Swelling in the lower legs – known as “lower extremity edema” in medical terms – is a problem that often affects older adults.
The good news is that most of the time, it’s annoying, but not terribly dangerous. However, in other cases, swelling in the feet, ankles, or lower legs can be the sign of a new health problem, or a worsening chronic condition.
And, even if it’s “benign” and not related to a dangerous health condition, edema can be a major risk factor for skin breakdown and reduced mobility in aging adults.
Since leg swelling becomes so common as people get older, in this article we’ll demystify leg edema and cover the most important things that older adults and families should know about this condition. In particular, we’ll cover:
- How does edema happen?
- Common causes of swollen ankles or legs in aging adults
- Medications that can cause leg swelling as a side-effect
- How leg swelling should be medically evaluated
- How to prevent and treat leg swelling
- What to know BEFORE going on a “water pill”
How does edema happen?
We notice edema when our shoes are too tight, or we get marks on our ankles from our socks. But what’s really going on inside the body?
Edema happens when fluid moves outside of blood vessels and into what’s called the interstitial spaces of the body. These spaces are also sometimes called the extra-vascular space (which literally just means “outside of blood vessels”), and is basically the moist space between cells, organs, and body parts.
Although you make think of blood vessels as being “waterproof”, physically they are more like a semi-permeable membrane, made of blood vessel cells that usually stay close together, and it’s normal for small quantities of fluid to pass back and forth.
If more fluid than usual passes out of the blood vessels, and this happens in the legs or near the surface of the body, it looks like a swollen or puffy area under the skin.
Fluid can move into the interstitial spaces and cause edema for a few different reasons. The most common causes are
- “Leaky” blood vessels: Sometimes the blood vessel cells don’t stick together as tightly as they should. This can allow fluid molecules to slip through the connections between the blood vessel cells (like gaps between the bricks in a wall).
- This can happen due to severe infection or inflammation, among other things.
- Low levels of protein in the blood: Proteins, such as albumin, help keep fluid inside blood vessels. This is because protein molecules in the blood exert an “osmotic” pressure (also called “oncotic pressure”) that helps retain fluid inside a blood vessel. If protein levels fall in the blood vessel, even if the membrane of the blood vessel is intact, fluid moves outside of the vein or artery to equalize the osmotic pressure across the membrane, and this creates edema.
- Some causes of low albumin levels in the blood include certain types of kidney disease, liver disease, and malnutrition.
- Fluid overload: If there’s more fluid than usual in the blood vessel, it becomes “overloaded.” The extra fluid will be then end up pushed across the blood vessel wall because of high hydrostatic pressures.
Normally, our kidneys regulate body fluid levels by adjusting the amount of water and salt that is excreted or retained. But if those mechanisms fail or are overwhelmed, edema is often the result.
When we look at common causes of edema, keep these different mechanisms in mind. The cause of the edema will play a major role in deciding on the best course of treatment.
What are the most common causes of leg edema
By far, the most common cause of leg edema is chronic venous insufficiency, but there are some other causes that are critical to rule out.
Chronic venous insufficiency
This is the cause in about 70% of older adults with leg edema. To understand chronic venous insufficiency (CVI), we first need to cover how veins work.
Veins are the blood vessels that return blood to the heart so that it can be pumped to the lungs and get oxygenated. Veins don’t have muscles in their linings like arteries do; instead, they rely on a system of valves to keep blood from flowing backwards. Over time, these valves become less effective, and blood can hang around in the veins longer than it needs to – a phenomenon called venous insufficiency.
When venous insufficiency becomes chronic, this can cause varicose veins and/or edema, due to there being extra fluid in the veins. Venous insufficiency can also end up causing phlebitis (inflammation of the veins), ulceration of the skin (sores and wounds) and even sometimes cellulitis (skin infections).
CVI is common, affecting an estimated 7 million people worldwide and causing 3 million to develop venous ulcers, the most common type of leg ulcers. The cost of venous ulcers to the US healthcare system is estimated at 2 to 3 billion dollars a year.
Risk factors for CVI include:
- Advancing age
- Family history
- Prolonged standing
- Obesity
- Smoking
- Sedentary lifestyle
- Lower extremity trauma
- Prior venous thrombosis (blood clots in the veins)
In the section on treatment, I’ll explain how to manage edema due to CVI and share tips on reducing the risk of complications. Keep in mind that leg swelling is something that people live with on a chronic basis and is rarely completely cured. The goals of a treatment plan are to reduce the edema, prevent the discoloration and thinning of the skin, and prevent or heal skin sores.
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) is the most common cause of generalized edema (affecting the legs, abdomen, and sometimes the lower back and even higher on the body), and a major cause of edema of the legs.
Heart failure is a term that we use when the heart muscle is weakened and not pumping blood as effectively as it should. Heart failure is often described as being “right-sided” or “left-sided” depending on which chamber of the heart is most affected. The “congestive” part refers to the backflow of blood into the veins in the lungs (if it’s “left-sided”) or the legs or lower part of the body (if right-sided”). Some people have right-and left-sided heart failure.
In CHF, there’s fluid congestion in the veins, but that’s not the whole story. When CHF is chronic, lasting more than a few weeks, it reduces blood flow to the kidneys, and they respond by causing the retention of salt and fluid in the body. This is an especially important factor when treating the edema associated with CHF.
In CHF, the edema in the lungs, or pulmonary edema, can be much more difficult to live with; it usually causes shortness of breath, coughing, and breathlessness when lying flat to sleep.
CHF treatment frequently involves diuretic medications (also known as “water pills” to relieve symptoms. Some commonly used diuretics used for CHF include furosemide, spironolactone and metalazone. The dosing of diuretics often must be managed carefully to minimize the potential side effects of low blood pressure, potassium depletion, dehydration, and kidney injury.
People living with CHF are usually advised to restrict their daily fluid and salt intake, weigh themselves frequently, and adjust the daily water pill dose depending on their weight, along with regular bloodwork.
In this article, we won’t go into more detail about CHF, as it’s a complicated topic of its own. The main thing you should know is that if you’ve been concerned about leg swelling in an older person, it’s important to find out if they have a history of heart failure or heart problems, especially if they are also reporting symptoms of shortness of breath.
