If you're unsure whether your legs are swollen, press your finger on the top of your foot or lower calf for a few seconds and see if you leave a small indentation
Are your legs ever so swollen that you cannot get your shoes on? It just so happens that one in three people have at some time experienced leg swelling, also known as pedal edema, the accumulation of extra fluid beneath the skin. Why the feet you may ask? Gravity! In fact, people with leg swelling due to excess fluid tend to wake up in the morning excited that their legs are now beautiful and slender, unaware that while lying in bed all night, all of that fluid has redistributed throughout their bodies, again due to gravity.
Why Your Legs Might Be Swollen
For those of you who are unsure whether your legs are swollen, press and hold your finger on the top of your foot or lower calf for a few seconds. Then see if you have left a small indentation (don't worry, you are not becoming the Pillsbury Doughboy). Admittedly, discovering that your legs are swollen can be very scary; however, most of the time it is just a souvenir of that salty binge you had in the days prior, along with a common condition called chronic venous insufficiency, when the veins in your legs are damaged and don't propel the fluid back up toward the heart. Besides age, other risk factors for developing chronic venous insufficiency include having a family history (does anyone in your family have swollen legs or varicose veins that are swollen and visible under the skin?), standing for long periods of time, being overweight, smoking, prior injury to the leg or being pregnant.
Interestingly, walking around or flexing your legs causes the muscles in your legs to contract, which in turn pushes blood back toward your heart. Therefore, inactivity such as standing or sitting for prolonged periods of time can result in leg swelling. Perhaps everyone should start taking breaks every hour for just 5 minutes to walk around. For those of you who enjoy the moniker "couch potato," try elevating your legs, preferably above the level of your heart (although that may look a bit awkward if you share a workspace).
What to Do About Leg Swelling
So what should you do to avoid leg swelling besides cutting back on those salty potato chips (darn!) and wearing compression stockings? If your symptoms persist or frequently recur, you should schedule an appointment with your doctor, who may evaluate you for chronic venous insufficiency and accordingly prescribe a low dose of a diuretic or a treatment called intermittent pneumatic compression pump. Of note, leg swelling can also result from several medications including some blood pressure medications (calcium channel blockers, hydralazine, minoxidil and methyl dopa) as well as prednisone and the anti-inflammatory pain medications called NSAIDS (ibuprofen, naproxen, diclofenac, indomethacin and celecoxib). In addition, hormone treatments such as estrogen, progesterone and testosterone can also cause leg swelling. Please do not stop any prescription medications without first speaking to your physician.
Also, many women experience weight gain and leg swelling several days prior to their period, and that resolves quickly. Make sure you inform your gynecologist about these symptoms.
When to Be Concerned
Should leg swelling ever cause you to panic? YES! In fact, the sudden onset of leg swelling, especially if associated with pain, can be very concerning for having a clot in your leg requiring emergent attention, particularly when the swelling only occurs in one leg and especially after prolonged immobilization, either due to a long car/plane ride or from wearing a cast for a broken bone. People on oral contraceptives are also at risk for developing leg clots, especially if they also smoke. As the clot can break off and travel to your lungs, causing a life-threatening condition called a pulmonary embolism, getting to an emergency room for an ultrasound to rule out a clot is CRUCIAL. And starting blood thinners promptly if you do have a clot can save your life. You should also haul yourself over to the emergency room if one of your legs is red, warm or painful, as you may either have a skin infection known as cellulitis or have unknowingly sustained an injury to the area. For those of you who are also experiencing shortness of breath, particularly when lying down, or are noticing that your abdomen also seems swollen, it is critical you seek emergent attention, as your symptoms may be the result of generalized fluid overload due to heart, liver or kidney failure.
What About Leg Cramps?
Tangentially, for the one in two of you experiencing leg cramping, sometimes waking you up at night, that improves after getting out of bed and walking around, try stretching or taking a hot bath prior to going to sleep. If that doesn't resolve the leg cramps, drinking a sip of tonic water before bed may help, as tonic water contains the chemical quinine that can prevent cramps; however, as quinine can also cause headache, nausea, ringing in your ears, abnormal heart rhythms and bleeding (do I sound like one of those commercials telling you the horrid risks while gentle music plays in the background?), be sure to speak to your doctor first.
By Dr. Marc Eisenberg
Dr. Marc Sabin Eisenberg, M.D., F.A.C.C. is an associate professor of medicine at Columbia University Medical Center. He is co-author of the book "Am I Dying?!: A Complete Guide to Your Symptoms and What to Do Next" and co-host of the "Am I Dying?!" podcast, which provides light-hearted advice for the hypochondriac in all of us. He writes the bi-weekly column "Rounds With Dr. E" for DoctorOz.com.