Dr KK Pandey
In our country, leg swelling emerges as the commonest problem out of all complaints pertaining to a leg. In some cases, there is a complaint of sudden onset of swelling and redness either in one leg or both. Majority of our complainants in India suffer from a classic case of swelling that appears in legs generally at the fag end of the day only. In the morning time, there is no leg pain and swelling but as the day advances, swelling begins to appear in the afternoon. In a few cases, people have persistent swelling in their legs. Sometimes, leg swelling is accompanied by black patches near the ankle. At the same time, ulcer with leg swelling also happens to be the main complaint by a significant number of people in India.
Present Scenario vis-à-vis leg swelling in our country
People suffering from leg swelling either recurrent or permanent do not know what to do and where to go. Out of their ignorance, they either visit some bone specialist or specialist in ancient medicines (ayurvedic or unani or homeopathic) or quack doctors practising in their vicinity. Sometimes they consult skin specialists, in case their leg swelling is associated with some black skin discoloration or ulceration. The sufferers are not at fault, as they mistake this leg ulceration for skin eczema. The process of consultation with various kinds of specialists other than a vascular surgeon goes on over a period of time. On the advice of their neighbours or friends or colleagues, the victim of leg swelling keeps consulting different doctors at various places with no relief in sight.
Why a sudden spurt in incidence of leg swelling problems ?
People in India are gradually adopting a daily routine or a lifestyle wherein a leg eventually becomes a casualty. People sit for long hours in the office in front of computers, ladies watch television serials dished out by various channels and spend at least 4-5 hours a day watching television. These television serials are designed and scheduled in such a way that housewives simply cannot resist temptation to watch. Even ladies who are office goers are hooked up to TV sets daily after office hours.
Due to the tremendous availability of different kinds of attractive video games on computers and mobile phones, children and teens keep away from playing fields and physical games. In nutshell, these computers and television sets are steadily emerging as enemies of legs. Call centers and BPO jobs are definitely causing occupational health hazards especially to legs in particular.
How does your lifestyle affect your legs?
If you have adopted a sedentary lifestyle due to affluence or have taken up a job that requires prolonged sitting or prolonged standing, your legs are bound to suffer from problems of leg swelling. Prolonged sitting causes disturbance in the drainage system of the leg, as the muscular pump in your legs stops functioning properly. This harms your leg in two ways. Firstly, it leads to an accumulation of large quantities of impure and oxygen-deficient blood in legs for a time longer than required. This causes discomfort, early fatigue, irritation and pain in the leg. Secondly, it may choke your leg veins due to blood clotting, triggered by stagnation of impure blood in legs.
Sudden Painful swelling in leg
A comfortable sedentary lifestyle associated with prolonged sitting in front of computer and total lack of active exercise may cause danger to your leg and life as well. Such a lifestyle, where overeating with no regular walking is the norm, will lead to accumulation of blood clots in legs. This condition in medical terms is called D.V.T. (Deep Vein Thrombosis). If this condition is not managed in time, it may pose danger to life, due to a complication called Pulmonary Embolism. In this dangerous condition, blood clots slip up from the leg veins, move upwards and reach lungs via heart and clog main blood pipes of the lung. If timely intervention is not done, a person may die eventually. Always consult a vascular surgeon in time whenever there is a complaint of sudden development of painful leg swelling.
Persistent Swelling in leg
If you find leg swelling always present and there is no significant change in size of leg swelling from morning to evening, it could be due to two reasons. One, the impure oxygen- deficient blood may not reach towards the heart in totality, resulting in accumulation of remainder of impure blood into legs. In this situation, a person might have a little less swelling in the leg in the morning , but by the end of the day it comes back again in its original size. The second reason is the obstruction in venous flow due to blockade of veins. This blockade results due to incomplete or no treatment in the initial stage of deposition of blood clots in deep veins of legs called DVT. All these factors lead to permanent swelling in the leg. This condition is called in medical terms as P.T.S. or Post Thrombotic Syndrome. Therefore, whenever you develop a sudden leg swelling and have doubts of having clots in deep veins of your leg, get in touch with a vascular surgeon without fail and get treated promptly under his supervision to avoid developing P.T.S. in legs.
