4 Health Issues That Sock Marks May Signal

You’ve probably noticed that sometimes your socks may leave a reddish imprint on your ankles. If it happens just once or twice, it can be a sign that the elastic that keeps the socks from slipping down is too strong. But if your sock marks are common, it’s a signal your body is using to tell you something might be wrong.

We at Bright Side have done some research to find out what health issues sock marks can alert you to. And don’t forget to check out the additional tips on how to prevent sock imprints at the end of the article.

1. High blood pressure

If you’re experiencing a disturbing feeling of swollen legs, the reason may be excess fluid that’s building up in your lower legs. Usually, it’s not painful by itself, but wearing socks may feel uncomfortable. High blood pressure is caused by fluid retention and makes it hard for the heart to transport blood throughout the body. The body responds by holding onto fluid that usually settles in the legs and feet.

2. Varicose veins

When the veins in your legs become weakened, they can’t return blood to your heart quickly enough. Blood then backs up in your leg veins and leads to painful swelling. This condition is one of the contributing factors to varicose veins. If you’re getting sock marks regularly, your body might be trying to send you a signal that your veins don’t let blood flow back up to your heart.

3. Dehydration

If your body doesn’t get enough water, it may damage your blood vessels. Damaged veins may begin to create small leaks that allow fluid to build up in the surrounding tissue. Common places for this fluid to be collected are around the ankles and feet. Sock marks that appear around your ankles may indicate that your body is dehydrated.

4. Side effects from medication

Certain medications can also cause lower leg swelling. Some kinds of antidepressants and blood pressure medications may lead to the unpleasant feeling of swollen feet. Certain types of contraception (especially birth control pills that contain estrogen) can change hormone levels in a woman’s body and cause water retention and leg swelling.

Bonus: what to do if you get sock marks regularly

If sock marks appear on your legs regularly, it’s best to consult a doctor. But you can improve the condition by following some simple recommendations that can ease the unpleasant feeling of swollen legs.

• Reduce salt in your diet.
• Maintain a healthy weight.
• Wear compression socks and stockings.
• Change positions frequently and avoid sitting and standing for long periods of time.
• Wear comfortable shoes with low heels.

Have you ever noticed sock marks on your ankles or feet? Do you have any tips on how to prevent them?

What You/Caregivers Should Know About Swollen Legs

The most common place to see edema, or swelling, is in your feet, ankles and lower legs. Edema is the result of fluid building up in your body. It can happen in any part of your body, but because of the effects of gravity, the fluid usually shows up as painless swelling in your lower extremities. Fluid in this area is called peripheral edema. The old name for edema was dropsy from the Greek word for water, hydrops. The word is no longer used in medicine, but descriptions of dropsy go back to the Ancient Egypt.

“Bloodletting, either by venesection or by leaches, was a popular way to alleviate symptoms from dropsy… Its treatment options were scanty and were aimed to cause ’emptying of the system,’ or to relieve fluid retention.” —Journal of Cardiac Failure

View the Parentgiving Picks to help find the right products to help with peripheral edema.

Symptoms of Peripheral Edema

Today doctors no longer use the term dropsy, and they don’t relieve edema by the old practice of bloodletting. Mild to moderate swelling in the lower legs is common with age and does not always mean you need to be treated. Your legs may feel tight and heavy, and you may notice the skin over your lower legs becoming stretched and shiny. If you press gently on a swollen area for about 15 seconds and it leaves a dent, it is called “pitting edema,” and you should let your doctor know about it.

Common Causes of Peripheral Edema

As you get older you are more likely to collect edema fluid in your lower legs if you stand or sit too long. You may notice tightness and swelling after a long flight or car trip. You may notice “sock marks” when you take off shoes and socks after a long day. In most cases these symptoms are not anything to worry about but if edema is pitting and doesn’t clear up quickly, alert your doctor.

Here are some more serious causes of peripheral edema:

Venous insufficiency. This happens when the veins in your legs have become weakened and can’t return blood to your heart quickly enough.
Congestive heart failure. This is the most common cause of serious peripheral edema. Congestive heart failure occurs when your heart is not pumping well enough to keep blood moving through your system.
Other diseases. Diseases of the lungs, liver, kidney and thyroid can all cause a buildup of fluid that leads to peripheral edema.
Medications. Some types of antidepressant medications and blood pressure medications can cause edema. If you are taking any of these types of medications and you have edema, talk to your doctor about it.

What You Can Do About Peripheral Edema

For mild cases of edema there are several things you can do for yourself:

• Avoid standing or sitting too long. Get up and move around to get a good blood flow going.
• If you have to sit or stand, wear support stockings. These stockings are available in most drug stores and online.
• Elevate your legs as much as possible. When lying down, put a knee wedge pillow under your legs to elevate them above your heart.
• Avoid too much salt in your diet. Ask your doctor about salt restriction and following a low-salt diet like DASH.
• If peripheral edema persists, see your doctor. Your doctor will treat any underlying conditions causing the edema. The most common medication used to treat edema is a diuretic, often called a “water pill.”

Warning Signs for Seniors and Caregivers

Edema fluid can also start to collect in your lungs, which is a dangerous stage of congestive heart failure. If you feel short of breath or have chest pain call your doctor immediately or call 911. Call your doctor right away if you have any of these warning signs:

• Fever, redness, swelling, warmth or pain in your leg, which could be symptoms of a clot or infection
• Any sudden increase in edema, decreased urine output or accumulation of edema fluid in your belly
• Any injury to the skin over a swollen leg—these areas are easily infected and take longer to heal

Peripheral edema becomes more common with age, and in many cases you can control occasional edema with home care. But persistent peripheral edema can be a sign of a serious disease like congestive heart failure that needs to be treated. If in doubt, call your doctor. Complications from edema can often be avoided with early recognition and treatment.

Sock marks may signal high blood pressure

Sock marks are a sign of lower leg swelling that could be caused by high blood pressure.

Standing or sitting too long may cause lower leg swelling, or edema, with symptoms like tight shoes and sock marks.

These symptoms may not be a problem if they are mild and don’t happen often. Recurring or worsening lower leg swelling could be a sign of a chronic health problem.

“Swelling in your ankles is abnormal,” said Dr. Michael McGill, a Marshfield Clinic cardiologist. “It needs to be evaluated if it becomes a common problem. Even if it just happens occasionally, you should discuss it with your health care provider.”

High blood pressure is the most common cause

Swelling happens when excess fluid builds up in your lower legs. Edema usually isn’t painful by itself, but wearing shoes and socks may feel uncomfortable if your legs and feet are swollen.

“Sodium retention causes high blood pressure and fluid retention, which is the most common reason for swollen lower legs,” McGill said.

High blood pressure may be accompanied by diastolic dysfunction, a type of heart failure that makes it hard for the heart to pump blood throughout the body. The body responds to insufficient blood flow by holding on to fluid that settles in the lowest parts of the body – usually the legs and feet.

Venous insufficiency is another cardiovascular problem that can cause swelling. Venous insufficiency happens when your leg veins don’t let blood to flow back up to your heart. When valves in your veins don’t work well, blood can collect in your legs and cause painful swelling. This condition also is known for causing varicose veins.

Kidney and liver problems and certain medications also can cause lower leg swelling. Your doctor will run tests to figure out what’s causing the problem.

Solutions for lower leg swelling

“Blood pressure medication and reducing salt in your diet usually help reduce swelling caused by high blood pressure,” McGill said.

Your doctor also may prescribe a diuretic, a medication that helps your body get rid of excess water and salt, to reduce swelling.

Compression stockings and elevating your feet may help reduce swelling caused by venous insufficiency.

Other causes of swelling, such as kidney or liver disease, require condition-specific treatment.

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Peripheral Edema – Causes, Symptoms, and Treatment

Edema describes swelling that occurs when small blood vessels leak excess fluid into nearby tissues. This build up of fluid causes tissue under the skin to swell. As a result, the skin looks puffy, stretched, or shiny. 

