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Painful, Swollen Legs? 3 Possible Causes

Feb 01, 2024
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Painful leg swelling isn’t something you can ignore and simply “hope for the best.” Instead, it should prompt you to seek expert evaluation and care ASAP. Learn more about three common — and serious — causes of painfully swollen legs.

First, your lower legs just looked a bit different. Maybe they seemed slightly puffy, or maybe your socks felt tighter. Then, your legs started feeling uncomfortably heavy or numb — just as your calves, ankles, feet, and toes swelled, tightened, and lost their definition.  

Painful leg swelling can be distressing and concerning; they can also limit your mobility, derail your daily routine, and interfere with your ability to sleep at night. 

Given that there are dozens of possible reasons for lower extremity swelling — ranging from relatively harmless to very serious — it’s important to have the problem evaluated by our skilled team of vascular experts at Somerset Surgical Associates, LLC, as soon as possible.    

Here, we discuss persistent leg pain and swelling and three of its most common causes. 

Leg swelling: Inflammation or fluid retention? 

Uncomfortable lower extremity swelling has a wide range of potential causes, all of which fall into one of two categories: inflammation-driven swelling and swelling that occurs because of abnormal fluid retention. 

Inflammatory swelling

Inflammatory leg swelling is commonly a sign of an acute injury (i.e., joint sprain, muscle strain, bone fracture), an infection, or excessive immune system stimulation from a chronic condition (i.e., osteoarthritis) or autoimmune disorder (i.e., vasculitis). 

The pain that accompanies this type of leg swelling tends to be localized around an affected joint, bone, or muscle; pinpointing and treating the underlying cause of the inflammation is usually all it takes to reduce or control swelling and pain.  

Edema-related swelling 

Just as often, leg swelling is a product of fluid accumulation in your lower extremity tissues. Known as peripheral edema, this type of swelling can be:  

  • Temporary, painless, and self-resolving  
  • Persistent, mostly stable, and painless
  • Ongoing, progressive, and uncomfortable  

For example, your legs may become temporarily swollen after hours of sitting, such as what might happen during lengthy car or airplane travel. The problem isn’t usually painful, though, and it tends to resolve once you resume normal movement. 

Lower extremity fluid retention that persists without pain and stays mostly stable (doesn’t typically worsen) can be a side effect of pregnancy, certain medications, or a high-sodium diet. 

How poor circulation leads to persistent swelling  

Your cardiovascular system works with your lymphatic, urinary, and digestive systems to keep your blood moving and your bodily fluids balanced. When disorder or disease affects any part of this process, chronic peripheral edema may emerge.    

Persistent leg swelling that progressively worsens over time often stems from poor circulation. Slow blood flow leads to lower extremity swelling through blood pooling, vascular stress, and capillary leakage; insufficient fluid clearing causes edema through the buildup of bodily fluids. In some cases, both problems play a role in painful leg swelling.  

Three common causes of painful, swollen legs 

For aging adults, poor circulation is a frequent cause of fluid-related leg swelling and pain. Three of the most common conditions behind the problem are:   

1. Chronic venous insufficiency

Chronic venous insufficiency (CVI) is a progressive, circulation-impairing condition that occurs when the one-way valves inside your leg veins become weakened or damaged, causing blood to pool behind them and exert pressure on the surrounding vessel wall. 

Besides setting the stage for spider veins and varicose veins, this condition can lead to slow circulation that causes ongoing blood pooling, vascular leakage, localized tissue swelling, and intermittent leg pain or heaviness.  

2. Peripheral vascular disease

Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD), occurs when cholesterol builds up in the walls of your peripheral blood vessels, or the arteries and veins in your legs, arms, stomach, and head.   

As plaque deposits gradually harden and narrow the vessels in your legs — a condition called atherosclerosis — your lower extremity blood flow slows and makes your legs swell. Early on, PVD is associated with claudication, or leg pain during exercise; as it progresses, it can cause ongoing leg pain, cramping, and fatigue.   

3. Heart, kidney, or liver disease 

Lower extremity fluid accumulation is a common warning sign of vital organ dysfunction, including heart, kidney, and liver disease. Leg swelling is often the first noticeable sign of congestive heart failure, which occurs when the heart no longer circulates an adequate blood supply through the body. 

When your heart stops pumping efficiently, blood pools in your lower extremities. Heart failure also causes reduced blood flow to the kidneys, which in turn causes them to retain sodium and water, contributing to a “fluid buildup overload” that exacerbates peripheral edema.  

Comprehensive care for lower extremity edema

Painful leg swelling isn’t something you can ignore and simply “hope for the best.” Instead, it should prompt you to seek expert evaluation and care ASAP. Once our team identifies the root cause of your problem, we can develop a tailored treatment plan to alleviate your symptoms and protect your health. 

If you’re dealing with leg swelling and pain, don’t wait — give us a call today, or click online to schedule a visit at Somerset Surgical Associates, LLC, in Somerset, Somerville, or Hillsborough, New Jersey, anytime.