Leg swelling with blue-colored veins
Whenever a person does not do daily regular morning walk or has not developed yet a habit of walking and leg exercise, the drainage system of leg gets disturbed and valves inside the leg vein stop functioning normally. This leads to failure of normal upward movement of impure blood and thus causes pooling of a large quantity of oxygen-deficient blood into the lower portion of legs near the ankle. When pooling of blood inside the leg crosses beyond a prescribed and tolerable limit, the veins situated just underneath the leg skin surface begin bulging outside and well seen prominently from outside. These spider or earthworm-like blue-coloured veins visible prominently on leg skin are called in medical terms as “varicose veins”. If a person continues his sedentary lifestyle and does not seek advice from a vascular surgeon, these varicose veins get enormously enlarged and sometimes become a source of bleeding from the leg.
Leg swelling with black spots
Our countrymen quite often suffer from this condition of painful leg swelling with the appearance of round oval black patches or spots on skin specially near the ankle region. Quite often they complain their legs are almost swelling- free in the morning but as evening sets in, the leg swelling reappears. This typical problem is generally prevalent among middle-aged ladies and persons who are overweight and sit continuously for long hours especially in shops or in offices in front of computers. This condition is known as C.V.I. (chronic venous insufficiency) in medical language. If black spots appear in the lower part of your leg, consult a vascular surgeon for advice.
Other causes of leg swelling
Besides diseases of veins, there are other reasons for leg swelling, like Lymphedema, elephantiasis, diseases of kidney and heart and medicines used in blood pressure control like Amlodipin etc. Lymphedema or ‘elephant leg’ is common in damp and foothill areas where mosquitoes are in plenty. One can get rid of leg swelling only after the cause of leg swelling is controlled.
What will happen if a leg swelling is not treated?
If a leg swelling is not treated, it will result in two main problems. Firstly, these veins will keep enlarging and eventually give way. This will lead to bleeding. Sometimes, due to enormous and uncontrollable bleeding, hospitalization becomes necessary. The second disadvantage is the development of itching and pain in the lower leg. After persistent scratching, a yellow- colored fluid starts oozing out from the site of scratch and this fluid irritates the surrounding skin and causes eczema- like the picture. Finally emerges a non-healing, wet and infected ulcer in the leg and people just out of their ignorance, go to a skin specialist for consultation. Therefore, one should take leg swelling seriously and consult a vascular surgeon without any further delay.
Where to go if you have a leg swelling?
If you have suddenly- developed or permanent leg swelling, you should visit those hospitals where exists a fully functional department of vascular surgery and a full-time vascular surgeon is there. Before entering a hospital make sure about the availability of modern investigations like angiography, MRI, Ventilation perfusion study of lung, venography and Doppler studies. In our country, a patient of leg swelling especially of sudden onset generally goes to a hospital which is devoid of these mandatory specific investigatory and treatment facilities and thus wastes his precious money and time. This ignorance cost a patient very heavily.
Treatment strategy in leg swelling
If a person develops leg swelling suddenly, he needs urgent hospitalization and efforts are made to dissolve the blood clots lodged inside the leg veins. Special techniques and medicines through intravenous routes are used to normalize the condition. Generally, surgery is not required in such cases. A drastic change in daily routine is needed. Regular morning walk, special limb raising exercises, specific medication and use of G.C. stockings are to be followed to avoid recurrence of the problem.
If a leg swelling with varicose veins are there, a laser surgery or radio frequency ablation technique are used to control varicose veins and swelling. In these methods, no skin cuts are made and the patient can resume his office work from the very next day. In the end, I would say if you have a problem with leg swelling, consult a vascular surgeon promptly without wasting further time.
The writer is Senior Vascular & CardioThoracic Surgeon, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,India and he can be reached at 9911,114081; 9810,114081, Email: [email protected]