Peripheral edema is a type of swelling that occurs in a person’s lower body. In most cases, it affects the legs, ankles, and feet. However, it can also occur in the arms too. Like other types of edema, it comes from a build up of excess fluid. Moreover, swelling depends largely on gravity. It can increase or decrease based on the position of the body.

Thankfully, it is usually a mild condition that resolves itself or the discomfort can be treated with medical socks called diabetes socks. Diabetic socks have loose tops that does not constrict blood flow and helps against swelling.

An example of a less severe case is edema arising from an increased salt intake. Another mild cause is sitting in one position for too long. On the other hand, it can be a symptom of a larger medical issue. This condition can affect the circulatory system, kidneys, and lymph nodes. Therefore, it is important to see the doctor if your symptoms have not improved. 

Peripheral Edema Symptoms

One of the most common signs with this condition is the display of swelling or puffiness surrounding the affected tissue. Some people describe the swelling as feeling tight or warm, but generally this is not a cause for concern. 

In addition, other signs include pitting, heaviness in the affected area, weight gain, and difficulty wearing socks or shoes. 

• Pitting: Using your finger tip, apply pressure to the swollen area for around five seconds. If there is an indent from your finger after removing pressure, this is known as pitting.

• Heaviness: Depending how severe the swelling is, you may notice a heavy feeling in the arms or legs. This could impact your ability to walk or perform daily tasks from a lack of strength or pain. 

• Weight gain: You may notice some weight gain from the fluid retention. Your weight should decrease once the condition improves.

• Tough to put on shoes or socks: Swollen feet can force you to change your clothing choices. You should avoid tight clothes until the swelling goes down.

Major Causes of Peripheral Edema

There are a variety of causes behind peripheral edema ranging from minor to more severe. Minor causes are usually temporary and will correct themselves over time. Making easy changes to your daily life will also fix these issues. Other causes are systematic, meaning there is an another health condition. If you are not sure of the cause, it is worth seeing your doctor to rule out other health concerns. 

Minor Causes of Peripheral Edema

allergies can be a cause

Minor causes are temporary. In fact, they may heal themselves over time. Another option is to make changes to your diet or daily living. 

• Standing/sitting too long: Sitting or standing too long can be harmful and can cause peripheral edema.
• Pregnancy: This condition is common during pregnancy as a woman’s body will retain more fluid for the developing fetus. Like gestational diabetes, this usually goes away after giving birth. 
• Hormone changes: Changes in hormones can cause swelling in the legs.
• Salt Intake: An increase in sodium in the body is another minor cause to look out for.
• Medication: Changes in your medication is another potential trigger for this condition.
• Allergic reaction: It is not as common to swell in the legs and arms during an allergic reaction. However, it does happen. If swelling occurs suddenly, seek medical help. 
• Obesity: Excess weight affects your health in many ways, including putting pressure on the veins causing edema. 
• Low altitude: Did you know that the elevation can have an impact on your body in a number of ways? Higher altitudes can make it more difficult to breathe in oxygen from the air. On the other hand, a lower one can cause swelling and other signs of edema.
• Tight clothing: Wearing clothes that are too tight will reduce your blood flow. This can cause certain parts of your body to become swollen.

Systematic Causes of Peripheral Edema

Unlike minor causes, systematic causes are the result of an underlying condition and may require other medical treatments. 

• Venous insufficiency: This is a condition where leg veins struggle to send blood back to the heart. This causes blood flow issues as it pools in the lower leg. 
• Inflammation: Inflammation is a normal immune response, especially when dealing with a chronic health condition. It causes body parts to swell including the legs or arms. 
• Deep vein thrombosis: This is a condition when a blood clot forms in the veins. In some cases, DVT requires medical care. Signs of this condition include sudden swelling of one leg. 
• Cancer: Some forms of cancer and chemotherapy can cause peripheral edema. 
• Heart failure: In this case, the heart is too weak to pump blood. Instead, the blood gathers in front of the heart. Consequently, this puts pressure on the veins causing fluid to leak into surrounding tissues. 
• Pericarditis: This is the swelling of the membrane surrounding the heart. This causes swelling and pain in the feet, ankles, and legs. 
• Preeclampsia: This is a complication that can occur during pregnancy. People with this condition have high blood pressure and signs of damage of an organ system. Peripheral edema is one of the symptoms of this complication. 
• Cirrhosis: This condition affects liver function and results from long-term damage to the liver. People suffering from cirrhosis can develop swelling in the lower legs.
• Renal failure: Renal failure occurs when a person’s kidneys are unable to effectively filter waste from their blood. This causes high levels of waste to build up in the body. 
• Pulmonary hypertension: This is a form of blood pressure affecting arteries in the lungs. Also, this affects how blood travels back to the heart. Swelling in the legs is a common sign of this condition. 
• Lymphedema is swelling in the arms or legs. Blockage in the lymphatic system that is part of the immune system is to blame.
• Cellulitis is a common bacterial skin infection that causes swelling, pain, and redness. 
• Malnutrition occurs when a person’s diet lacks proper nutrients for optimal health. Malnutrition can lead to low protein levels in the blood, causing peripheral edema.
• Sleep apnea: This is a serious sleeping disorder when a person’s breathing stops and starts again. Most importantly, when sleep apnea is severe, leg swelling can occur. 

Peripheral Edema Treatments

For instance, in mild cases, try lifting your legs up with a pillow so they are higher than your heart. This should increase blood flow to the legs and help manage most symptoms. Other treatments include movement, diabetes socks, compression socks, massage, and reducing salt intake. 

Diabetic socks: Diabetes socks have relaxed tops that reduce binding that comes from swelling. These socks are also suited for those with nerve damage.They also feature plush bottoms and a breathable mesh. As a result, not only are they more comfortable, but they also increase blood flow in the legs. These socks come in various lengths including crew and knee. Those who prefer a shorter ones can opt for diabetes ankle socks. Read this in-depth guide to learn more about these socks.

Compression socks are advisable after swelling has gone down. These are knee length socks. They work by applying pressure to the affected area to stop fluid from collecting in the legs. There are many different types of socks on the market. Know the differences between compression socks vs diabetic socks.

Keep swelling down with compression socks

Massage: Applying firm pressure to the affected area can help remove excess fluid. It also helps improve poor circulation in the legs.

Movement: Exercises that target the legs can be helpful for decreasing swelling and providing relief to the affected area. 

Reduce salt intake: Salt causes the body to retain water, which can worsen this condition. However, before reducing salt in your diet, seek advice from a doctor. Also, read about the 10 best foods for people with diabetes. It can help anyone improve their diet.

Eating less salt helps decrease swelling.

Take Away

In some cases, the heaviness and swelling associated with this condition can cause painful feet and legs or interfere with normal activities. If this sounds like you, you should rest and try the above treatments to manage your symptoms. 

For severe cases, your doctor might prescribe medication to help your body remove excess fluid through urination. 

When Should You Visit the Doctor and What To Expect

Peripheral edema typically resolves itself after a few days without medical intervention. If you experience sudden pain or severe swelling, you should see your doctor to rule out serious medical concerns. 

When making an appointment, make note of any restrictions that could affect testing. This includes fasting before blood work. Above all, your doctor will want to know your symptoms. For example, include details such as the severity and duration. Additionally, brush up on your medical history including any medicines and supplements you are taking, and current medical conditions. 

Your doctor will ask a variety of questions:

• How long have you noticed symptoms?
• Is the swelling only in your legs? 
• Have you had a form of edema before?
• Does swelling go down after elevating your legs? 
• Does anything make the swelling better or worse? 

Prepare to answer questions like these will help your doctor make a diagnosis.

Also, your doctor will perform a physical exam, potentially followed by further testing such as ultrasound, blood tests, and x-rays. 

Treatments depends on the underlying cause. For minor cases, symptoms will resolve on their own or by making changes to your lifestyle. If the cause is systematic, your doctor will prescribe a treatment suitable for the condition. Luckily, you can manage most of these symptoms at home. 

