Edema of the legs occurs due to the accumulation of fluid in the intercellular space of the tissues of the lower extremities, provoked by lesions of the blood and lymphatic vessels, heart, kidneys, joint diseases, injuries, purulent processes, and some other pathologies. More often they are detected in the distal sections, they are bilateral and unilateral. In most cases, they appear in the afternoon, after a long stay in an upright position. The cause of the edema is established on the basis of the data of the survey, an objective examination, ultrasound, radiography, CT, MRI, and laboratory tests. Before making a diagnosis, it is recommended to avoid overloading, to ensure an elevated position of the limb.
Why do legs swell
Physiological causes
In healthy people, the symptom becomes a consequence of increased hydrostatic pressure in the vessels of the microcirculatory bed, appears in the evenings after a long stay in a standing position, heavy physical exertion. Additional provoking factors are high temperature, stuffiness outdoors or indoors, exposure to the sun, at high altitudes. The edema is symmetrical, covering the feet, ankles, less often the shins. Completely disappear after rest.
Hormonal fluctuations in women
Before menstruation, the level of progesterone in the blood decreases in a woman. This can cause fluid retention, pasty ankles. Puffiness is more pronounced with premenstrual syndrome. Hormonal changes during pregnancy also contribute to the accumulation of fluid in the tissues. Edema becomes more pronounced as the gestational age increases.
During menopause, the level of female sex hormones fluctuates constantly. This can lead to occasional swelling. Sometimes swelling of the legs in menopause is due to hormone replacement therapy. Another common medical cause of swelling of the legs and feet, this time in women of reproductive age, is the use of oral contraceptives.
kidney disease
Feet, shins swell with damage to the kidneys. Edema of the legs is soft, elastic, watery, symmetrical, combined with a yellowish skin color. The symptom is found in the following diseases:
- nephrotic syndrome. It occurs acutely or gradually against the background of renal pathologies, collagenoses, purulent processes, lesions of the lymphatic system, parasitic, infectious diseases. Significant peripheral edema makes movement difficult, combined with ascites, hydropericardium, hydrothorax.
- HPN. It develops as a result of chronic diseases of both kidneys or the only functioning kidney. Edema increases as renal failure worsens, progressing over several years.
- Glomerulonephritis. The acute form is accompanied by swelling of the lower extremities, which persists for several weeks. In a chronic process, pastosity of the legs is detected in the acute phase.
- Amyloidosis of the kidneys. It can be primary or potentiated by purulent processes, tumors, intestinal diseases, and other causes. Edema appears in the proteinuric stage, progressing sharply in the nephrotic stage.
- membranous nephropathy. Diagnosed after taking certain medications, acute infectious diseases, treatment of malignant neoplasms.
- Nephropathy of pregnancy. Occurs after 2 weeks of gestation. The severity of the symptom ranges from slight pastosity to widespread swelling in the hands, ankles, feet, face.
- Other nephropathies . Pathology develops against the background of diabetes mellitus, arterial hypertension, alcoholism, poisoning, malignant tumors, and metabolic disorders in children.
Swelling of the legs
Pathologies of the heart and blood vessels
Legs with cardiovascular diseases swell more than with renal pathology. Edema is symmetrical, but more dense, slowly resolves, the skin is cool to the touch, with a bluish tint. In the initial stages, a slight pastiness of the feet and ankles is determined. In severe cases, swelling completely covers the legs up to the knee joints. Possible reasons are:
- Primary and secondary cardiomyopathies . The primary form of the disease occurs for no apparent reason, the secondary is detected against the background of pathologies of the endocrine and digestive systems, viral, parasitic diseases, beriberi, metabolic disorders.
- Cardiosclerosis. It is observed in the outcome of myocarditis, with long-term angina pectoris, after myocardial infarction.
- amyloidosis of the heart. It can be hereditary or diagnosed against the background of rheumatic diseases, lung lesions, Crohn's disease, lymphogranulomatosis, and other pathologies.
- arterial hypertension. Patients have hypertension, secondary arterial hypertension of various origins.
In addition, heart failure, which causes the appearance of swelling of the legs, can be observed with rheumatism, heart defects. Sometimes the cause of swelling of the ankles, legs, feet become severe arrhythmias, constrictive pericarditis.
Vascular pathologies
Swelling of the legs is a constant symptom of venous disease. More pronounced in the ankles. Differ in the high density, firmness. Increase after standing, especially after prolonged standing, decrease in the prone position. Caused by the following conditions:
- Varicose disease. Edema progresses gradually. They cover both legs, but may be asymmetrical. They are combined with heaviness in the legs, pain, fatigue, dilation of superficial veins.
- Deep vein thrombosis. Puffiness is unilateral, appears suddenly, is accompanied by arching pains, cyanosis, fever of the skin of the limb, swelling of the superficial veins.