Medication-related leg edema
Some medications can cause or worsen swollen legs. or make them worse. In most cases, the drugs increase fluid and salt retention, causing edema, but for some drugs, such as dihydropyridine calcium channel blockers (like amlodipine) the capillaries become leakier, and in other cases, the exact mechanism for edema isn’t known. Below is a list of medications that may cause edema.
- Antihypertensive drugs
- Calcium channel blockers
- Beta blockers
- Clonidine
- Hydralazine
- Minoxidil
- Methyldopa
- Hormones
- Corticosteroids
- Estrogen
- Progesterone
- Testosterone
- Other
- Nonsteroidal anti-inflammatory drugs (including over-the-counter painkillers)
- Pioglitazone
- Rosiglitazone
- Monoamine oxidase inhibitors
New or worsened leg swelling should always prompt a medical evaluation, to make sure the swelling isn’t due to a medication side-effect. (To learn more about medications to avoid in aging adults, read this article: Medications Older Adults Should Avoid or Use with Caution).
Liver disease
In cirrhosis of the liver, edema may occur in the lower limbs or, more commonly, localized to the belly (called ascites). The liver is where the body makes albumin, a major component of protein in the blood, but in cirrhosis, the damaged liver can no longer maintain adequate production of albumin and other key proteins. The resulting lower blood protein levels mean that fluid will leak out into the interstitial spaces, which can cause edema and also noticeable swelling of the belly.
Diuretics can be used to help people with cirrhosis, and sometimes drainage of the abdominal ascites is performed, with careful management of blood pressure and electrolyte balance.
Kidney disease
A kidney condition called nephrotic syndrome is associated with protein leaking out into the urine. This can cause edema in the legs and elsewhere in the body.
A urine dipstick normally checks for protein in the urine, and a more precise check can be done through a urinalysis.
Lymphedema
Although most fluid in the body moves through blood vessels, the body also has a network of lymphatic vessels, which connect to lymph nodes and move fluid and immune system cells through the body.
Lymphedema means edema caused by fluid overload in the lymphatic vessels, not the veins. When there’s too much fluid for the lymph system to drain, or not enough capacity in the lymphatic channels, swelling is the result.
Lymphedema is most often associated with a history of cancer and/or lymph node surgery, and usually affects one limb, rather than both. Seventy percent of prostate and breast cancer survivors experience lymphedema as do 80% of those with severe obesity.
This type of edema is treated by elevating the limb as much as possible, the use of compression garments, a special kind of decongestive massage, or microsurgery to enhance the lymphatic system. Of note, treatment with diuretics (“water pills”) is not usually effective.
How Leg Swelling is Medically Evaluated
What to Tell Your Doctor About Leg Swelling
If you’ve noticed new or worsening leg swelling, it’s important to let your health provider know, so that you can be evaluated.
The doctor should check to make sure that you aren’t suffering from a potentially serious problem (such as one involving the heart, kidney, or liver), and will generally try to determine what is causing the leg swelling.
Questions the doctor will probably ask include:
- How long has the edema been there?
- Is it affecting both legs equally, or one more than the other?
- Is it painful? (Venous edema can cause aches, lymphedema is painless)
- What medications are being taken? Any recent changes?
- Does it get better overnight? Or with elevation of the legs?
- Any shortness of breath? Any difficulty lying flat?
Of course, they will also want to take a complete health history, to know whether you’ve ever had cancer, radiation or surgery to your pelvis or legs, and any known heart, liver or kidney problems.
Signs that more urgent evaluation of leg swelling may be needed
Certain signs and symptoms should prompt a more urgent evaluation. They include:
- Breathing symptoms: Shortness of breath, cough, and trouble breathing when lying flat might be indicators of pulmonary edema, from CHF or another cause. If a person has these symptoms along with leg swelling, they should seek medical attention right away.
- Swelling on one side only: Most of the causes of swelling described above will cause both legs to be affected, so if only one leg is swollen, it might be caused by:
- A blood clot, which usually does limited harm in the leg but could break off and travel to the lung causing severe illness or even death,
- Infection
- Blockage related to a tumor
(Of course, if a person has previously had a blood clot or injury to one leg, it may appear quite different from the other leg and the swelling might be chronically asymmetric, so that needs to be considered as well.)
- Pain: Most of the time, edema due to CVI is painless, although some people experience discomfort similar to an achy tiredness. Severe or significant pain should not be ignored. In particular, a sudden severe pain in the legs or the chest is a reason to seek help without hesitation.
What Your Doctor Will Do
Your doctor will check for “pitting,” by gently pressing on the swollen area. Pitting occurs when pressure to the swollen area leaves a little depression behind for a few seconds to minutes. Most causes of edema are pitting, but if there’s no pitting we would think about lymphedema or a fat deposit (lipedema).
A close examination of the legs is vital, to check for any varicose veins, discoloration of the skin, ulcers or breaks in the skin, and skin dryness. If the legs seem to be different from each other in size, your doctor might measure both limbs to see if there’s true asymmetry.
It’s also important to do an examination of the heart and lungs. Expect your doctor to listen to the breath sounds and heart sounds, and to check your pulse and blood pressure. Doctors will also often examine the belly, to feel the liver and also make sure they don’t see signs of edema outside the legs.
Potential Tests and Additional Evaluation
Based on what you tell the doctor, your past medical history, and what the doctor observes through the physical examination, the doctor will then determine whether additional testing is needed.
Tests that may be ordered include urinalysis (to look for protein in the urine), creatinine (a test of kidney function), TSH (some thyroid conditions lead to edema), glucose, albumin (a major protein found in the blood) and liver function tests may be ordered. (For more on blood tests, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.)
Tests of cardiac function may be a part of the work-up as well, such as a chest x-ray to look for an enlarged heart or fluid in the lungs, or an echocardiogram, which is an ultrasound study to look at the heart chambers and muscle contractility.
D-dimer is a blood test that can help detect a blood clot, and a doppler ultrasound of the leg can usually find a deep vein thrombosis – a common cause of swelling in one leg only.
If your doctor is looking for deeper causes to explain leg swelling, they may refer you for a sleep study. Sleep apnea, if left untreated, can lead to the right-sided heart failure that we mentioned earlier.