Related Links:

Sources:

Leg Edema Treatment Austin – Leg Ankle Foot Swelling Therapy

Leg Edema Treatment Austin | Leg Ankle Foot Swelling

What is Causing My Lower Extremity Leg Swelling?

Leg Edema Evaluation & Treatments in  Austin Texas

Definition of Lower Extremity Edema / Swelling

Lower extremity swelling is known by the medical term “edema.”  Edema is the pathological process of fluid or water building up within the soft tissues of the leg, including the skin, fat, and muscles of the lower extremity.  Edema most commonly occurs it the lowest parts of the legs, particularly the ankles, as a result of gravity effect.  But it can affect any part of the leg or foot or the entire leg or foot.  Patients who suffer from lower extremity edema / swelling tend to report that their legs or feet will swell worse as it gets later in the day or when they are on their feet for prolonged periods of time.  The swelling tends to improve throughout the night when the legs and feet are elevated, so that the swelling tends to be much less when they awake in the morning.  People with the condition begin to notice that their shoes, socks, or clothes begin fitting too tight as a result of the increased size of their extremity.  The condition can affect just one leg or one foot, or affect both extremities at the same time.  Sometimes one leg or foot has worse swelling than the other.  Patients with edema often report a feeling a heaviness, tightness, dull aching discomfort, or tingling / numbness in the involved leg or foot.  Sometimes their is no discomfort, just the visible change in the size of the leg.  Patients also report that when they remove their shoes or socks, that their is a visible indentation or mark on their leg  or ankle where the tissues transition from an area of more prominent swelling to an area of less prominent swelling.  It is common to develop some discoloration of the skin as a result of the edema swelling, most commonly a slight pink or red discoloration of the skin or even a dark brown discoloration of the involved skin.

Symptoms of Edema of Leg / Foot

Over 4 million people in the United States (about 1.6% of the population) suffer from lower extremity edema.    Symptoms of edema include visible enlargement of the leg / foot, pain, skin discoloration (red, pink, purple, blue, or tan), tenderness of the leg, increased warmth or redness of the skin,  “tightening” of the skin, heaviness of the leg, imbalance, or difficulty walking.  Patients with severe edema can go on to develop skin blisters or even open wounds or ulcers of the legs, ankle, or foot.  Sometime fever can result if the skin gets an infection.  There is a higher risk of skin infections in patients with edema.

Cause of Lower Extemity Edema of the Leg / Foot

The etiologies of leg edema are multiple are there is a very long list of possibilities. Some of the more common causes include include kidney problems (kidneys are designed to rid your body of excess fluid), circulation diseases such as blood clots or venous valve insufficiency, heart problems such as congestive heart failure or arrhythmias, prolonged immobilization (such as during prolonged travel), surgery, physical trauma, pregnancy, medications such as hormone therapy, obesity, cancer, vein catheters, May-Thurner’s Syndrome, advanced age, lymphatic system damage, and infections.  It can sometime be something as simple as salt retention from too high of salt intake in the diet (when you retain salt you also retain water).  Also, normal physiologic hormone fluctuations can cause cyclic fluid retention, particularly in women who have constant fluctuations in their hormone levels throughout the month or those that have thyroid disorders.  There are also many prescription and over-the-counter medications that can have edema as a potential side effect.

Also, any dysfunction in a major organ (no matter how mild) can throw off the balance of your body’s normal fluid balance and cause an accumulation of excess fluid in your tissues.  This can include any problem with the heart, kidneys, liver, blood vessel, or thyroid gland, or adrenal gland. Any hormone imbalance in your body could also cause edema to accumulate in your legs.  Since gravity will always carry the fluid to the lowest part of your body, it is usually first becomes evident in the lower legs or feet.

Vein malfunction / vein dysfunction is also another common cause of leg swelling.  Veins are the blood vessels in the legs that are designed to carry blood out of the legs and back to the heart (they fight gravity).  When veins stop working correctly, the blood “backs up” in the leg veins and leads to pressure build-up and swelling of the legs. The reason that veins usually stop working is because of weakened valves within the veins.  As vein valves begin to break, the valves can no longer adequately fight gravity flow.  As a results, venous blood begins to travel backwards within the veins. This condition is known as venous insufficiency or venous reflux disease. This vein valve diseae is a common reason that people develop leg or ankle swelling.  Vein valve disease can lead to varicose veins as well.  Vein valve dysfunction can be an inherited condition or it can be caused by blood clot damage or trauma to the veins.

Lymphedema is another cause of leg or foot swelling.  It is caused by damage to the lymphatic immune system.  The immune system is a network of small spider-web sized channels that carry a water consistency fluid.  This watery fluid, called lymph, contains many types of immune system cells.  Lymph circulated  throughout the body, including the legs and pelvis. When the immune system is functioning normally, many gallons of lymph fluid are circulated through the legs and pelvis every day.   When either the lymph channels or their connecting “depots” known as lymph nodes are damaged, lymphedema swelling can occur.  Some known causes of lymphedema are infections, trauma, surgery, or cancer.  There are also some form of lymphedema that are called primary or idiopathic lymphedema, the cause of which is often unknown.

One of the more dangerous causes of leg or foot edema / swelling is blood clots within the veins (known as Deep Venous Thrombosis or DVT).  Blood clots can be lethal, as they can grow, dislodge,  and travel to the heart and lungs,  leading to a potentially deadly pulmonary embolism.  Pulmonary embolism is one dangerous cause of sudden death in people of all ages.  Some known predisposing factors that lead to the veins clots forming include decreased blood flow within the veins (i.e. venous stasis), damage to the blood vessel walls and the valves located within the vein walls, and thickening of the blood itself (known as a hypercoagulable state). Leg or foot swelling is one of the few potential warning signs that one can develop where there is a blood clot present in your body.  Therefore if you develop sudden onset of leg swelling of edema,  it is critical that you be evaluated by a doctor to ensure that you do not have a blood clot.  A simple duplex ultrasound test of the legs or a blood test called a D-dimer test are often the only test(s) required.

If you have undergone a basic workup by a doctor but you continue to have unexplained lower extremity swelling, you may need to be assessed for more unusual etiologies. This often involves assessing the vessels in the pelvis. Since the leg circulation has to drain through the pelvis on its ways to the heart, any abnormal circulation pathology in the abdomen or pelvis can potentially cause leg swelling. This can include a mass or tumor in the pelvis or groin that may be compressing your pelvic veins or pelvic lymphatics. Certain cancers can cause venous or lymphatic obstruction. There is potential for a venous clot or anatomical venous obstruction up higher in your abdomen or pelvis that could be obstructing normal flow out of your legs. May-Thurner Syndrome is an anatomical abnormality of the pelvis venous drainage that can present with leg swelling as its main symptoms.

These potential pelvic or abdominal pathologies that can lead to leg swelling are often assessed with either MRI or CT scans. If your doctor feels that these type of tests need to be performed, these tests will be scheduled through a radiology department. They often involve the administration of oral or intravenous contrast materials.

Diagnosis of Causes of Swelling / Edema

The most common way that the leg circulation is tested to evaluate a patient with leg swelling is a vein ultrasound, also known as a venous duplex study. Other methods of diagnosis include a D-dimer blood test, a CT scan (CAT scan), a MRI, or catheter venography. Some additional blood testing may be recommended to evaluate your organs for potential dysfunction.   These blood tests may include test of your kidney and liver function or your hormone levels.  Some patients, depending on their age and risk factors, will require a heart test such as an echocardiogram to test their heart function.  Physical exam by a doctor can aid in the diagnosis, but a confirmatory imaging test is typically necessary.

What Are Possible Complications of Leg Swelling?

That depends on the cause.  One possible complication of edema is steady progressive enlargement of the extremity over time, to the point where the excess fluid weight in the leg(s) is hindering your ability to walk or function normally.  One of the goals with leg swelling is to treat it as soon as possible.  The worse the swelling  gets the harder it is to treat.  In general, the longer that the edema is present the more difficult it will be for the body to get rid of it.  After a certain length of time the leg gets “used to” the swelling and will no longer try to get rid of it, as the body begins to see the leg swelling as an”expected norm”  So the sooner that treatment is begun, the better chances that it can be cured (and the less chance that it will become a long-standing chronic problem).

