re venous specialist must rule out other causes.

When the venous specialist does an ultrasound, he/she will be able to tell if there is reflux in your venous system and how severe it is. Your doctor can tell if it is from the superficial veins or from deeper veins.

A good point to remember is that if you have varicose veins, your problem is most likely venous in origin. If the swelling goes down at night and reoccurs when you are on your feet, this is another good indication that you have venous reflux.

Ron Bush, MD, FACS
Peggy Bush, APN, CNS, MSN