It’s also possible that your doctor might not feel the need to order additional testing. Especially if bloodwork has been done in the past few months and if the symptoms and examination fit with chronic venous insufficiency, it can be reasonable for the doctor to proceed with treatment for this condition.
How Leg Swelling is Treated
As I noted above: most of the time, leg swelling in an older adult is caused by chronic venous insufficiency (CVI), an issue with the leg veins not doing an adequate job to return blood to the heart.
What to know BEFORE starting a “water pill” for leg or ankle swelling
You might think that a diuretic (a “water pill”) will help, and they certainly are often prescribed for this purpose. However, research has shown that they often don’t help much, probably because they don’t really address the underlying issue, which is weak valves in the veins and local fluid overload.
Furthermore, diuretics in older adults can easily cause side effects like dehydration low blood pressure, low potassium levels, and constipation. They also increase urination, which can cause or worsen urinary continence issues. (For more on these issues, see How to Prevent and Treat Dehydration in Aging Adults and Urinary Incontinence in Aging.)
How to treat chronic venous insufficiency in aging adults
So before starting a water pill, be sure to ask your doctor about the cause of your leg swelling and consider trying these strategies first:
- Elevate the legs: raise your legs to at least the level of your heart for 30 minutes 3 or four times a day – this habit uses gravity to help the veins drain the blood from the lower limbs to return to the heart for circulation.
- Wear stockings: compression stockings with a low pressure (15-20 mmHg of pressure) are readily available at many drug stores and are not too difficult to put on and wear. The stockings have higher pressure at the ankle which gradually reduces the higher up the leg it goes. Those with more moderate to severe edema may need to be specially measured and fitted for compression socks, which may require a prescription.
- Reduce salt intake: salt (aka sodium) can worsen edema by promoting fluid retention. Lowering salt intake can also reduce the risk of high blood pressure. Hide the saltshaker and avoid processed food and takeout.
- Exercise the calf muscles: walking and pumping your calves is recommended to reduce the symptoms of CVI and speed the healing of ulcers if present.
Other treatment options for chronic venous insufficiency
- Venoactive agents: these are compounds that act in a variety of ways to relieve CVI symptoms. They improve venous tone, improve lymphatic drainage, fight inflammation, and increase blood viscosity. Examples are horse chestnut seed extract, micronized purified flavonoid fraction (MPFF)and pycnogenol. A large review of scientific studies of venoactive agents showed that they can reduce swelling.
- Skin care: This may not help with edema but is a critical step to prevent ulcers (skin sores), which can occur as a complication of CVI.
- Ulcer care: ulcers on the legs and feet from CVI can be chronic and hard to treat. A specialized wound care team is often consulted to advise about any topical treatments or surgical procedures that can help with healing. All of the measures to reduce edema described above will help with ulcer prevention and healing.
Again, the goal of treatment is to manage symptoms and prevent other problems, like ulcers and discomfort. Most older adults can treat their leg swelling with some of the strategies described above and maintain their usual activities and quality of life.
Treatment of Leg Edema from Other Causes
If edema is not due to CVI, the treatment plan will target the underlying problem, whether it’s heart failure, a medication side effect, a kidney issue, or liver disease.
The Take-Home Messages about Leg Swelling:
Edema (or swelling) of the lower limbs is common in older adults. The most common cause (about 70%) of leg edema is due to Chronic Venous Insufficiency (CVI).
Other serious causes of edema include congestive heart failure, kidney disease, and liver disease. Always be sure to get evaluated for new or worsened leg swelling, to make sure one of these more serious medical problems isn’t at hand.
If the leg swelling is present in one leg only, or if there’s a lot of pain, or if you notice other serious symptoms along with the leg swelling (shortness of breath, chest pain, cough or trouble breathing when lying flat), this could be a sign of an urgent problem which needs medical attention right away.
But again, most leg swelling in aging adults is chronic venous insufficiency. The ideal management of this chronic condition includes “lifestyle” measures such as elevating the legs regularly, using compression stockings, reducing salt intake, and doing exercises which improve fluid movement in the legs.
It’s important to get help from your health providers to manage CVI, because without treatment, it can cause complications such as ulcers (skin sores), infections, and reductions in quality of life.
Diuretic medications (“water pills”) can sometimes help to reduce edema from CVI, but the side effects can be serious: dehydration, potassium depletion, urinary incontinence and low blood pressure. So geriatricians recommend using these medications with caution in older adults. They are also not a substitute for the lifestyle measures listed above.
To learn more about edema, here are some useful links:
- VIDEO: What Causes Swollen Legs with Dr. Didyk
- Treatment of edema (American Family Physician Review)
- Patient education: Low-sodium diet (Beyond the Basics) – UpToDate
- Patient education: Edema (swelling) (Beyond the Basics) – UpToDate
- Phlebotonics for venous insufficiency – Martinez-Zapata, MJ – 2020 | Cochrane Library
- Chronic Venous Insufficiency | Circulation (ahajournals.org)
If you have swollen legs, you’re not alone and there are strategies you can use, without medications, to reduce the symptoms of edema. Like everything, being consistent is key.
I’d love to hear about your experience with leg swelling and what you’ve found to be helpful, or any thoughts about topics for future blog articles. Please leave a comment below and join our mailing list so you won’t miss another article!
Dr. Nicole Didyk is a board-certified geriatrician in Canada and a regular expert contributor to Better Health While Aging. You can learn more from her by visiting her site TheWrinkle.ca, or her aging health channel on YouTube.
I have very puffy ankles that are worse on the inside of the leg and I cannot wear boots due to this as my ankles are sore if anything is against the leg or if I should press the swollen part of the leg there is no indentation when I press on the swollen part but they are so sore to the touch
I am 65 years old and my ankles have been like this for about 8 years but have got worse in the last 3 years I have never seen a doctor about it
It sounds like you’ve been living with puffy ankles for a while now, and it could be related to chronic venous insufficiency as described in the article. If that’s the case then sitting with your legs up at the level of your heart for 20-30 minutes a few times a day should help, and so should cutting back on salt and fluid intake.