Other problems that can occur as the result of chronic leg swelling are the following: skin or tissue infections which can become recurrent, chronic pain, development of permanent skin damage or even skin ulcers, development of leg blisters, or compromise of the leg circulation. If a blood clot is the cause, more dangerous consequences are possible.  Blood clots can sometime lead to death or amputation of a limb.

Post-thrombotic Syndrome (PTS) is a chronic condition that can result many months or years after having a blood clot.  In this condition, the invovled veins become damaged long-term as a result of scar tissue formation or valve damage within the lining of the veins. This can lead to areas of obstruction or stenosis that hinders the ability of blood to circulate normally. If the valves are dysfunctional within the veins, this can lead to venous insufficiency or venous reflux, a chronic circulatory disease. This leads to a condition that is referred to as “venous hypertension” of the leg. The symptoms of this condition include long-term leg swelling / edema, chronic leg pain that is often worse with walking or prolonged standing, skin damage that often manifests as brown discoloration at the ankles, or skin ulcers of the leg (most often located on the inside of the ankles).

Treatment of Lower Extremity Edema / Swelling

There are many different treatment options available for edema.  The type of treatment recommended will depend on the cause of the swelling, the extent of the swelling, and the location of the swelling. The type and length of treatment will be determined by your physician.  Some simple and commonly applied treatment recommendations for most types of leg swelling include:  leg elevation, exercise / movement of the legs, and external compression with some form of support stockings or support hose.

Some other common treatment recommendatoins involve the use of diuretics (“fluid pill”) to get rid of the excess fluid, prescription compression stockings of the legs which help “push” the fluid out of the legs / feet, and interventional vein treatments of abnormal vein circulation to improve the direction of blood flow.   When venous insufficiency or vein valve dysfunction is present, venous ablation is often indictated.  Vein ablation often involves a laser treatment or vein injections in the doctors office.  When there is a venous obstruction in the pelvis, a catheter procedure with angioplasty or stenting may be indicated.

Obviously, if there is underlying organ dysfunction, then the organ involved will need to be treated in order to improve it’s function.  For example, if the kidneys are not working at 100% and allowing build-up of fluid in the body, then the kidneys will need to be treated.  If the heart if having problem and there is fluid build-up because of congestive heart failure or arrhythmia, the heart will need to be treated to improve its function.  If there is liver dysfunction causing fluid accumulation in the tissues, the liver will need treatment.  Remember that no matter what organ is having problems, the fluid always tends to go to where gravity carries it . . . since we live in the standing position the swellig typically builds up in the legs, ankles, and feet!

For blood clots, the most common treatment offered is anticoagulant medications, either Coumadin (Warfarin), Lovenox, Heparin, or a combination of these. When these medications cannot be administered for medical reasons (such as risk of bleeding), a metal filter device is often placed within the vein (known as an Inferior Vena Cava Filter or IVC filter). IVC filters can often be removed at a future date when they are no longer needed. Other common therapies include “clot-busting” or “clot-dissolving” medications that can be delivered through a catheter directly into the clot under x-ray guidance. One such medicine is referred to as t-PA or Tissue Plasminogen Activator. Other possible therapies for regions of vein obstruction or stenosis that do not respond to the medications include balloon angioplasty or stents placed into the vein under x-ray guidance. It is best to have a consultation with a Vein Specialist as quickly as possible after being diagnosed with a DVT so that all of your options can be discussed.

When lymphema is expected, pneumatic compression devices are often beneficial.  These are devices that are massaging velcro sleeves that you wrap around your legs.  These sleeves allow for continous or intermitttent leg massage and they are controlled by an electric box that plugs into an electrical wall socket.  External manual massage by a trained lymphatic massage therapist may be useful as well.

Prevention of Edema / Swelling of the Legs / Feet

Prophylaxis includes early and frequent exercise / movement, compression stockings, maintaining a normal body weight, treating any underlying medical conditions appropriately, and getting an annual physical exam to pick up any medical issues before they become a problem.  Please consult with a physician to find out which options are best for your particular situation.

Contact Our Leg Swelling Clinics

We have clinics in Austin as well as the Cedar Park / Round Rock Texas area just north of Austin. If you are interested in a physician consultation for evaluation of you lower extremity symptoms, please contact Austin Vascular Specialists@ (512) 964-8346.

Vascular Surgeon Dr. Joel G. Gotvald MD, serving Austin, West Lake Hills, Lakeway, Jollyville, Pflugerville, Cedar Park, Elgin, Bastrop, Taylor, Leander, Brushy Creek, Round Rock, Georgetown Texas and the surrounding areas.

Austin Vascular Specialists | Plaza North Building | 12319 N. Mopac Expy, Suite 250 | Austin, TX 78758 | 512-964-8346 | www.CardioVascularAustin.com

Austin Vascular Specialists | Synergy Building | 7700 Cat Hollow Dr | Round Rock, TX 78681 | 512-964-8346 | www.CardioVascularAustin.com

Spinal Cord Injury Update – Fall 2013

By Shawn Song, MD, SCI Medicine Fellow, UW Department of Rehabilitation Medicine

Contents

Edema is swelling caused by too much fluid in your body’s tissues. Edema in the lower extremities—feet, ankles and legs— is a common problem among patients with spinal cord injury (SCI). It occurs more frequently in people with SCI compared to able-bodied individuals because paralyzed muscles are unable to pump blood that has pooled in the legs due to gravity back from the leg veins to the heart. As a result, blood collects in the legs, and fluid from the blood leaks out of the vessels into the surrounding tissue. This type of edema is termed dependent edema (because the legs are “dependent” or hanging down while sitting). While there are several other medical conditions that can cause lower extremity edema, dependent edema is the most common type among patients with SCI.

Though you can usually tell whether edema is present just by looking, legs can sometimes appear normal if the edema is mild. A reliable way to detect edema is by pressing a finger into the skin over the lower shin. If an indentation remains for several seconds after removing your finger (called “pitting”), lower extremity edema is present (see figure on right). You can also examine the skin under your sock – an indentation left by the sock is an indicator of edema.

If leg swelling is asymmetric (not the same in both legs), this may be a sign of a more serious medical condition. For example, blood clots in the veins of the leg, a bony fracture, or an abnormal bone formation called heterotopic ossification, can all result in new, asymmetric leg swelling and require immediate medical attention. You should always let your medical provider know if you have any new leg swelling, even if in both legs, since this may be a sign of a new or worsening medical condition.

The major consequences of dependent edema involve the skin. Dependent edema, especially if long-standing, can cause the skin to become thin, fragile, and more vulnerable to breakdown. Significant foot swelling can cause shoes to fit poorly, potentially leading to pressure ulcers. If you already have a pressure ulcer, dependent edema can prevent or delay healing. Finally, dependent edema is a risk factor for infections of the skin of the legs, known as cellulitis. Be sure to seek immediate medical attention if you have edema along with new redness and/or warmth, since this may be a sign of cellulitis.

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Leg elevation

Elevating the legs reduces the effect of gravity and helps the fluid that has collected in the lower legs to drain back to the heart. The higher your legs are relative to the level of your heart, the faster fluid will drain out of your legs. For example, lying in bed with the feet at the level of your heart is generally better than raising your legs while seated. However, lying in bed is not always practical, so you can extend your legs from a seated position or perform tilt-backs in a power wheelchair at regular intervals to minimize fluid collection in the legs. Small studies have shown that elevating the feet by as little as 30 degrees for 15 minutes reduces the amount of lower extremity edema.

Precautions

• Take care to protect your skin while elevating your legs. If you are sitting down with knees straight and heels resting on a chair, make sure your heels are on a cushioned surface for no longer than 15 minutes in order to prevent a pressure ulcer.
• Another concern is the possibility of increased urine output as the lower extremity edema resolves. For example, if you have significant dependent edema and get into bed, the fluid from your legs returns to circulation, and your urine output overnight may be greater compared to during the day. You therefore may need to self-catheterize more frequently at night as a result of increased urine output.

