Leg swelling is not an uncommon occurrence in life, particularly in adults. In many instances, it is temporary and passes without treatment. Leg swelling may arise with walking or standing for long periods beyond what a person is accustomed to, and also occurs more frequently in a person who is overweight or leads a sedentary lifestyle. This may also apply to the elderly who are frail and immobilized. Although it is is often not caused by any diseases in these situations and passes shortly thereafter, there are times when leg swelling needs to be taken as a very serious sign. Leg swelling that is persistent or recurrent for no apparent reason or swelling of the legs in the elderly may be a sign of an underlying disorder. Some of these conditions, particularly in the elderly, are very serious and potentially fatal.
There are several reasons for swelling of the legs but in most instances, it is due to fluid accumulation in the legs. Sometimes excess fluid pools within the tissue spaces (edema) while at other times it may be accumulated within the blood vessels. Fluid normally flows in and out of the tissue spaces and blood vessels in order for nutrients, oxygen, carbon dioxide or wastes. The body has several efficient mechanisms to ensure that fluid does not accumulate in any part of the body.
The legs are the most prone to swelling because the return of fluid to the heart is against gravity. Therefore any problem in terms of excess fluid within the body, reduced heart function, problems with the blood vessels and related dysfunction will lead to fluid accumulating in the legs first before arising in other parts of the body. Leg swelling is, therefore, a sign of an underlying problem in one or more of these systems.
Swollen legs may occur for a myriad of reasons. The more important causes in the elderly includes:
- Venous insufficiency where the leg veins are compromised and the blood from the legs cannot return to the heart efficiently. It is due to conditions like varicose veins where the valves in the veins are inadequate and the veins bulge. Deep vein thrombosis (DVT) is one of the serious conditions that can arise in the elderly – if the clot in the leg dislodges, it can block the artery in the lungs which can be fatal.
- Heart failure where the heart cannot pump blood effectively which also compromises the return of blood to the heart.
- Kidney problems where the kidney’s ability to regulate the water levels in the body are affected thereby causing the retention of fluid in the body.
- Fractures of the leg bone which is more commonly in the elderly with age-related decrease in bone density and diseases that cause brittle bones like osteoporosis. Sometimes if there is damage to the nerves in the leg like with long-term diabetes mellitus and there may be no severe pain despite a fracture.
- Joint swelling particularly in the toe, ankle or knee joints due to conditions such as rheumatoid arthritis, gout, and osteoarthritis which are also more frequently seen in the elderly.
- Medication for conditions such as high blood pressure (hypertension) and diabetes mellitus. These conditions are also more common in the elderly and require lifelong medication. Swelling may arise as a side effect.
- Sitting for a long time such as during long road trip, train rides or flights
- Standing for a long time such as during parade and other celebrations
- Blood cloth occurs in the leg (Thrombophlebitis)
- Gout: a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood. The build-up of uric acid could result in sudden, severe attacks of pain, redness, and tenderness in joints especially near the base of the big toe.
- Sprained Ankle: an injury which occurs when the ankle is rolled, twisted or turned in an abnormal manner that results in tearing or stretching of the ligaments.
- Popliteal Cyst (Baker’s Cyst): a prominent swelling at the back of the knee. It is usually caused by an underlying injury or condition in the knee joint.
- Broken Foot
- Broken Leg
- Knee (Prepatellar) Bursitis: an inflammation of the bursa in your knee.
Although these are not the only conditions that cause leg swelling, it is among the more common and important causes of a swollen leg in an elderly person. A further diagnostic investigation is necessary to conclusively identify the cause.
If your legs swelling is not caused by the more severe underlying medical condition, the following remedies might provide some relief during the recovery period
- Try Magnesium Supplement
- Do Light Exercise: Exercise can help improve your circulation and reduce the chance of fluid accumulation. Swimming or floating float in water can be especially effective as the pressure from the water can help promote circulation, and floating gives your circulatory system a relief from gravity’s constant pull.
- Raise Your Feet (ideally above your heart): This counters the effect of gravity on blood circulation.
- Hydration: Excess salt is a major cause of the swelling. If you increase your fluid intake, it can help dilute salt content in your body.
- Diet Adjustment: Consider increase intakes of anti-inflammation food like strawberries, blueberries, cherries, and oranges, olive, nuts, fatty fish like salmon, mackerel, tuna, and sardines.
- Wear Compression Gear like compression socks
- Lower Extremities Massage
- Take an Epsom Salt Bath: Epsom salt, named for a bitter saline spring at Epsom in Surrey, England, is not actually salt but a naturally occurring pure mineral compound of magnesium and sulfate. The theory is that when you soak in an Epsom salt bath, these get into your body through your skin.
While swelling of legs is often non-emergent medical condition, one should seek immediate medical help if any of the following symptoms or conditions occur with the swelling. This may indicate a blood clot in your lungs or other serious heart issues:
- Difficulty in breathing
- Shortness of breath
- Chest pain
- Coughing blood
- Swelling in one leg only
- Swelling occurs for no apparent reason
- Swelling related to a physical injury
Starting a gout diet? Understand which foods are OK and which to avoid.
Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.
A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.
People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.
Gout diet goals
A gout diet is designed to help you:
- Achieve a healthy weight and good eating habits
- Avoid some, but not all, foods with purines
- Include some foods that can control uric acid levels
A good rule of thumb is to eat moderate portions of healthy foods.
The general principles of a gout diet follow typical healthy-diet recommendations:
- Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
- Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
- Water. Stay well-hydrated by drinking water.
- Fats. Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
- Proteins. Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.
Recommendations for specific foods or supplements include:
- Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
- Red meat. Limit serving sizes of beef, lamb and pork.
- Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
- High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don’t increase the risk of gout or recurring gout attacks.
- Alcohol. Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn’t appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
- Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
- Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
- Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
- Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.
Here’s what you might eat during a typical day on a gout diet.
- Whole-grain, unsweetened cereal with skim or low-fat milk
- 1 cup fresh strawberries
- Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
- Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
- Skim or low-fat milk or water
- 1 cup fresh cherries
- Roasted salmon (3 to 4 ounces)
- Roasted or steamed green beans
- 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
- Low-fat yogurt
- 1 cup fresh melon
- Caffeine-free beverage, such as herbal tea
Steve Ramsey, PHD PUBLIC HEALTH – Calgary – Canada