It sounds like you’re experiencing some pain, and that is worth mentioning to your doctor, so they can make sure there isn’t a more serious issue. Usually, if a symptom has been going on for years, it’s unlikely we’re missing anything urgent, but there may be interventions that could make it better!
I am 78 and a Type 1 diabetic, taking lotensin , hydrocholorathyazied and metoprolol for high blood pressure. I do not have edema issues, but I have very small broken vessels pooled and located between the inner ankle bone and achilles tendon, visible just under the skin. How might that condition related to the topic you are addressing here, I wonder? Thanks!
Hi Linda. I wonder if you’re describing “spider veins”, also known as telangiectasia in medical terms. These are quite common, affecting about one-half to two-thirds of those with chronic venous insufficiency.
What happens is this: there’s some laxity in the valves of the veins in the legs, so blood tends to hang around longer in the lower extremities and create those expanded and more visible tiny veins. People who get spider veins may also be at risk for varicose veins.
By themselves, spider veins aren’t dangerous, but they may be a sign of chronic venous insufficiency, so elevating the legs and wearing compression socks might reduce their appearance.
Thank you Dr. Nicole Didyk for the highly informative article on leg swelling in aging. With English as a second language, I yet find it easy to understand your lucid writing style when addressing a rather complexed medical condition.
My wife, just turned 80’s, taking candesartan cilexetil, have been having swollen legs and ankles for weeks. A Chinese herbal medicine doctor took her pulses and found that she had a weakening chi in her heart and lungs. So she was given an acupuncture treatment on her legs and ankles, a balm to rub and massage her legs routinely, and instruction to often lift her legs up as high as possible while sitting.
Due to a recent worsening COVID-19 pandemic situation, the doctor had to close their clinic thereby preventing further treatments for my wife. So she decided she would see her family doctor soon.
What kind of clinical tests or measurements would you generally recommend for a patient like my wife? Any medication? Any additional advice?
Thank you so much for your time and attention. I certainly appreciate your kindly sharing such a valuable and informative article with us senior citizens.
Sincerely,
Don Yong
Hello Don and thanks for reading the article and letting me know that it was helpful and understandable! I’m so glad you’re being proactive about getting medical attention for your wife.
In older adults, the most common cause for leg swelling is a weakness in the valves of the leg veins, so that the blood returns more slowly to the heart and stays in the feet longer, causing some puffiness. But there can be a connection between swollen legs and the heart and lungs, so a doctor would want to start by learning all about a person’s medical history (any previous heart attacks, high blood pressure, or heart surgery), look at the legs and feet, and listen to the heart and lungs in a physical examination.
If the doctor thinks the swelling is all related to the leg veins, additional tests might not be needed, but if they want to get more information, they may order a chest x-ray, ultrasound of the legs, and some basic blood tests, like an albumin (protein) level. They may also suggest an echocardiogram (ultrasound of the heart) or an ultrasound of the legs, depending on what they learn from the history and physical examination.
Thanks again for sharing your kind comments about the article and I wish you good luck!
My mum is a cancer patient. It’s been 4 years since her cancer is gone and he removed her breast. She also has high blood pressure. She has swollen feet lately with no pain. She also often gets a cough and postnasal drip.
Well, the most common cause of painless leg swelling is chronic venous insufficiency, which is often a longstanding (chronic) problem. When there’s a cough, I think it would be important to rule out congestive heart failure, but this condition usually also causes shortness of breath and difficulty lying flat.
In a cancer survivor, lymphedema can be an issue. I made a short video about that which you can watch here: https://www.youtube.com/watch?v=0_O73jbVo38
Thank you for this article. My husband has recently developed swollen feet and lower legs. There are also red warm patches. He is 79 and on beta blockers and has a slightly enlarged aortic valve. In the past he has had varicose veins stripped and has lots of small bluish veins on his legs and ankles. He walks over 5 miles each day and has no discomfort so I am hoping that means it is not his heart. He had the Covid vaccine a couple of months ago when this issue was noticed. Any advice please as we cannot have a face to face discussion with the doctor during cover.
Hi Josie, and you’re welcome for the article, glad you liked it.
It’s good that your husband is still able to walk and is not having pain. When a patient tells me about warm, red patches it makes me think of inflammation or infection. There is a condition called thrombophlebitis, where the veins can get inflamed,. but it’s usually painful. Varicose veins and a prior vein stripping can be risk factors for thrombophlebitis. You can read more about it, here: https://www.mayoclinic.org/diseases-conditions/thrombophlebitis/symptoms-causes/syc-20354607
I know it’s hard to get access to a doctor face-to-face right now, but I would tell someone in your situation to seek an assessment with your primary care provider as soon as you can, even if it’s over video.
Thank you for the article. My mum is 88 and both legs are swollen and hard. Dr has done blood work and all came back ok except her thyroid, so he has increased her T4 dose back to 100 MCG. He lowered her dose 5 years ago which I think was a mistake. He has put her on two water tablets which do nothing. It is non pitting swelling, I think she has Myxoedema. She has every thyroid symptom. I also have hypothyroidism and misdiagnosed for 20 years. I have a genetic defect in DI02 gene which means I cannot convert T4 to T3. I paid for mum to be tested and await the results. I take combination therapy which I think mum needs. Problem is the NHS GP says he is not allowed to test Free T3 which is ridiculous. I think they just can’t be bothered because she is at the end of her life. Myxoedema does not always present with coma. I will have to pay for a private blood test. She may have some venous insufficiency but her feet and ankles have been swollen for ages before this. I doubt many doctors have ever seen a presentation of Myxoedema in their careers, but I know what I am looking at. Her legs look identical to a photograph of a woman’s legs in Myxoedema, identical. If it were not for the Covid19 situation I would take her to A & E and get an Endocrinologist to examine her.
What a great advocate you are for your mom, and I’m sorry you’re running into those challenges.
Genetic mutations in deiodinases can cause differences in thyroid hormone metabolism, but I wasn’t aware of this until you brought it up. It may not be something that a GP would be familiar with. Still, it must be so frustrating to not be able to get tests and consultations that could help.
I hope the thyroid replacement helps with the edema, and that you manage to get some answers for your mom. Thanks for sharing your story and stay well.