Compression stockings

There are two main types of compression stockings—gradient and anti-embolism. Gradient compression stockings are the type appropriate for the majority of SCI patients. Gradient compression stockings are constructed so that the compression level is highest (or tightest) at the ankle and less at the top of the hose. This pressure gradient helps to minimize fluid collection in the legs and return blood to the heart. Gradient compression stockings come in different compression levels and can also be custom-made. There are also different lengths of stockings, from knee-high to thigh-high.

You should put on the compression stockings in the morning before getting out of bed, as your legs will have the least amount of fluid at that time. Make sure the stockings do not bunch or wrinkle as this can cause increased pressure over these areas. Consult a medical professional to determine the compression level and appropriateness of gradient compression stockings.

Precautions

• You should not wear compression stockings if you have peripheral artery disease (PAD). If there is any question of PAD, you will need to have a vascular evaluation including an ankle-brachial index.
• You should not wear compression stockings if you have active cellulitis of the lower extremities.
• If you are susceptible to autonomic dysreflexia, speak to your SCI physician before using compression stockings.
• If you have impaired hand function you will need to be supervised the first time you put on compression stockings to make sure you are putting them on correctly.
• Make sure to closely monitor your skin for evidence of irritation or breakdown when first using compression stockings and remove stockings at the first sign of skin irritation.

Medications

Diuretic medications, which help the body shed water, can treat some forms of edema. However, we do not recommend routine use of diuretics for dependent edema, as these medications can have unwanted side effects, especially related to low blood pressure.

1. Dependent edema is a common problem among individuals with SCI.
2. Dependent edema is caused by blood pooling in the leg veins, with fluid from the blood then leaking out of the vessels into the surrounding tissue.
3. Potential consequences of dependent edema include fragile skin, pressure ulcers, and infection of the skin called cellulitis.
4. New or asymmetric leg swelling may be a sign of a more serious medical condition and requires medical attention.
5. Treatments include leg elevation and compression stockings.
6. Compression stockings should be prescribed by a medical professional.
7. Patients should closely monitor the skin over their legs for signs of irritation when elevating them or when first using compression stockings.

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Leg Swelling in Aging: What to Know & What to Do

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

1. “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).
   1. This can happen due to severe infection or inflammation, among other things.

2. 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.
   1. Some causes of low albumin levels in the blood include certain types of kidney disease, liver disease, and malnutrition.

3. 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

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:

1. 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.

2. 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.)

3. 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:

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.

Dent on the leg: p_ster – LiveJournal

operator circle ( p_ster ) wrote,
2009-01-10 12:13:00 operator circle
p_ster
2009-01-10 12:13:00

Category: Literally about a month ago I noticed a dent on my leg, just above the ankle. And the first thing I thought was: “I recently took off my socks, probably a tight elastic band on top did it,” after all, it’s true that sometimes it happens when you wear “tight” socks.But for some reason the dent was only on the right leg and after many hours it did not dissolve anyway. It was then that I became nervous that I had worn these socks for too long (although I had not worn them for a long time) and now the dent will remain for life.
Imagine my relief when I once again sat down at my computer to check my mail, etc. The fact is that my desk on the right has a stand for the system unit, there is a system unit in it, and it itself is iron and sometimes terribly gets in the way. I have long ceased to pay attention to it, and yesterday I noticed that my leg constantly rests against it exactly in the place where I have a dent.
Now I am glad that I know where I got this dent from, but I will still rest my foot against the piece of iron, for it is convenient and already used to it.

• Taxi for taxi drivers or passengers?

  A heartbreaking conflict of interest has been unfolding for several years now. Yandex.Taxi has significantly reduced the prices for taxis, which is not very pleasant …

• Phone number change

  I’m thinking about changing my old regular number to a beautiful new one.The idea came when I came across an offer from one of the operators, …

• Game of trust

  By an absurd coincidence, a couple of years ago, I did not post here a link to this mini-game about trust. I am correcting myself, because more and more often I remember about …

Photo

Hint http://pics.livejournal.com/igrick/pic/000r1edq

Edema: causes, prevention, treatment

Problems and Symptoms

Kidneys.With kidney dysfunction, water and salt are poorly excreted from the body, which leads to edema. Also, with certain urological diseases, the amount of protein in the blood decreases (it is washed out in the urine), which also leads to swelling.

The symptoms are as follows: renal edema appears in the morning. The first sign is bags under the eyes and puffy eyelids. In the afternoon, the swelling becomes less or disappears altogether.

What to do: diuretic teas help to remove important micro and macro elements from the body, so do not waste time on self-medication, consult a urologist.

Cardiology. Another cause of edema is associated with heart failure. The heart cannot pump blood to its fullest, so it builds up in the legs, causing swelling.

The symptoms are as follows : cardiac edema occurs in the evening, and disappears in the morning. Most often, the ankles swell. In addition, there are manifestations such as pain or discomfort in the chest, weakness, shortness of breath, feeling of lack of air.

What to do: in order not to risk your well-being, seek help from a cardiologist.The doctor will prescribe drugs that normalize cardiac activity.

Varicose veins. This disease affects 80% of women and 30% of men. The main reasons: standing for a long time, sedentary work, genetic predisposition – sooner or later all this can lead to poor circulation in the legs, provoking varicose veins and swelling.

Symptoms are as follows: venous edema also appears in the evening (ingrained marks from the elastic of socks, stockings). With swelling, a feeling of heaviness appears, soreness in the legs and feet.

What to do: compression hosiery (socks, stockings, tights) will come to the rescue, which will improve blood circulation in the legs. For the correct selection of medical jersey, you need to contact a phlebologist and purchase it, preferably in specialized salons or pharmacy departments, where experienced specialists will select the appropriate model.

To reduce the manifestations of venous disease, you can use special pharmacy cosmetics (ointments, creams, gels), which reduce and facilitate the physical condition of varicose veins.

Hormonal disorders. Another risk factor is hormonal imbalance. For example, a disease such as hypothyroidism, when the thyroid gland does not produce enough thyroid hormones. In this case, special substances accumulate in the blood, forcing the tissues to retain water.

Symptoms are as follows: “hormonal” edema, as a rule, is localized on the legs. When pressed, a characteristic density is felt, but no traces remain. In addition to puffiness, other symptoms are observed: overweight, disturbances in the gastrointestinal tract (constipation), a rare pulse, increased drowsiness.

What to do: immediately make an appointment with an endocrinologist and go through the examination prescribed by him.

Allergy. With this disease, swelling very often occurs. It is important to note that allergic edema is both outside (swollen surface of the skin at the site of an insect bite) and internal. For example, if there is an allergy to a certain food and a person predisposed to it eats something dangerous, laryngeal edema can occur – a serious health threat that requires immediate medical attention.

The symptoms are as follows: redness, swelling appears at the site of the bite, and the skin begins to itch. With Quincke’s edema, the tongue, lips, tonsils, larynx usually swell, and if medical attention is not provided in time, a person may suffocate.

What to do: Antihistamines (tablets and ointments) will cope with slight swelling. If these drugs do not help, it is better to contact an allergist: you may need corticosteroids. If you suspect Quincke’s edema, you must urgently call an ambulance.Until the team arrives, they need to take an antihistamine and apply something cold to the swollen area.

