TLC Asked :
I’m a 42 year old female, 15 lbs overweight, otherwise healthy. For over 2 weeks now, I’ve had unilateral (R), pitting edema of my lower right leg, ankle, foot. All of the tests ordered by the doctor came back normal (Doppler US, chest x-ray, ankle & knee x-rays, lab tests to check heart & kidneys) – no DVT or Baker’s Cyst found.
I’ve been using Epsom salt soaks & have been keeping my leg elevated regularly. I tried wearing a compression stocking one night but woke up in pain so I took it off & haven’t worn it anymore. Swelling has gone down slightly a couple of times when I stayed off my feet for a few days – but, the swelling keeps returning to the point where it’s hard to move my toes or bend my leg at the knee because everything is so tight.
My history for this leg involves a broken & healed ankle (avulsion fracture) 4 years ago. I also twisted my ankle about 2 months ago – but, there was no swelling and the discomfort from twisting it didn’t last more than 20 minutes. The week before I noticed the swelling, I did experience some tightness behind my right calf/knee while I was using a new elliptical exercise machine.
In the same weekend that I noticed the swelling, I had driven out of town and back in less than 2 days (6 hours up and 8 hours back). Other than stiffness, the only time I’ve felt discomfort is during the few instances when the swelling receded slightly. So, since my doctor didn’t know what else to do, I went with the assumption that a combination of factors produced some sort of soft tissue injury and that I would just have to wait it out.
However, I am curious if this is the wisest course to take. If it’s not a soft tissue injury – then, I could be exercising which usually helps most health issues. How can I know – and, will it just get better on its own? Could there be something else that could be getting worse by not addressing it? Do you think I should see someone else for another opinion or just wait and see?
This question was posted under the Swollen Legs and Swelling of the Feet article.
Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.
Dr. Chris Answered :
A ‘wait and watch’ approach should only be adopted if you have been examined by a doctor and he or she has advised so.
Pitting edema is the most common type of edema and should always alert you to possible conditions of the heart, kidney or even the liver. As you have indicated, your doctor has conducted extensive tests and this should have been detected if they were the cause. If you are not certain, it would be wise to seek a second opinion and undergo these tests again. A CT scan of the chest and abdomen, ECG and LFT (liver function test) is also advisable.
While peripheral vascular disease often causes this type of swelling, especially during and after movement, the fact that this has been excluded does raise other serious concerns. Cellulitis may be a possibility but you would have experiencing significant pain at this point. Certain autoimmune disease and connective tissues may also be a consideration.
If it was soft tissue injury with accompanying inflammation, then you would be experiencing significant pain which should respond to anti-inflammatory drugs and this is not present from what you have mentioned. Since exercise is aggravating your condition, you should definitely not continue with it despite the health benefits of exercising. At least not until your doctor says that it is fine to go ahead with it.
There are so many possibilities that may be contributing to this swelling. As mentioned above, the heart, kidney and liver is the first consideration. Inflammation of the veins, varicose veins, water and salt retention, infections, cardiac or liver failure, DVT (undetected), arthritis, osteomyelitis, certain types of bone cancer, diabetes, sarcoidosis, autoimmune diseases like Hashimoto’s thyroiditis (a form of hypothyrodism) and even drug side effects can be causing this swelling. As you can see, the list is endless for possible causes of leg swelling. Refer to the article on Diseases that Cause Edema.
If you are not satisfied with the advice and treatment from your current doctor, then you should definitely seek a second opinion. For now, stay off your feet as much as possible, do not exercise and avoid any massage or related therapies until your doctor completes all tests and makes a final diagnosis.
Lastly you should take note of old injuries which may have not completely healed and are now showing symptoms due to your increased body weight. Age is also a factor here as bone degeneration is known to aggravate previous fractures.
Article reviewed by Dr. Greg. Last updated on April 19, 2010