Why do your legs swell – is it fluid, fat or something else? DR SRIRAM NARAYANAN, Senior Consultant Vascular Surgeon at The Harley Street Heart and Vascular Centre, discusses what causes swollen ankles or legs.
Why your legs and ankles swell
Did you know that humans were never quite designed to stand upright? Various studies have documented how our bodies were originally structured to live on all fours. Over time, however, adaptation to bipedalism meant that we have developed various ways to return blood and fluid back to the heart against gravity.
When these mechanisms fail, fluid builds up in the legs and ankles, resulting in swollen ankles or legs. In some cases, an abnormal distribution of fat may be the cause. The knowledge that limb swelling is essentially related to poor circulation and may be a harbinger of more serious underlying conditions is medically well known. Despite this, few people seek a circulation specialist for advice.
How your circulation plays a role
Blood and fluid return to the heart to be pumped forward via two basic routes. First, the veins, which carry blood, and second the lymph vessels, which carry fluid drained from between the cells. Blockages in the veins from clots (also known as thrombosis) can lead to sudden leg swelling accompanied by pain and redness in the calf. If the valves within the veins are also functioning poorly, varicose veins may result.
On the other hand, poorly developed lymph vessels may lead to progressive accumulation of fluid in the legs over many years. Lymph glands, which serve as “motorway stations” along the lymphatic route, may become clogged due to infection. Additionally, the heart itself may not be pumping efficiently due to underlying heart disease. Indeed, silent heart failure is not uncommon and is frequently missed.
Of course, as with so many other modern lifestyle issues, fat has a role to play as well. Being overweight is a common cause of leg swelling. This can be both from direct accumulation of fat tissue as well as how excess weight slows down blood flow in the veins. In some women, however, this may be due to lipoedema. This is a condition where lumpy fat accumulates in the legs, and sometimes the thighs and buttocks, while the torso remains slim. Typically, the feet are not involved. This a frustrating genetic condition, and it can cause much distress.
When to visit a specialist for your swollen ankles and legs
From vein and lymph vessel issues to fat accumulation and possible heart disease, a common red flag is swollen legs. Leg swelling, whether on one leg or both, should be looked into in a stepwise and deliberate manner. This can help to diagnose where the circulation might have gone wrong. Most causes are innocuous and can be easily managed with lifestyle or diet changes, targeted exercise, or perhaps a minor procedure or medication from a vascular specialist.
However, to ignore swollen ankles and legs or sudden calf pain may mean missing a possible underlying condition. That’s especially true if the swelling lasts a few days after a flight or you observe some brown pigmentation above the swollen ankle. After all, your circulation is your lifeline.
The Harley Street Heart and Vascular Centre (Gleneagles Hospital)
#02-38/41 Annexe Block, 6A Napier Road
WhatsApp 8822 8164 | vascular.harleystreet.sg | circulation@harleystreet.sg
This article on The Harley Street Heart and Vascular Centre first appeared in the November 2024 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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