Prevention methods

Of course, when eliminating puffiness, it is important to take into account that this phenomenon has different causes, therefore, the methods of struggle should also be different. However, prevention in most cases is the same:

• Spend more time being physically active: go for walks more often, play sports, try to walk regularly during the work week (take the stairs instead of the elevator, take a walk to the subway after work, etc.).etc.). While on the move, you can remove excess fluid from the body.
• Swimming is perhaps the most effective way to combat edema, as it improves blood circulation and strengthens the vascular system of the body.
• Massage of fingers and toes has a beneficial effect.
• Water procedures, for example, a contrast shower, are a good training for blood vessels and a preventive method of dealing with edema. While taking a shower, change the water temperature 5-6 times (hot – cool and vice versa).At the same time, do not forget that you need to get used to cold water gradually. Always finish the procedure with cool water.
• For the prevention of varicose veins, do special exercises every day. There are many different complexes on the Internet and you can create an individual exercise program that disperses the blood well and does not require high sports training.
• Wear high-heeled shoes as little as possible. Place a small cushion or pillow under your feet before bed.
• If your legs swell from heat and fatigue, during the day try to put them on a slight elevation for at least 10-15 minutes to facilitate the outflow of fluid.
• Bags under the eyes and swelling on the face are often caused by sleeping on your stomach, so sleep on your back.

Eating habits

• First of all, you should limit the consumption of spicy and fried foods, as well as liquids, especially before bedtime.
• The diet should contain steamed foods, herbs (primarily parsley, dill), fresh fruits and vegetables.
• Include “decongestant” products in the menu: apples, cottage cheese, tea with lemon. But if you have food allergies, avoid illegal foods and stick to your diet.
• It is useful to drink a decoction of flaxseed.
• It is desirable to reduce salt intake to 2–5 g per day. It is best to add salt to ready-made food to your liking. Season food with soy sauce instead of salt.
• The drinking regime for healthy people is 1.5-2 liters of liquid. While “cores” and “kidneys” are advised to coordinate the optimal amount of water and liquid products with a doctor.

Anti-edema cosmetics

Pharmaceutical and professional cosmetic products are the best to save from puffiness of various types.

• For edema of the eyelids – moisturizing creams and gels of light texture with extracts of parsley, Chinese mushroom, vitamin E and a lifting effect.
• In case of swelling of the body, the composition of the product should contain retinol and caffeine, guarana.
• If the legs are swollen, venotonic gels with a cooling effect will ease the condition.

What can be recommended from folk remedies:

• Warm baths will help with leg swelling. A tablespoon of mustard or sea salt per liter of water.
• Bags under the eyes can be reduced by making a mask with freshly grated potatoes and parsley. Compresses from broth of sage, parsley, chamomile, birch have also proven themselves well.

If the edema is not associated with any serious disease, then all of the above recommendations will help to cope with the problem.Otherwise, you cannot do without medical help and drug therapy, therefore, self-medication is unacceptable.

Source: Sofia Milovanova , journalist

Darkening of the skin

Structural changes in the epidermis indicate a severe stage of the pathology, so in no case postpone your visit to the doctor. Lack of oxygen and tissue death can lead to gangrene.

Darkening of the skin of the legs and feet can appear with chronic venous insufficiency, thrombosis or varicose veins. The main cause is blood stasis, slow blood flow or lack of oxygen in the tissues. That is why you need to deal with the problem from the inside. It is impossible to get rid of the defect with the help of cosmetics and procedures.

Often, this symptom is a sign of diabetes mellitus, because blood flow throughout the body is significantly impaired.This slows down wound healing, especially in the affected area. Infection is a serious complication, as it weakens the body as a whole, and the penetration of nutrients into tissues is complicated due to slow blood flow.

Darkening of the skin of the legs and feet may indicate gangrene. As soon as the veins expand and change their structure, and the blood begins to stagnate, circulation and oxygen supply to the tissues becomes more difficult. The same darkening of the skin of the legs and feet refers to thrombosis, because blood clots lead to narrowing of the lumen and gradual death of the vein.All this leads to external manifestations in the form of puffiness, darkening, pallor of the epidermis, etc.

When varicose veins occur, the operation of the valves changes. They do not cope with their functions, so the blood cannot rise up (does not overcome the force of gravity). Expansion occurs gradually due to stagnation of blood. This not only causes darkening of the skin of the legs and feet, but also provokes the onset of edema. The stronger the swelling, the more difficult it is to lead a habitual lifestyle (mobility decreases).

For what reasons do these diseases appear?

1. Work – if you are on your feet all day and cannot take a break, then this negatively affects the condition of the veins and blood vessels of the lower extremities. This includes the following professions: hairdresser, dentist, sales consultant, security guard, etc.
2. Genetics – genetic predisposition is an important factor that causes darkening of the skin of the legs and feet. If there are people in the family with chronic venous insufficiency or varicose veins, then you are at risk.
3. Injuries are not only injuries, but also surgical interventions. If the wall of a vessel or vein is damaged, then the body starts recovery processes. This can lead to the formation of blood clots, and then to a discoloration of the epidermis.
4. Hormonal changes – occur during adolescence, during pregnancy or taking contraceptives. Changes in the hormonal system can lead to thrombosis, varicose veins, chronic venous insufficiency, or spider veins.
5. Sports – Sports activities can have serious impact on the lower extremities. This is especially true for heavy sports such as powerlifting (work with critical weights).

Make an appointment with a specialist

If you notice darkening of the skin of the legs and feet, then consult a professional. The phlebology center “First Phlebological Center” conducts a comprehensive examination and uses the best methods of treatment that are practiced abroad.By contacting us, you will get rid of the cause of this pathology and receive further recommendations to exclude relapses. Call us now to make an appointment. 90,000 is a violation of the distribution of adipose tissue on the thighs, legs and pelvic girdle.

Lipedema is an inherited disorder of adipose tissue distribution

Lipedema is a non-obesity-related body fat. This is a pathological change with the result of an increase in the number of fat cells.Since lipedema occurs almost exclusively in women, experts suggest hormonal causes. Liver problems are common in some men who develop lipedema.

Symptoms and signs

In lipedema, the skin at the base of the second and third toes can be folded into a fold (negative Stemmer symptom). This is not possible with lymphedema (positive Stemmer symptom). Other signs of lipedema are a tendency to develop telangiectasia, bruising, or increased leg edema in the afternoon.

Unlike lymphedema, lipedema is always symmetrical. It is characterized by a “columnar” deformity of the legs. The typical sign is breeches on the thighs and buttocks.

If the disease spreads further down the legs, then they talk about such a phenomenon as a symptom of “trousers”, because the deformity always ends at the level of the ankles, which, however, are overlapped by folds of adipose tissue.

Lipedema is painful to pressure and touch. Subsequently, pain occurs even when wearing tight clothing.Unlike lymphedema, there is no Stemmer symptom in lipedema.

Breeches

Breeches are fat deposits on the buttocks, thighs and inner sides of the knees that are found almost exclusively in women.

Non-dietary fatty deposits

Women of lean physique are particularly affected. If body fat is not susceptible to dieting and sports, then breeches can be a sign of lipedema – a congenital disorder of the distribution of adipose tissue.

Another symptom of lipedema is a tendency to form telangiectasias, bruising, and tenderness to touch and pressure. Unlike lymphedema, both legs and sometimes both arms are affected.

Overview of clinical signs of lipedema:

• No Semmer symptom
• Symmetrical edema
• Pain when touched and pressed
• Bursting pain
• Telangiectasia
• Bruising
• Heredity
• Soft, knobby skin
• Sometimes hands are affected

Risk factors and causes

Lipedema affects almost exclusively women and girls, therefore hormonal changes are considered one of the developmental factors.Typically, lipedema develops at the end of puberty, during pregnancy, or at the onset of menopause. In addition, there is a genetic predisposition to lipedema.

Prevention

Sports and healthy eating help in the early stages of lipedema. Patients should exercise about three times a week for at least 45 minutes (the body begins to burn fat only after 30 minutes of exercise). It is important to wear compression hosiery when playing sports.This prevents the development of edema, since circulatory support prevents excess water from leaving the tissues.

There are a variety of treatments for lipedema.

Tips for Living with Lipedema

Lipedema is a chronic condition. The recommendations you follow in addition to medication will determine the success of lipedema treatment.

Sports

Sports are recommended, but only when using compression hosiery or bandages. Otherwise, the circumference of the limbs may increase. The following sports are recommended:

• Walking
• Walking
• Hiking
• Aerobics
• Aqua jogging and swimming are also recommended, which can be done without compression, as the water pressure acts as a compression product.