This all makes sense now. I just never knew what to search to find somewhat of an answer. I’ve been dealing with my feet and ankles swelling for over 10 yrs now. I’m in my mid 30s. If I stood to long while cooking, out walking around all day, or even sitting in a chair for long periods my ankles would swell. I’ve talked to a Dr. and it was passed off as a simple “oh it just happens”. Though it happens daily. In the mornings my ankles and feet would be “normal”, if so bad throughout I’d elevate them. So it’s glad to know that I’ve been doing something right. But I’d really like to get a handle on this besides put your feet up or go to bed.
Hi Erica and I’m glad that the article was helpful!
I usually see older people with ankle swelling. In my patients, venous insufficiency is a common cause of ankle swelling, and it gets better with elevation as you describe. This can happen in younger people too, but other causes could include medications, salt intake, or slower drainage of the lymph system.
This article about treatment of swollen legs suggests that exercise might help too: https://www.aafp.org/afp/2005/0601/p2111.html. I hope you get some answers and some relief!
Hi mam , my father age is 61 years.it’s right leg is swelling and pain.already he has arthritis problm addnd he tske alcohol day by day and smoking also .so please advice any treatment
We can’t give medical advice over the internet, but when I see someone with only one swollen leg, I do worry about infection or a blood clot. Treatment of those conditions would need a doctor’s input, so it’s important that they be seen and have the correct diagnosis.
Thank you so much for the article. I wonder if lymphatic massage would help to reduce swelling? I ask this as the caregiver for my 84 Type 2 diabetic Mother. She takes a blood thinner, water pills and a couple of others. Do you believe that a massage could help?
That’s a good question.
Lymphatic massage is a gentle massage technique aimed at reducing swelling from lymphedema (caused by a blockage of lymph flow). Edema that’s not caused by lymphedema might not respond to this approach, although some people have a mixture of edema due to venous insufficiency and lymph-related causes.
I found this article about whether massage helps with quality of life (an important outcome to look at in older adults, I think). The study was inconclusive, so based on the current evidence, it’s up to you about whether this would be a good use of your resources and time. If it’s something you could learn to do at home, it may be worth a shot.
My 86 year old father is suffering with swelling of his ankles but worse in the left. This is clearly affecting his walking but how much is down to his shoes being tight I cannot say. A 2018 he was diagnosed with Stage 4 Lymphoma (non Hodgkins)- he was very poorly and underwent chemotherapy which was successful, thank goodness. He thinks the swelling is due to the chemotherapy but I am concerned it is something else. I have tried to persuade him to walk more but he is not convinced it will help. He also has an enlarged prostate for which he takes Tamsulosin & Finasteride. Both conditions are monitored but with Covid this is currently a blood test then a telephone consultation.
Having read your article I feel that this needs further investigation, would you agree?
Hi Lesley and thanks for sharing your dad’s story.
Swelling in only one leg does make me think about infection or a blood clot and these conditions usually come on suddenly and are associated with warmth, pain and redness. If a person has a history of lymphoma, there’s a possibility of swelling due to reduced lymphatic drainage, such as if there’s a swollen lymph node, or a tumour-related infiltration of a lymph node.
An ultrasound of the legs is a test that can fairly reliably rule out a blood clot, and ultrasound of the pelvic area could determine if there’s an issue in the pelvic lymph nodes. This is something I would consider in a situation like the one you describe. It’s a challenge to get tests done during COVID, but I hope you can work with your dad’s health care team to get things sorted out.
Hi, I am 70, and throughout this pandemic, I have been very uncomfortable about going out much, so I am not nearly as mobile as I used to be and sit a lot more than I have done in the past. I do spend a lot more time doing genealogical work on my computer, and find I lose track of the time, so it often turns into several hours.
I have begun to notice that my both my legs and feet are swelling in the evening. It seems to be relived by going to bed and sleeping. It is gone in the morning. It seems much worse in hot weather, which we are now experiencing.
I’m not used to this at all and it is quite disturbing. Should I be considering some of those compression socks?
Hi Janine and thanks for taking the time to comment. I’m sorry to hear that you’re noticing ankle swelling, and it could be a symptom of chronic venous insufficiency, which is more noticeable after sitting or standing for a long time (positions where the legs are “dependent” or hanging down).
For someone in your situation, I would recommend exercising the legs regularly (like walking or doing some light weights and stretches), elevating them a few times a day, and trying compression socks for times when there’s going to be prolonged standing or sitting. The lower pressure socks can be purchased at most pharmacies.
I would also try to be careful with salt intake and review any medications that are being taken (like ibuprofen or amlodipine, for example). I hope that helps and that you’re back to an active lifestyle soon.
My Mother In Law has been experiencing swelling in both legs & ankle for about 3 Months now. Two days ago she suddenly cannot walk. She has taken 7 falls thus far. She refuses to go to the Hospital what do I do?
Hi Lynette and this sounds very concerning. From your story, it’s not clear that the leg swelling and falls are related, but 7 falls in 2 days likely signifies that something is going on. When someone refuses to go to hospital, it’s a dilemma for sure. Sometimes I’ve had family members call an ambulance and let the paramedics decide if a hospital trip is needed. This can take the decision out of the family member’s hands and is sometimes more acceptable for the older person.
There can be some serious causes for leg swelling and decreased walking, such as kidney disease and heart failure, that require a prompt medical assessment. I hope your mom gets some help soon.
Thank you greatly for the details you provided.
I’m 63 yrs old (female) and 6 weeks ago I had a “complicated” spine surgery (7 hour on operating table under anasthesia. I believe it was a successful surgery and I had to have it done for 3 serious spine diseases (stenosis caused stage one “Cauda Equina”
That was the beginning of non-stop edema in typical areas, lower leg, ankles and feet. Equally swollen on each side.
Since, I have had recurring cystitus and now kidney infection which causes general malaise, lack of energy.
Night is awful, burning, itching and redness keeps me awake. 100 grams of protein in urine. Dr. prescribed anti-bio and acts as if no big deal. No breathing symptons or nausea.
I think my phys. should wake up and take note. He acts as if I’m overreacting and read med info online.
Isn’t 100 grams of protein in urine analysis a somewhat “big deal”?
THANK YOU AGAIN AND AGAIN
I’m so glad that you found the article to be helpful and congratulations on your surgery! That sounds like a big operation and I wish you a full recovery.
