By Elliot Sambol, MD and Kelly Gray, PT
Do you ever feel as if your legs are made of lead?
That heavy, uncomfortable feeling can occur when fluid backs up or pools in the legs, causing them to swell.
Leg swelling is a common condition that can range from mild to severe and can have a variety of underlying causes, including lymphedema or chronic venous insufficiency (CVI) — or in many cases a combination of the two.
If you are experiencing leg swelling, it is important to see your doctor for a proper diagnosis.
At Penn Medicine Princeton Health, patients have access to a variety of effective treatment options to reduce leg swelling and manage the underlying cause.
Understanding Lymphedema and CVI
While lymphedema and CVI are distinct conditions, they can often occur together, as both involve issues with the circulation and drainage of fluids in the body. Your lymphatic system is network of tissues and organs made up of lymph vessels and lymph nodes that drain lymph fluid (which contains white blood cells, water, proteins, salts, and lipids) from all over the body.
When the lymphatic system is damaged or blocked, it can cause an accumulation of water and proteins in your body’s soft tissues. This can lead to lymphedema — or swelling — which can occur anywhere in the body but is most common in the arms and legs.
CVI, on the other hand, is a condition in which the veins in the legs are unable to properly return blood to the heart. This can cause blood to pool in the veins, leading to swelling and other uncomfortable symptoms.
Causes
Lymphedema is often a result of cancer treatment, but it can also occur in patients who have been diagnosed with a variety of conditions, including those with damage to their vascular system and those who are experiencing congestive heart failure, a severe infection, or those who are obese.
CVI is often caused by a combination of factors, including aging, obesity, and a history of blood clots or vein damage.
Symptoms
In cases of both lymphedema and CVI, swelling is one of the most common symptoms.
Other symptoms can include:
- A heavy or tight sensation.
- Pain or discomfort.
- Limited range of motion.
- Thickening or hardening of the skin in the affected area.
- Discoloration of the skin.
- Recurrent infections in the affected limb.
- Ulcers or sores.
Left unmanaged, lymphedema and CVI can lead to loss of functional mobility and the ability to accomplish activities of daily living.
Additionally, lymphedema and CVI may cause people to feel embarrassed, depressed, or frustrated because of how the condition makes them look and feel.
Treatment
Treatment for both lymphedema and CVI often involves a combination of lifestyle changes, such as exercise and weight management, as well as medical interventions like compression garments, massage, and in some cases, surgery.
The Lymphedema Management Program at Penn Medicine Princeton Medical Center Princeton Rehabilitation focuses on treating the swelling associated with lymphedema and CVI as well as helping patients manage symptoms.
Certified therapists offer one-on-one treatment and education that are tailored to meet each patient’s specific needs.
- Exercises aimed at helping fluid drain, decreasing swelling, and improving strength,
range of motion, and function. - Manual drainage massage to help push the fluid out of the swollen area.
- Compression bandaging to encourage removal of fluid in the area.
- Compression garments such as sleeves or stockings to help reduce fluid in the area.
For patients who may benefit from compression garments, proper fit of the garment is critical to ensure the maximum health benefits. A trained therapist must ensure they have selected the correct length, size, and level of compression.
Therapists at Princeton Rehabilitation use sophisticated 3D imaging software that, in just 60 seconds, captures precise limb circumference measurements to ensure the proper fit of custom or over-the-counter garments.
The traditional approach is a cumbersome process of manually measuring the patient’s arm or leg along many different points, which can take more than 15 minutes.
For 3D compression garment measuring, patients must have a prescription from their doctor. Most insurances are accepted.
Prevention
While there is no sure way to prevent leg swelling associated with lymphedema or CVI, there are ways to lower your risk and reduce its severity.
- Maintain a healthy weight.
- Exercise regularly to keep your blood and lymph fluid moving.
- Protect your skin from infection, particularly for patients at risk of lymphedema.
- Avoid sitting or standing for prolonged periods of time. Get up and move around.
- Avoid wearing restrictive clothing.
Though leg swelling is a common condition, especially with age, treatment is available to help get the fluids — and you — moving again.
To view a brief video and learn more about 3D compression garment measuring at Princeton Rehabilitation, visit princetonhcs.org and type “lymphedema management” in the search bar.
To find a physician affiliated with Penn Medicine Princeton Health, call 888.742.7496, or visit www.princetonhcs.org.
Elliot Sambol, MD, is a board-certified vascular surgeon and a member of the Medical Staff at Penn Medicine Princeton Health. Kelly Gray, PT, is a licensed physical therapist and rehabilitation manager with Penn Medicine Princeton Medical Center Princeton Rehabilitation.