Comfortable clothes

It is important to wear loose clothing and comfortable shoes. Do not tighten the belts or buckles of laundry or clothing.

Balanced diet

The fat pads seen in lipoedema are not caused by overweight. This is why they cannot be counteracted by dieting.Nevertheless, losing weight and taking part in sporting activities (with compression) has positive effects. You should avoid putting on weight at all costs. If you are overweight, you should definitely try to reduce your body weight to a Body Mass Index (BMI) of between 19 and 25 and to maintain it.

Medicines

Unfortunately, tablets or ointments are not helpful in treating lipedema.

Skincare

For patients with edema, hygiene is very important. Use pH neutral products to keep your skin clean. Do not use deodorants on the affected areas of the body.

How is lipedema treated?

Compression therapy for lipedema

Lipedema affects almost exclusively women.Although it is impossible to cope with lipedema with diet or exercise, compression therapy works well and ensures that swelling does not develop further. This way you can control the swelling.

Compression hosiery reduces manifestations of lipedema, or at least stops its development. In stage 1 of the disease, it is often possible to use CCL 2 or CCL 3 circular knit compression hosiery. However, in most cases, experts recommend using flat knit compression hosiery.It is recommended to wear compression stockings every day, but at least three days a week (and also during sports). In the second stage, patients use flat-knit compression hosiery (with a seam). In the third stage, the same complex physical decongestant therapy is used as for lymphedema. The first phase of therapy begins with manual lymphatic drainage followed by compression banding. This is followed by a maintenance phase using flat-knit compression hosiery.

Other treatments: liposuction

Liposuction is another treatment. After this procedure, pits may form on the skin. This is largely hindered by the use of special compression products. Before liposuction, it is imperative to first consult a doctor.

Summary: If your legs, thighs, or buttocks begin to increase in size, don’t rely on diet alone. Check with your doctor if it is about lipedema.If the answer is yes, follow all of his treatment recommendations and exercise, but always using compression. Make sure your diet is balanced. This will keep you in shape and live an active life – even with lipedema.

Lipedema – Liposuction and follow-up treatment

Medi products

medi Compression Products will help you treat lipedema.Medi offers two different types of compression products for this:

Products for the treatment of lipedema

Human body

How do veins work?

Veins

90,000 Feet swelling in heat | GBUZ “Outpatient clinic No. 1 g.Novorossiysk “MZ KK

Summer heat is a serious test for the feet. It is at this time that many of us experience edema for the first time. Or have you known the problem for a long time? In any case, you do not need to put up with it, consider it a feature of the body, wait until it passes by itself. Swelling can be prevented, quickly reduced and even completely eliminated.

By the evening, the legs swell a little in most people, this is normal, if imperceptible and almost imperceptible. For this reason, it is recommended to buy shoes at the end of the day.If it is convenient in this state, it means that it will always be comfortable in a new thing.

But when:

• feet already in the morning do not fit into worn-out shoes;
• you and others can clearly see that the feet, ankles, shins have increased;
• you are experiencing discomfort in the lower extremities;
• when pressing on the swollen places, a dent remains and does not go away for a long time,

then this is a problem that requires a solution and, possibly, specific treatment.

Swelling of the legs occurs and worsens in summer, in the heat.

When the air temperature rises, the body reorganizes its work, trying to avoid overheating. The vessels dilate to allow more blood to pass through. But at the same time, it becomes more difficult for the valves of the veins of the lower extremities to push the blood upward. Its large volumes are delayed, the legs swell a lot. This happens most often in the summer.

Lymph also stagnates. Its free movement is impeded due to the fact that in the heat the body loses a lot of salt with sweat (and it helps to draw out the accumulated stagnant lymph fluid from the tissues).

The problem is exacerbated if a history of:

• varicose veins;
• diseases of the kidneys, heart and blood vessels;
• pregnancy;
• hormonal fluctuations;
• or the day before you “abused” alcohol, junk food, overworked and the body did not have time to recover.

What helps with edema

If a person, in addition to edema, has any diseases, they must be treated and controlled first. Means that must be taken without fail can only be recommended by a specialist.In this case, swelling of the legs in summer is a consequence.

If the legs swell during pregnancy in the summer, the question of what to do should also be resolved with the doctor leading the expectant mother. Only he is able to exclude the dangerous conditions of a woman and a child, he has the right to prescribe medications.

It happens that the legs swell a lot in hot weather, in this case, you can start with proven folk recipes.

• The easiest way is to lie down with your legs up. They can be leaned against the wall, placed on pillows.The outflow of blood will begin under the influence of gravity, the work of the venous valves will be facilitated, and the movement of lymph will speed up. In this position, you should spend at least ten minutes and repeat this “trick” several times during the day, one – necessarily before bedtime.
• Take a contrast shower, preferably with a strong massage pressure (this additionally trains the vessels).
• Move more during the day, but only in a variety of ways to better disperse the blood and lymph.
• Drink a lot in the heat.But not coffee or soda, but simple clean, maybe mineral water.
• Reduce your intake of unhealthy fatty, salty, spicy foods and, of course, alcohol.

And do not forget that in addition to drugs, there are effective herbal remedies for edema.

How to prevent edema

Warm up regularly. Sit at the computer – take breaks every hour: walk, do a few squats, jump in place.On airplanes and buses, there is less opportunity to get up and down, so warm up right in the chair: rotate your feet, tighten your glutes and thigh muscles, bend and unbend your knees, force your feet to work with rolling from toe to heel.

Sleep. At least 7 hours a day. If only simply because lack of sleep leads to chronic stress, and both of these factors provoke a variety of disorders in the body. And it’s good if you sleep with your legs raised up, for example, by placing a rolled-up blanket under them.And do not deny yourself the pleasure of just lying in bed with your legs thrown up for 15 minutes.

Drink. But smart. Don’t get thirsty: dehydration will make the body retain precious moisture and further provoke swelling (and a bunch of other problems). Replace coffee and soda with clean water or unsweetened compotes, fruit drinks, herbal teas. Drink 2-2.5 liters of water on a hot day.

Do not self-medicate. Do not drink any diuretic on your own in an attempt to remove “excess fluid”: all such drugs should only be taken under medical supervision.

Feel free. Put aside tight shoes, in which beauty requires inhuman sacrifices. Wear comfortable and loose shoes with low heels. Clothes – spacious, not restricting movement, made of natural fabrics.

Remember about water treatments. In the morning and in the evening – a contrast shower or at least contrasting douches for the feet. Do cool foot soaks with sea salt in the evenings to relieve fatigue and strengthen blood vessels.

Eat right. Lean less on salty, spicy, smoked, sweet: all this increases thirst and at the same time retains liquid. Eat dried fruits, they are high in potassium, which strengthens the heart muscle and blood vessels. Include in the diet more foods rich in vitamin A. These are carrots, parsley, bell peppers, sea buckthorn. Natural diuretics are also good, so they can be taken without a doctor’s prescription: cucumbers, watermelons, plums, zucchini, strawberries. It is worth adding lingonberry leaves or dill seeds to tea.

Swelling of the legs: symptoms and manifestations

First of all, you need to decide if there is a cause for concern.Even in a practically healthy person, edema may appear.

If the swelling of the legs is barely noticeable, rarely occurs, by the morning it completely disappears and is not accompanied by other troubles, you should not worry. Such edema can be dealt with without resorting to medical help.

Another cause of leg swelling is varicose veins. Under the influence of the sun, heat and an increased volume of fluid, the walls of the veins stretch, become thinner, and begin to let water into the intercellular spaces of the surrounding tissues.

First of all, venous insufficiency manifests itself in the legs. If on summer evenings your legs “buzz”, become “heavy” or “wadded”, you must definitely find time to visit a vascular surgeon.

Even without visible signs in the form of blue patterns under the skin, these symptoms may indicate developing varicose veins. In the early stages, venous insufficiency is well treated, the main thing is to get down to business on time!