100 grams of protein in the urine would be shockingly elevated, but 100 MILIGRAMS would be high (normal is less than 20 mg per day). A kidney infection could definitely cause protein to appear in the urine, but it should get better when the infection is treated, so this is something to follow up on for sure. You can read more about proteinuria (protein in the urine) here:https://www.mayoclinic.org/symptoms/protein-in-urine/basics/causes/sym-20050656 A repeat urine test if the symptoms don’t abate with the antibiotics is a good next step.
I’m sorry for the frustrating experience and I hope that you get relief soon, and can get on with rehabilitation and getting back to your regular routine.
Hi, I am 75 and my ankles are slowly getting puffier. Both sides affected but more so on my right side. I have a dog, so I walk a bit every day. The summer heat makes the situation worse. I am overweight with most of the excess weight on my belly. Every small meal makes me look 8 months pregnant. I take synthroid but little else, am usually a healthy person. Using Alcohol sparingly and trying the keto diet for weightloss, but little success so far. (Need to lose 30 lbs). Have only had brief telephone consultations with my doctor since COVID. When mentioning this problem briefly in the past, she just giggled and said that this what happens when we get older. Should I insist on further ivestigation?
It sounds like you have some very healthy habits like daily exercise and moderate alcohol use, so I would encourage you to keep those habits up!
Ankle swelling might be more common with older age but it can be annoying if you’re the one experiencing it, and I don’t think it should be ignored, especially if it’s associated with abdominal bloating. Causes of puffiness can include underactive thyroid function, and sometimes a longstanding thyroid hormone dose needs to be adjusted.
The most common cause of ankle swelling is chronic venous insufficiency, and that is often an ongoing issue, but elevating the feet and legs, avoiding salt, and trying compression stockings can help. I hope you get some more clarity and relief soon.
Hi my mom is been suffering for a months now with back shoulder pain and at night when she sleep her heart beat fast and swelling her both legs.. please suggest what will do.? Visited doctor but said it’s fine..
I’m not sure what to make of that cluster of symptoms and it must be frustrating to be told that you’re “fine” when you’re experiencing difficulty.
Persistence is often the key to getting help with medical issues, as well as documenting symptoms carefully, and sharing this information with your medical team. Don’t give up with seeking answers from your doctor. Good luck.
Thank you for your very informative article. My father is 96 years old and has had increased swelling of his legs and feet over the last week. In the last two days I have noticed clear fluid dripping out of a small hole in one of his thighs. Is this cause for an immediate trip to the doctor or is it common with swelling from CVI?
If there’s enough edema for there to be “weeping” of fluid, or if the edema comes on or worsens over a short period of time (days), I would seek out a medical opinion right away.
CVI can cause fluid leakage, and this is often a reason to use compression therapy, like stockings or bandages, but it’s vital to get medical advice before starting this. If someone has blockage of the arteries, and not just vein issues, compression could be the wrong way to go.
Firstly, thank you for your insightful article! My mother (age 73) has both her feet swollen (the left side seems puffier than the right one). I press on them and both are non-pitting edema. Both are also slightly red. She has no other symptoms.
She has high blood pressure but she has recently gone through Cardiovascular CT Scan last month and it turned out alright so I do not think heart condition is the underlying problem.
Can swollen feet is caused by sitting at prolonged period? (She is overweight) Should I take her to the hospital? ( I am very concerned about her having blood clot in the leg). Thank you very much for your time!
I’m so glad you found the article helpful!
A blood clot usually happens in the calf region of the leg and causes swelling in that area, rather than just the feet. Other symptoms of a blood clot include warmth and pain, and those symptoms usually come on suddenly. Shortness of breath and sudden, sharp chest pain can be a sign that a clot has gone into the lungs, which is very serious and would require a trip to the emergency room right away.
Sitting can definitely make foot swelling worse, unless the person is sitting with their feet elevated. In overweight individuals, swelling can sometimes be due to adipose tissue (fat) that wouldn’t cause pitting either.
I’m glad your mom’s Ct scan was reassuring and that you’re being proactive in looking after her health care needs. I think it’s best to trust your gut feeling if you think something is wrong and need attention by a doctor. Best of luck.
Thank you so much for your reply. I have made an appointment with the doctor for her just to make sure there’s no underlying causes. Hope you have a wonderful day.
Have had ongoing Edema for almost three months.
It started with left foot being red and swollen which didn’t go away after couple weeks. Contacted my family doctor who then requested full blood work up ultrasound on left leg and X-ray of left foot. Ultrasound found no clots and X-ray showed beginnings of bone spur blood work just showed elevated cholesterol and RA factor a little high. Liver, kidney function normal. No diabetes. Thyroid normal. Urinalysis ok.
Edema then started in right foot and then progressed up both legs and now the abdomen. Edema in legs is making them hard and shiny while abdomen is soft and hanging. I am not obese and am an active person. Have had chest X-ray echocardiogram ultrasound on lower extremities and abdomen. Chest X-ray showed borderline enlarged heart and hyper inflated lungs
I have severe asthma on Adair 500. Echocardiogram was negative for heart problems. Have been on diuretics for five weeks and no change in Edema. Elevating legs just results in Edema above the elevated area. Wearing compression knee highs just makes for swelling above sock line. It is very hard to walk as it feels like my legs are sticks with no flexibility because back of calves and back of thighs are hitting each other. My ankles feel like rubber bands are around them and they look bruised. Doctors so far have no answers as to cause. This just started about a month after I got first COVID vaccine. I am scared this is just going to keep spreading 😞
I’m sorry to hear about all the trouble you’ve had with edema and it sounds like you’ve had a lot of workup by your medical team.
It could be a coincidence that your symptoms started after your vaccine, and I would advise talking to your doctor about a potential side effect there. Although some conditions can cause swelling and shortness of breath, as far as I know, asthma isn’t usually associated with ankle swelling.
I wish I could give you an answer to your symptoms, but I’m glad to hear that your doctors are working on it, and that most of your tests have been reassuring.
