The common causes of leg edema are Chronic Venous Insufficiency (veins with poorly functioning valves). However, other causes such as Lipedema (swelling associated with obesity and deposition of fat under the skin), Lymphedema (associated with blockage or insufficient lymph node channels) and Dependency Edema (due to immobility and standing or sitting for long hours) are next in frequency, in healthy patients (i.e. without heart failure, liver failure, kidney failure, low protein in plasma, low thyroid hormone, rheumatoid arthritis and post vascular surgery, congenital lymphedema and vascular malformation).
Other causes of chronic leg swelling are drugs, such as high blood pressure medications like Hydralazine, Nifedipine and Methyldopa; anti-inflammatory medication, Phenylbutzaone and hormones such as Estrogen and Progesterone; allergy disorders and hereditary conditions such as angioedema and congenital malformation of the vessels.
Temporary leg swelling can occur after trauma, snake or insect bites, infection, inflammation and collection of clot in the tissues (hematoma).
Blockage of lymphatics or veins by tumor or cancer or clots can cause progressive leg or arm swelling. Surgery in the groin and pelvis can reduce the lymphatic cannels resulting in swelling of the limbs.
The venous blood in the lower extremity is pumped up towards the heart by muscles of the calf (musculovenous pump) during walking or exercise. The valves in the veins determine the direction of the flow toward the heart against the force of gravity. If the valves become stretched, they become two-way valves, which will result in the distention of the veins, and subsequently, swelling of legs and feet. This condition can be diagnosed by physical examination and venous Doppler ultrasound, which detects the malfunction of the valves. There are effective treatments available today by laser ablation or other modalities that can divert the blood to the healthy veins.
-Hormoze A. Goudarzi, MD