People with overweight and relatively small footwear are prone to edema, those who suffer from flat feet, and also like to wear tight high-heeled shoes.

Pay attention to the toes: if the second toe on the foot is longer than all the others, the likelihood of developing edema, varicose veins and flat feet is minimal, if the fingers are lined up in an even ladder, alas, there is a risk.

There are other causes of edema: serious heart and kidney diseases, thyroid disorders, protein metabolism disorders, diabetes mellitus, liver disease, and so on.

If the edema is persistent, does not disappear after a good rest and gradually builds up, you cannot ignore it, blaming it only on the heat, especially if, in addition to the swelling of your legs, you have other complaints.Contact a phlebologist or vascular surgeon immediately.

If you have a tendency to edema, it is useful to do the following exercises:

1. Rolling from heel to toe and back will help relieve tension from the calf muscles and “disperse” the blood. Repeat this exercise 5-6 times every two hours. When you sit down at your desk, complement this simple gymnastics with circular movements of the foot in the ankle joint.

2. Don’t waste your time: while watching TV in the evening, take off your shoes, put a light rug or a piece of thick fabric under your feet, try to crumple it into an accordion with your feet.

Repeat 5-6 times. It is useful to roll a tight ball or rolling pin on the floor with bare feet: this is an excellent massage for your tired legs during the day.

3. Include the exercise “bicycle” in your daily morning exercise routine: while lying on your back, perform such movements with your legs as if you were participating in a bike ride.If you don’t have the strength for a “big” sport, just lie down with your legs up for a few minutes.

By the way, if possible, try to sit at the table, put your feet on some elevation and even sleep “backwards”, putting a pillow under your feet. This will improve blood flow and reduce the appearance of puffiness .

How to choose sneakers for everyday walking

Sneakers have long ceased to be just shoes for sports.The daily rhythm of life is conducive to walking several kilometers. Lovers of long walks should take care of the quality and comfort of the purchased footwear. How to choose the right running shoes for your everyday walking?

Sneakers are the perfect everyday shoe for a number of reasons:

• are designed to overcome long routes;
• can withstand significant external loads;
• are created taking into account the anatomical features of the foot;
• are represented by a wide range of models.

Good urban walking shoes should have a thick, cushioned sole, a stiff high heel for foot stability and joint fixation, and be flexible.

Running shoes are oriented towards the forward bending of the body, which is unacceptable when walking.

Requirements for sports shoes

There are several guidelines for understanding how to choose urban sneakers for everyday wear:

• Choose a durable sole to protect your foot from stones and bumps on the road;
• the heel must be strong and high;
• For walking on rough terrain, choose sneakers with cushioning;
• the presence of an instep support will prevent the appearance of flat feet and will not allow the leg to tire quickly while walking or doing fitness;
• Opt for moisture-wicking and easy-to-reach insoles;
• The upper part of the sneaker must be breathable, a mesh can be placed in the toe part, providing a proper level of ventilation of the foot;
• laces should not come loose when playing sports and moving around the city.

The type of walking determines the type of sneaker

How to choose a comfortable running shoe for walking on asphalt? Consider where and how you will walk. The type of walks forms the choice of the model for the set goals.

Choose comfortable and breathable sneakers for daily wear.

Choose lightweight, non-slip, and ventilated shoes for your gym and wellness walking. The main function of sneakers is to fix the ankle during sports.

Sneakers used outside the city are designed for up and down runs over long distances. The shoe has spikes on the sole, additional cushioning, and the heel and toe are made of durable material. If your shoe has a waterproof upper, it will provide protection from rain and moisture.

Scandinavian walking should be done in sneakers with flexible and embossed soles.

Pay attention to how to choose the right shoe size for walking on tarmac and out of town.Any footwear should not press, hinder movement, cause discomfort. Do not take your shoes back to back. Make a purchase in the late afternoon, when the leg is full in a day, so as not to be mistaken with the size.

Recommendations for men and women

Prefer branded sports stores over marketplaces. There you can buy high quality shoes, tailored to all standards and designed to be worn around the city and rough terrain.

Sneakers should not have a pungent smell, glue streams should not be allowed, the seams should be carefully processed.

Good lacing will provide a secure fit for your foot.

The insole plays an important role. It is good if it comes out freely from the shoe. High quality sneakers have a thick heel that has been stitched several times.

The elasticity of the sneaker is provided by the elastic socks. Press down on the surface, if the dent disappeared quickly, the shoes are suitable for walking.

The sole should bend at the toe of the shoe.If it bends in several places or does not bend, put those shoes aside.

Post-thrombotic disease

Such a common disease as deep vein thrombosis can lead to a combination of symptoms, which are united by the name “Post-thrombotic disease”, or PTB. This disease is accompanied by visible edema and is one of the types of chronic insufficiency of the veins of the lower extremities.

Factors provoking the onset of post-thrombotic syndrome

As you know, deep vein thrombosis is characterized primarily by an acute disruption of the normal venous outflow.Symptoms of this disease are severe swelling and acute pain. After a thrombosis treatment regimen is prescribed, blood flow is restored as the blood thinns and blood clots dissolve. However, at the same time, the lumen of the vein narrows, and the venous valves undergo cicatricial changes, which provoke a violation of their function. Over time, the throughput of the deep vein also decreases, which is accompanied by symptoms characteristic of chronic venous insufficiency, namely, pain in the legs and the appearance of pronounced edema.

Phlebologists distinguish four forms of PTB:

• varicose;
• edematous pain;
• ulcerative;
• mixed.

From the name of each type of syndrome, it is possible to understand which symptoms prevail in the patients affected by it.

A qualified specialist – namely, such doctors are receiving appointments in the department of phlebology “ON CLINIC in Ryazan” – can easily differentiate one type of post-thrombotic syndrome from another and prescribe an effective treatment that will help, if not to reverse degenerative processes in tissues, then at least stop the development of pathological changes in the lower extremities.

Signs of post-thrombotic disease

There are the following symptoms characteristic of patients suffering from post-thrombotic syndrome:

• severe swelling of the lower extremities, on which a deep mark from the elastic of socks or the seam of tights remains for a long time. After pressing on the ankle, a dent from the finger remains on it for a long time. Swelling of the legs does not go away even after a night’s rest;
• severe pain syndrome – patients describe pain as “pulling” and “bursting”.A slight temporary relief to the patient is given only by a change in body position – when he lies with his legs raised above the body, the pain decreases slightly. In some – quite rare, however – cases, pain appears only when pressing on the gastrocnemius muscle and when touching the inner edge of the foot;
• in 7 out of 10 cases, post-thrombotic disease is accompanied by secondary varicose syndrome , in which they become nodular and clearly stand out under the skin of the veins on the thigh and lower leg;
• Most patients with PTB experience leg cramps.They can be especially painful if a person was forced to spend a long time in a standing position, as well as during his night’s rest;
• If the patient does not consult a phlebologist for the treatment of the syndrome, then at the later stages of this disease, trophic ulcers that do not heal for a long time may appear on the skin of the affected limb. This does not happen all of a sudden – skin ulceration is preceded by thickening and hyperpigmentation; the adipose tissue located directly under the skin also becomes denser, gradually developing areas of the so-called “white atrophy”, in which the skin loses its pigmentation.

Diagnostics and treatment of PTB at ON CLINIC in Ryazan

To make a preliminary diagnosis, it is often enough to have only one face-to-face examination by one of our specialists. However, for confirmation, it is necessary to conduct an instrumental study, namely, USDG of the lower extremities. Our medical center is equipped with all the necessary equipment that may be needed to detect other venous diseases, for example, chronic venous insufficiency, varicose veins, including reticular varicose veins, thrombophlebitis, etc.etc.

Treatment of PTB involves the use of predominantly conservative methods and includes the following measures:

• Wearing compression hosiery;
• local treatment of trophic ulcers and other pathologies manifested on the skin;
• physiotherapy exercises prescribed by the attending physician;
• drug therapy, the purpose of which is to arrest all manifestations of the disease associated with chronic venous insufficiency;
• some types of physiotherapy, etc.