My mom is 85 and has been diagnosed with delirium and anemia and low iron and memory loss. I care for her and she has carers morning and night but I feel no help from GP. Her legs are swelling again, I’m on my own and feel so tired but I will always be there for her just need a bit of advice. Been in hospital and care homes and I thought to get her home so it’s my job. Just a bit of help would be appreciated
You sound like such a dedicated care partner to your mom, and that’s a job that can be tiring and isolating. Good for you for reaching out for help.
Leg swelling can be caused by a variety of things, sometimes more than one thing at a time, so it can be tough to sort out, even with a doctor’s guidance.
One thing that’s often overlooked is medications – there are several blood pressure pills that can worsen leg swelling, like amlodipine or methyldopa. Also, some causes of anemia could also worsen leg swelling, for example if the anemia is related to liver or kidney disease.
Unfortunately, most causes of leg swelling are chronic and it’s hard to get symptoms completely under control for good. Elevating the legs almost always helps, no matter the cause of leg swelling. I hope you get some support and answers soon.
Thank you so much for responding. I will discuss this with his haemoncologist.
Kind regards
Lesley
I am 73 years old, do not take any medications. My ankles swelled about two years ago, I went to a vein specialist, he used a laser to collapse some veins in each leg. I am still having edema in both ankles. Swelling, and burning sensation sometimes. I purchased a memory foam adjustable bed, that seems to help with feet elevation. But as soon as I get out of bed, the swelling begins. I had Furosemide 40 pills, but they made me sick. My heart has been tested, it’s fine. I am concerned mainly about the burning sensation. I just received a machine that is supposed to massage the legs. What can I do to alleviate the pain and swelling? What help can you suggest? Thank you for the most informative article that I have read regarding ankle edema.
I’m so glad you enjoyed the article on ankle edema!
Chronic venous insufficiency is the most common cause of leg swelling, and can also be responsible for varicose veins and spider veins. Elevating the legs, like you’re doing is a good strategy. and so is exercise, like doing calf pumps (pointing and flexing your toes), heel raises and walking.
Most of the time, the pain of CVI is more of an ache or soreness. Burning makes me wonder about a peripheral neuropathy, which is caused by changes in the nerves in the feet and legs. Risk factors for peripheral neuropathy include diabetes, blocked or narrowed arteries, and some autoimmune diseases. Alcohol can also worsen or cause peripheral neuropathy.
If there is a nerve issue, identifying the cause is important. Treatment of the pain can include topical rubs (capsacin, for example) or oral medications like gabapentin or pregabalin. I would check in with your doctor to see if peripheral neuropathy is something that needs to be ruled out.
I am 49 years old and have had edema around eyes and in legs from last 7 months. All the kidney, liver and heart tests came normal. And from last 3 months, facing peripheral neuropathy. I do not have diabetes or Blood pressure. And the MRI taken for neuropathy have shown no issues. Could you suggest what could be wrong?
Well, I don’t have as much expertise regarding edema in middle-aged folks, but it sounds like the workup has been fairly thorough for many of the common causes of edema.
The only thing that comes to mind without additional information is Vitamin B12 deficiency, which can cause anemia and swollen ankles, but this is usually only when the anemia is sever enough to affect heart function.
Dr. K has an excellent article about Vitamin B12, which you can read here: https://betterhealthwhileaging.net/how-to-avoid-harm-vitamin-b12-deficiency/
I am of 67 years old and have a long history of varicose vein on my right leg. Recently or three to four years I experienced swollen ankles especially the right leg. I visited a doctor then and was prescribed diuretics but they had serious consequences such as dehydration and fluids lost in the body and ended up abandoning them. Early this year my heart bid was lower than 35 and this was a trend over the past six months. Heart pace maker was inserted on my left arm. But the heart bit is now normal. I think it could be CVI. Last week I got injured on my right leg as some object pill off my skin causing some minor bleeding but what shocked me was the whole leg was swelling quickly as it is being pumped like a bicycle tube. Now it’s swollen with pains in the ankle and along the calf. Lifting it up tend to work. I need your advice for what kind of medical help one may seek.
Varicose veins can definitely be a symptom of CVI (chronic venous insufficiency) and you’re correct that elevating your legs will help. Also, as you point out, diuretics are often limited in their benefit and can have side effects.
If there was an injury with new, worsening swelling, I would want to make sure there isn’t an infection. Especially if there’s heat and redness too. This would call for a doctor’s visit right away.
My mom has been experiencing swelling in her right leg below the knee. She was working remotely at desk for a few months and so we thought that was the issue…however, it seems to come and go. It happened so sudden so she went to the ER. DVT was ruled out, her heart rates and such are normal. She does have high blood pressure and was taking high doses of Amolodipine but was recently taken off of that med. She has been wearing compression socks the past month and the swelling is gone for the most part and hasn’t come back. She was still asked to have an Echocardiogram but I’m so nervous that it’s something else. Is it possible it could’ve just been a flare up?
Swelling in only one leg can be a cause for concern, so I’m glad to hear that a venous blood clot (DVT or deep vein thrombosis) has been ruled out. Other causes of unilateral leg swelling can include a Baker’s cyst (small cartilaginous swelling behind the knee), injury, infection, or lymphedema of only one limb (usually happens with a history of cancer for example).
It may be that there’s some venous inflammation (phlebitis) or more varicose veins in that leg, making it appear more swollen. If the swelling doesn’t continue to improve, it might be worth seeing a vein specialist who could help diagnose a more complicated vein issue.
Another cause could be arthritis, especially if the swelling is close to the knee joint.
I can understand being worried about a serious issue, but most causes of swelling are chronic and fairly benign. Hope the echo results are reassuring!
Hello.
I first experienced a swollen right foot and ankle 30 months ago, following a two hour flight. The swelling has got steadily worse and spread up the lower half of my leg. I suffer from eczema and Parkinson’s disease and urticaria. I have recently been treated for a lytchen skin condition in my private area. Betnovate controls it.
The skin around my ankle became very rough and thickened plus an occasional unbearable itch. I recently tried Betnovate for relief. This is curing my skin problem and simultaneously my swelling has started to reduce! By no means gone but very noticeably reduced.
Since inception my GP has conducted a variety of investigations without a real outcome. Presently I wait to see the hospital vascular team.
