Are You Suffering from Leg-Swelling?

Are your legs or feet swollen persistently, or swelling in the leg appears at the fag end of the day after office hours? Or did you have an episode of sudden appearance of swelling in one or both legs a few months or a few years back, but you find swelling reduced though, but still persisting. Do you suffer from recurrent swelling in leg as well as difficulty in walking and get tired early? Do you develop breathing problem while walking with a swollen leg? Have your swollen leg recently developed red or blue patches on its skin surface, or eczema or ulcer? If yes, please do not sit idle and consult immediately a vascular or a cardiovascular surgeon.

Why Does a Leg Swelling Appear?

There can be several reasons of a leg swelling. The problem of Chronic Venous Insufficiency (C.V.L) tops the list of causes of leg swelling. In this disease, the mechanism of carrying back of desaturated blood with a very low content of oxygen from legs to lung gets slowed and deranged. This leads to an accumulation of deoxygenated blood into the leg and feet. This becomes an important cause of a leg swelling. In today's modern world, this problem is rampant. Due to lack of habit of a daily walk, majority of young males and females are falling victim to this disease. With a steady emergence of new vocations every month, this problem of CVI too is catching up. An uninterrupted prolonged sitting hours from morning till evening in offices of various multinational and other private organizations is the root cause of this problem.

Blockade of Leg Veins Contribute to Leg Swelling

The second important cause of leg swelling is a disease of vein called Post Thrombotic Syndrome (PTS), where in old blood clots are permanently stationed inside the vein and thus affect the drainage system of legs. This leads to stagnation of impure blood inside the legs and feet, because free and continuous flow of blood inside the vein fail to sustain. This heralds the opening of a Pandora's box of problem in the leg one after the other in succession. Therefore, patient suffering from such problem must consult without fail a vascular or a cardiovascular surgeon and start treatment under his guidance.

Blockade of Lymphatic Channels of Leg Plays a Major Role

The third commonest cause of a leg swelling in our country is a medical condition called Lymphedema. The existing lymphatic channel of the leg may get blocked due to infection, or an old injury or a cancer. Sometimes, legs and feet develop swelling after a surgery on thigh or abdomen and sometimes after radiotherapy. In our country the most common cause of infection in the lymphatic channels are first due to filaria and secondly from bacteria called streptococci. Our body has two types of liquids; one is the blood and another lymph, which is full of proteins. For a proper circulation of blood, two channels namely arteries and vein are required, but for a normal lymphatic flow in the human body, lymph channels play an important role. While blood acts as a medium for oxygen supply to legs likewise lymph regularly keeps on taking out excess water from the leg and protect them from infection spreading upwards. When due to any condition, the channels carrying lymph develop blockade, this results into an accumulation of lymph into the legs and feet and thus leads to swelling in feet which becomes deformed in a due course of times, if a prompt and an effective treatment is not initiated in time.

Certain Medicines Too are Responsible for Lea Swelling

Besides these three important causes, there are other reasons of a leg swelling too, like a disease of kidney or heart or a lack of adequate proteins in the body. The peculiarity of leg swelling in such condition is that the swelling occurs in both the legs in contrast to a single leg. Sometimes, myxedema, a disease of thyroid happens to be the cause of leg swelling. At times, swelling in leg appears after use of some medicines. Drugs used for controlling blood pressure like Nifedepin and Methyldopa, hormones (estrogen or progesterone preparation), medicines meant for inflammation (phenyl butanone) and those used in mental diseases (like M.A.O.) contribute to leg swelling.

Where to Go If You Have a Leg Swelling?

For a detailed study of a leg swelling, one requires a battery of some latest investigations like Doppler study, plethysmography, lymph scintigraphy, venography, pedal lymphangiography and ventilation perfusion scan. Always one should go to a hospital, where facilities for all these modern investigations are available. Make sure before entering any hospital whether availability of a full time vascular or a cardiovascular surgeon is there or not. Sometimes other investigations like echocardiogram, CT of leg, MRI of protuberant bulky masses over the thigh, is required to establish the cause of leg swelling.

With the help of these investigations, an attempt is made to ascertain the real cause of leg swelling. How far and how severe are the blockades in veins or lymphatic channel, have to be assessed. On the basis of the result of these investigations, a correct strategy for treatment is established.

Treatment Options in a Case of Leg Swelling

In majority of the cases of leg swelling, operation is not required. Initially some specific non-surgical treatment including medicines. special exercises and use of intermittent pneumatic compression are tried to control the swelling. Sometimes special surgical procedures such as venous bypass surgery, debulking operation, lymphatic channel surgery (lymphovenous anastomosis or lymphatic grafting), and omental transposition and lymph node transplantation are employed. In this operation, the area of obstruction is bypassed and free flow of deoxygenated blood and lymph is restored to a greater extent.

What Precaution to Be Taken In Case of a Leg Swelling?

  1. Avoid postures or occupations that involve prolonged standing or prolonged sitting because this will aggravate the resistance to easy venous return as well as lymph from the leg.
  2. Avoid excess weight and obesity. Shedding excess kilograms takes unnecessary pressure off your drainage system of leg. Keep an eye on your legs. Fibrous and low calorie diet is essential.
  3. Avoid jogging; skipping, aerobics and other exercise, which involve repeated impact on knee joint, can do more harm than good. Gentle stretching exercises are helpful.
  4. Avoid tight clothing around your waist. These tight clothing will restrict circulation.
  5. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for veins.
  6. Leg Elevation is very beneficial. In an informal place or while watching television at home, keep your legs elevated. Keep the foot of your bed elevated by between 6-12 inches. It will facilitate drainage of legs at night.
  7. Do daily morning walk for at least 6-8 km with leg stockings. Remember no walking without wearing stockings. Walking without stockings does aggravate the problem rather than solving it. Walking is the best exercise for you, as it will encourage blood circulation in your legs.
  8. Do yogic exercise involving postures where legs remain elevated for a few minutes are helpful. Do resting with the legs higher than the head for at least 10 minutes everyday in your workplace will help both long-term and also decrease any immediate discomfort. Lying either on a slant board or on the floor with the legs and feet supported by a chair for a few minutes will be helpful.
  9. Do wear graduated compression stockings daily from the time you get out of bed until you retire at night. Stockings promote circulation and help limit gravity's downward pull and thus prevent syndrome leg swelling. Proper fitting of stockings is essential. Never forget to wear these special stocking while driving, during journey in a bus/ train or in a plane

If at any stage, you develop ulcer or eczema on your swollen legs, consult immediately your vascular/cardio-vascular surgeion.

Submitted By
Dr. K. K. Pandey

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