Leg swelling is one of the most commonly ignored symptoms I see in clinic. Many people assume it’s just long working hours, travel, or age. Sometimes that is true. However, in other cases, leg swelling-medically called edema-is an early warning sign of an underlying vascular or systemic problem that should not be delayed.
In my practice at Trinity Hospital and Heart Foundation, patients often come after months of self-management. By then, the swelling has progressed, skin changes have appeared, or walking has become painful. This article explains how I look at leg swelling clinically and when I recommend a vascular evaluation.
What Leg Swelling (Edema) Actually Means
Leg swelling occurs when excess fluid accumulates in the tissues of the legs or ankles. This fluid buildup can be temporary or persistent.
Clinically, I first distinguish between:
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Pitting edema – pressing the swollen area leaves an indentation.
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Non-pitting edema – firm swelling without indentation.
This distinction, combined with the pattern and timing, gives important clues about the cause.
Common Causes of Leg Swelling I See in Practice
1. Prolonged Standing or Sitting
Office work, factory jobs, long travel, or standing for many hours can cause temporary swelling. This usually reduces with leg elevation and rest.
2. Varicose Veins and Venous Insufficiency
When leg veins fail to pump blood efficiently back to the heart, blood pools in the legs. Over time, this leads to:
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Evening swelling
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Heaviness
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Skin darkening near the ankles
This is one of the most frequent causes of chronic leg swelling.
3. Blocked or Narrowed Arteries (PAD)
Some patients notice swelling along with pain while walking or calf tightness. Poor arterial circulation can coexist with venous problems, especially in diabetics and smokers.
4. Heart, Kidney, or Liver Conditions
Systemic illnesses can cause bilateral leg swelling that is often worse by evening and improves overnight.
5. Medication-Related Swelling
Certain blood pressure medicines, painkillers, or hormonal medications can contribute to edema.
Red Flags That Should Not Be Ignored
I advise immediate evaluation if leg swelling is associated with:
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Swelling in one leg only
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Sudden onset with pain or redness
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Skin discoloration, ulcers, or non-healing wounds
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Breathlessness along with swelling
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Pain while walking that improves with rest
These features may indicate a vascular condition that needs timely treatment.
How I Clinically Evaluate Leg Swelling
Evaluation is not based on guesswork. I follow a structured approach:
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Detailed history – onset, duration, lifestyle, and medical background
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Physical examination – veins, skin changes, pulses, and swelling pattern
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Vascular Doppler scan (when indicated) – to assess blood flow in veins and arteries
This helps identify whether swelling is benign, venous, arterial, or systemic.
When Simple Measures Are Enough – and When They Aren’t
Swelling that often improves with:
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Lifestyle changes
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Leg elevation
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Weight management
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Compression therapy (when appropriate)
Swelling that needs medical or procedural care:
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Persistent varicose-related edema
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Skin changes or ulcers
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Reduced walking distance due to pain
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Recurrent or worsening swelling despite rest
Delaying treatment in these cases can lead to long-term complications.
Frequently Asked Questions
Is leg swelling always dangerous?
No. Temporary swelling after long hours of standing is common. Persistent or worsening swelling needs evaluation.
Can varicose veins cause leg swelling?
Yes. Varicose veins are a leading cause of chronic leg swelling due to venous pressure buildup.
Does walking help or worsen swelling?
Gentle walking helps circulation. Pain while walking may suggest arterial disease and should be assessed.
When should I see a vascular surgeon?
If swelling is persistent, one-sided, painful, or associated with skin changes or walking discomfort.
A Note on Consultation
If leg swelling has been persistent or progressive, a focused vascular evaluation can clarify the cause and guide the next steps. I consult at Trinity Hospital and Heart Foundation, Basavanagudi, and can be reached via Call or WhatsApp: 9353384953 for an appointment when clinically required.
Next in this series:
Leg Pain While Walking: How to Tell Nerve Pain from Blood Flow Problems (PAD Explained)