- Postthrombophlebitic disease. Edema is unilateral, persistent, occurs several months or years after acute thrombosis. There is a feeling of fullness, night cramps. Over time, the tissues on the lower leg become denser, ring-shaped pigmentation appears. Dermatitis, trophic ulcers are possible.
Edema of lymphatic origin is found on one side. Even more resistant and dense than with lesions of the veins, when pressed, a long-lasting fossa is formed. A distinctive feature is the change in the dorsum of the foot in the form of a pillow. They are formed during lymphostasis of various origins, including against the background of somatic diseases, lymphangitis, lymphadenitis. The cause of lymphedema can also be the removal of regional lymph nodes, compression of the lymphatic vessels by tumors, rough scars.
Joint diseases
Swelling of the joints of the legs can be provoked by arthritis. Depending on the prevalence of the process, it can be one- or two-sided, symmetrical or asymmetrical. Appears after the onset of pain, combined with local hyperemia, hyperthermia, a feeling of stiffness, restriction of movement. The cause of the development of the symptom may be the following forms of arthritis:
- Rheumatoid. Predominantly small joints of the feet are involved, sometimes the knee, less often the hip joints. The defeat of the distal parts is symmetrical, polyarthritis is observed.
- Psoriatic. Foot and knee joints suffer. The disease often occurs in the form of oligoarthritis. In the malignant form, polyarthritis is found in combination with lymphadenopathy, damage to internal organs, and cachexia.
- Gouty. Gout manifests as acute arthritis of the 1st metatarsophalangeal joint with pronounced edema, bright hyperemia, and intense pain. Attacks are repeated periodically. Sometimes there is a subacute course. In young people, one or more large joints of the lower extremities may be affected.
- Reactive. It proceeds acutely, with significant edema, develops after urogenital, intestinal infections. Typical mono- or oligoarthritis of the knees, ankles, small joints of the foot.
- Infectious (non-specific). Provoked by viral and nonspecific bacterial flora. Has pronounced symptoms. Characterized by monoarthritis of the ankle, hip or knee joint.
- Infectious (specific). With gonorrhea, the knee and ankle are affected; with syphilis, the knees; with tuberculosis, any large joint may be involved.
With arthrosis, edema is absent for a long time or remains insignificant. It is more common in patients with gonarthrosis. Increases during periods of exacerbation. A rapid increase in edema, a spherical appearance of the joint indicate the development of reactive synovitis.
Traumatic injuries
Edema is a typical symptom of injuries to bones, joints, and soft tissues. It is unilateral in nature, localized mainly in the area of damage, sometimes to some extent extends to nearby segments (mainly distal). May be associated with bruising, abrasions, flushing, cyanosis or purplish skin tone. Detected with the following damage:
- Injury. Edema limited, slight or moderate. Limb function is preserved.
- Ligament damage. Ligaments of the knee and ankle are most commonly affected. Soft tissues in the projection of damage swell. With sprains, a slight swelling is determined, with tears and ruptures, the edema is spilled, combined with cyanosis, bruising. The support is broken.
- Hematoma. Edema is dense, local. After some time, a fluctuation area appears in the center of the damaged zone. Deep hematomas on the thigh sometimes cause diagnostic difficulties, because they are “covered” by a large array of muscles.
- Meniscus tear. There is severe pain in the knee. The swelling increases, but over time becomes less noticeable due to the developing hemarthrosis. The knee looks spherical. Walking is impossible, movements are sharply limited.
- Fracture. The symptom is pronounced, progresses rapidly, correlates with the severity of the injury. Leg function is sharply limited, support is impossible. Crepitus, pathological mobility, deformity of the limb can be detected.
- Dislocation. A strong, rapidly growing edema is combined with a sharp deformity of the leg in the affected area. Movement is not possible, spring resistance is determined. Dislocations are often combined with fractures, which complicates and aggravates the picture of the injury.
Purulent processes
Rapidly growing dense local edema, redness, bluish-purple color of the skin, sharp twitching pains, intoxication syndrome are common signs of purulent processes:
- Skin lesions . Furuncles and carbuncles form where there are hair follicles: on the thighs, less often on the legs. They are a focus with one or more yellowish "islands" in the center.
- Soft tissue lesions . With abscesses, edema spreads mainly around a limited purulent focus, rarely goes beyond the segment. Phlegmon is characterized by diffuse puffiness, passing to neighboring segments.
- Damage to bones and joints . With osteomyelitis, the lower leg or thigh swells; with arthritis, the knee, ankle or hip joint swells. The swelling is pronounced, accompanied by extremely intense tearing and twisting pains, gross movement disorders, severe fever, and sometimes disturbances of consciousness.