The swelling has always subsided overnight. Walking makes no difference. I had a bursitis on my right knee 6/7 years ago. I am an active 82 year old male.
Thanks for sharing your edema journey!
That is interesting that your leg improved with betnovate (a topical steroid). There is a condition called stasis dermatitis which can cause an eczema like rash on the legs. Those who have chronic venous insufficiency are more likely to get stasis dermatitis. It’s an inflammatory process that causes an itchy, red, scaly, sometimes even weeping skin change. This rash can become infected too.
I’m so glad your symptoms improved and thanks again for taking the time to comment.
Thank you for your blog. I am 83 and went through about six months of unwellness related to BPH and recently had a Transurethral resection of the prostate. Have had to use a catheter for about four months. Just above my left ankle I was wearing a wrap around to keep a bag in place and had it too tight. I then noticed my left foot was swollen and no longer use that tight restraint but still have swelling without oedema. I do plenty of walking and a bit of yoga. Evidently I also had kidney damage but this is recovering.
Might the ankle wrap have acted as a tourniquet or is it more likely just coincidence? As for drug related side effects during hospitalization I lost track of what seemed like a never ending succession of medications. After reading your advice I began this evening to elevate the leg. If I were to do this faithfully might I expect the swelling to gradually disappear?
UPDATE: Two days later and elevating the leg has seen the swelling disappear. Walked a couple of ks and no problem.
Thanks or letting us know how your swelling worked out! I’m so happy that you found some useful advice in the article.
It’s likely that the tight compression interfered with the veins draining the foot and leg properly, causing the swelling. Glad you’re recovering from your surgery and I also want to encourage you to keepm up with the physical activity.
Your article really gave me information and validation that is so helpful. I really appreciate what you wrote. My 98 yr Dad has been living with me since July 2021. He had a stroke in 2009 which left neuropathy in the right leg. He has had swelling in his lower right leg for a while. He has primarily been healthy and independent for all his life. More recently (Oct 2021) he got an ulcerated wound on the right ankle. We have home nursing come in 3x a week to check and dress the wound. No healing in sight. In the last week the swelling has grown in his right lower leg and transferred over to the left leg but not as bad. The right foot and leg are very red. The redness has grown up the leg toward the knee in the last two days. I elevate his leg regularly. He has terrible pain (accentuate terrible) in the right foot and weeping out of the skin. He’s on a water pill and it doesn’t seem to help. It’s very disheartening because I am at a loss for what to do. When do I call an ambulance to take him to the hospital?
I’m so sorry to hear about your dad’s suffering.
It’s always right to call an ambulance if you feel like urgent or emergent medical care is needed, but it’s impossible for me to give this type of advice over the internet. Certainly, if there’s trouble breathing, loss of consciousness, or sever sudden pain, that would be emergent, in my opinion.
It is concerning that there’s spreading redness and severe pain – I would wonder about a blood clot or an infection in such a situation. My advice would be to seek medical attention as soon as possible to get clarity on the daignosis and make sure you’re on the right treatment.
Hi I’m Joy..I have a grandmother, 90yrs old now..after a heart attack she has water on the lungs. And now she suddenly has swelling in both legs..
Can any herbal remedies help leg swelling?
Hi Joy. Sorry to hear that your grandmother had a heart attack and now leg swelling.
After a heart attack, “water on the lungs” or pulmonary edema is common if a person develops a complication called Congestive Heart Failure (CHF). This can cause swelling in the legs also, when the heart has trouble filling and there’s a strain on the kidneys.
I’m not aware that there are any herbal remedies for the edema that’s caused by CHF and I would ask a doctor or pharmacist before starting any new medication or supplement if an older adult is on prescription medications for a heart condition.
Dear Doctor Didyk, I just started reading your article and the questions and your answers.
What relief from seeing similar problems and your answers are so very educational and easy to follow.
I will be following up soon with my pcp, but I’m going to elevate, cut out salt and do more walking. Thank you again. I subscribed to this website.
I’m so glad you enjoy the articles and the comments! It is a great way for our readers to share their experiences and questions. Thank you so much for subscribing!
Love these articles. It would be so helpful if they were available in printer-friendly format, also. 62 pages is too long to print, and the type is huge.
I have PAD and insufficient vein flow. I tried sleeping with both feet elevated. My left foot became chilled. My dr exsmines my feet but never refers me to a specialist. I often get swollen ankles which my dr says is a vein problem but I also have PAD. Trying a varieties of strategies, but I am basically on my own. Apparently elevating legs is good. But not all night. Walking seems to help PAD but not sure about vein problem
It is common for a person to have chronic venous insufficiency and peripheral artery disease (PAD) and the treatment is different as you point out.
It sounds like you’re wondering if elevation makes your PAD symptoms worse, and that is possible. In fact, elevating the foot, and then putting it back down to see how long it takes for the arteries to fill the leg is a part of the physical examination a doctor might do for PAD.
It’s recommended to elevate the feet above the level of the heart for about 30 minutes, 3 times a day. Elevating the legs all night is probably not feasible for most people.
Exercise will help with the PAD, and any other blood vessel disease that you might have. It can help with venous insufficiency as well, so that might be your best bet.
Thank you for your very interesting and helpful advice . My left leg ankle snd foot are swollen with skin discolouration . Some areas are tender to touch. I am fit and healthy in every way for a lady of 80 yrs
If I walk for longer than 10 mnts I get an ache in my calf that goes away when I stop and rest for a bit . It comes back when I have been walking for a while . When sitting I get a slight sensation of pins and needles in my ankle and when I press on my foot there is a slight indentation. My right leg is normal but swelling is quite a lot in the left leg ankle and foot. Could you advise how I can relieve this please. Many thanks
I always get concerned when there’s swelling in only one leg – it’s more likely that there’s an infection or a blood clot if that’s the case. Either of those conditions wouldn’t tend to cause the pins and needles or the pain with walking that’s relieved with rest.
Pins and needles makes me think of a nerve problem, and the pain with walking can be a symptom of an artery blockage in the leg (peripheral arterial disease causing claudication).
In short, I’m not sure what’s causing your left leg swelling based on the information I have. I would advise someone in your situation to go see your primary care provider so that they can do a full examination and order some tests, such as an ultrasound. Good luck!