Other reasons
Swelling of the legs may be accompanied by such diseases and pathological conditions as:
- Endocrine disorders : hyperaldosteronism, Itsenko-Cushing's disease and syndrome, hypothyroidism, myxedema.
- Wasting : alimentary cachexia, significant weight loss and hypoproteinemia in severe illness, trauma, anorexia nervosa, after extensive surgical interventions.
- Nervous diseases : paresis, paralysis of various origins.
- Taking medications : antidiabetic (thiazolidinediones), vasodilators, NSAIDs, calcium channel blockers.
Swellings are insignificant or moderate, uniform, soft, symmetrical (with the exception of cases of unilateral paralysis), rather stably persist throughout the day, sometimes increase in the evening.
Diagnostics
Due to the frequent association of leg edema with somatic diseases, general practitioners are usually involved in the primary diagnosis of pathology. According to indications, patients are redirected to phlebologists, cardiologists, nephrologists, and other specialists. To clarify the diagnosis, the following methods are used:
- Interrogation, external examination . The doctor finds out the time and circumstances of the appearance of edema, their relationship with the time of day, the mode of physical activity. Identifies the presence of other symptoms. Assesses the appearance of the limbs, the prevalence and characteristics (severity, density) of edema, color, temperature, the presence of pulsation, and other parameters.
- Ultrasound . It is prescribed for patients with diseases of blood vessels, kidneys, heart, organs of internal secretion. Sometimes it is carried out with purulent processes, hematomas. Detects violations of blood flow and lymph flow, signs of inflammatory and structural changes in soft tissues.
- Radiography . It is used for injuries, articular pathologies, osteomyelitis. Detects fractures, dislocations, signs of inflammation and degeneration, areas of bone destruction. Contrasting, less often - native studies are sometimes prescribed for diseases of the internal organs.
- Other Imaging Techniques . At the final stage of diagnosis, to clarify the data obtained during ultrasound and radiography, according to indications, CT or MRI is performed. Methods are used for somatic and endocrine pathologies, injuries, joint diseases.
- Laboratory tests . The laboratory examination plan is determined by the nature of the disease, may include determining the severity of inflammation, the presence of hypoproteinemia, impaired renal function, markers of cardiac and rheumatic diseases.
Lymphatic drainage foot massage
Treatment
Help at the prehospital stage
The load needs to be reduced. To reduce swelling, it is recommended to give the legs an elevated position. In case of injuries, you need to fix the limb with a splint, apply an ice pack or a heating pad with cold water, and give an analgesic. With arthrosis and arthritis, local anti-inflammatory drugs are effective. Suspicion of a somatic cause of swelling of the legs, the presence of intoxication syndrome, severe pain should be considered as a basis for an urgent visit to the doctor.
Conservative therapy
The tactics of conservative treatment is determined by the cause of the symptom:
- Diseases of the kidneys . A high-calorie salt-free or low-salt diet is prescribed. Etiopathogenetic and symptomatic therapy is carried out, which may include antibacterial agents, immunosuppressants, diuretics, antihypertensive drugs. According to the indications, hemodialysis is performed.
- Pathology of the heart . Easily digestible fortified food is recommended. Cardiac glycosides, ATP inhibitors, nitrates, vasodilators, diuretics, anticoagulants, B-blockers are used.
- Vascular diseases . Phlebotropic medicines, elastic compression, lymphatic drainage massage, pneumocompression are used.
- Diseases of the joints . NSAIDs are shown in the form of tablet forms, injections, and topical agents. Physiotherapy, physiotherapy exercises, massage are carried out.
- Injuries . Fractures are repositioned, dislocations are reduced, plaster casts or skeletal traction are applied. Analgesics, physiotherapy, massage, exercise therapy are prescribed.
- Local infectious processes . Conservative therapy is carried out in conjunction with surgical measures, involves the use of antibiotics and analgesics.
Surgery
In diseases accompanied by swelling of the legs, the following operations are performed:
- Kidney disease : kidney transplant.
- Cardiovascular pathologies : pericardectomy, interventions on septa, valves and chambers for heart defects, implantation of a pacemaker, radiofrequency ablation.
- Vascular diseases : sclerotherapy, microsclerotherapy, various options for phlebectomy, radiofrequency ablation, laser coagulation of varicose veins, thrombectomy, regional thrombolysis, vein bypass surgery, tunneling, lymphovenous bypass.
- Joint diseases : arthrodesis, arthroplasty, arthroplasty.
- Traumatic injuries : open osteosynthesis, opening of hematomas, open and arthroscopic options for ligament plasty, meniscectomy.
- Purulent processes : opening of phlegmon, abscesses, carbuncles, boils, sequestrectomy, arthrotomy.
In the postoperative period, dressings are performed, analgesics and antibiotics are prescribed, and complex restorative measures are taken.