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Many Americans live with swelling in their legs on a daily basis and have come to accept it as a normal part of life.
Swelling in the legs can be caused by a variety of issues, some of which are less serious and some of which are life-threatening. Fluids can get trapped due to obstruction of the lymphatic vessels, injury, some medications, infection, low blood protein levels, obesity and pregnancy. Leg swelling, pain, or tenderness in the soft tissues,  are important reasons to seek professional help as untreated symptoms can lead to infections, clots or more serious health issues. Swelling of the ankles and legs is common and patients usually seek advice because they want to know the cause.
Lymphoedema is the excessive accumulation of interstitial fluid as a result of defective lymphatic drainage. There may be associated haemosiderin and atrophic or ulcerated skin changes around the ankle. Examin the groins for pathological lymph nodes and a rectal and vaginal examination are indicated if a secondary cause is suspected.
In long-standing cases the skin is hypertrophied and lichenified with cracks in the interdigital clefts. Pelvic and abdominal ultrasound to identify masses which may be compressing the pelvic veins or occluding the pelvic lymphatics. Photoplethysmography will confirm the findings of the duplex scan and provide information about the patency of the pelvic veins. Radionuclear lymphscintogram is a simple test in which a small volume of a high-energy-emitting colloid-bound radionucleotide is injected into a webspace in both feet.
If oedema is a major problem or there are concomitant venous leg problems then surgical intervention may be required. Counselling explains that the disorder does not involve any major pathology and although it may progress it very rarely requires surgery. The patient and their partner can be taught leg and foot massage which provides both psychological and physical relief.
Drug treatment is of little proven value and diuretics and anticoagulation should be avoided.
Antibiotics should be given promptly and hospital admission will be required if there is no rapid response.
Prevention requires careful foot hygiene, including the use of antifungal powder or cream to prevent athlete’s foot. Should only be undertaken when the heaviness of the leg is severely hampering the patient’s quality of life. It is possible to remove the mass of oedematous fatty tissue under the skin, superficial to the muscular fascia; only half the leg is treated at a time. However, if patients are selected carefully a very high patient satisfaction rate is achieved. Cyclocross started in Europe more than one hundred years ago when cyclist were looking for a way to stay fit in winter. Cyclocross requires the power of a sprinter, the speed and endurance of a time trialist, the bike-handling skills of a mountain biker and the tactics of a road racer. It is not surprising that cyclocross has become the fastest growing part of the sport of cycling in the U.S.

Events foster a festive atmosphere and encourage everyone to have fun while racing as hard as possible.
Swelling of the legs is abnormal and should be evaluated by a physician if it occurs more than occasionally after a long day of sitting or standing. Swelling may occur due to high pressure in the veins of the legs, local injury, inflammatory changes, obstruction of lymphatic fluid outflow, infection, low blood protein levels, obesity, pregnancy, fluid retention states, or drug effects. Failure of the calf muscles to pump venous blood out of the legs due to stroke, venous injury, arthritis limiting ankle motion, or inactivity. Localized swelling may be due to trauma, hematoma (collection of non-flowing blood in the soft tissue), infections, fracture, superficial thrombophlebitis (clots in veins of the fatty tissues), rupture of a tendon or muscle, cyst at a joint (such as a synovial cyst at the knee), and, sometimes, spontaneous bleeding into the tissue due to a ruptured blood vessel. Some of the most common medications which cause leg swelling are non-steroidal anti-inflammatory drugs taken for pain relief or for arthritic discomfort and calcium channel blockers taken for heart disease or hypertension.
Cellulitis, infection of the skin and fatty tissues of the leg may cause swelling with pain and tenderness.
Swelling of the foot, especially if the skin does not pit with brief application of pressure, may be due to lymphedema, a failure of the microscopic network of channels which move tissue fluid from the extremity back to the blood stream at the level of the upper chest. After venous insufficiency, obesity is the next most common cause of lower extremity swelling in the United States. Routine daily use of graduated compression support hose, often rated at a compression level of 20-30 or 30-40 mm Hg.
Lymphedema may require special treatments called manual lymphatic drainage to massage the legs over a period of time with wrapping of the legs in special “short-stretch” elastic wraps and, sometimes, compression pump therapy to mobilize lymphatic fluid from the legs back to the bloodstream in the chest by intermittent squeezing of the legs.
Management of swelling of the legs often becomes a lifelong issue, but it is important because swelling will increase the risk of infection or leg ulcer and the underlying conditions may be associated with serious complications such as deep vein thrombosis or difficulty healing injuries or surgical incisions.
The most common causes of leg swelling or soft tissue pain or tenderness in North America are venous insufficiency and obesity. In some cases it means nothing more than a bit of discomfort, but with the potential of bigger health issues on the line, leg swelling isn’t something to ignore or take lightly. Among the lesser-known and less common causes are kidney failure, heart failure, hormone therapy and preeclampsia (high blood pressure caused by pregnancy).
Believe it or not, gravity also plays a part in legging swelling issues, particularly if you sit or stand for long periods of time.  The most common causes of leg swelling in North America are Venous Insufficiency (failure of the one-way valves in the veins) and obesity. Your specialist should look at family medical history, your medical past and examine your legs while you are standing.  If you have any leg swelling or varicose veins, it is important to get a lower extremity venous ultrasound examination which evaluates the veins for blockage and for valve leakage. The sequential segmental machines such as the lymphopress are probably more effective than the single chamber boots, but are usually more expensive.
To prevent this the patient needs to oil the skin at least once a day with a low allergenic oil; often olive oil is best. Infection is more likely, causing increased swelling and cellulitis which can spread rapidly. Pain or tenderness in the legs associated with swelling is an especially important reason to seek evaluation. Further testing is based upon the clinical assessment and may include ultrasound, X-ray,CT, or MRI imaging in the legs or evaluation of the heart or blood vessels in the abdomen or pelvis. The causes of swelling in one leg may be similar to the other leg, but it is not unusual for different factors to cause the swelling in each leg.
High pressure in the veins of the legs results in fluid, proteins, and blood cells leaking through the wall of small veins into the soft tissues, especially near the ankles.

Pain from cellulitis may be very severe or may manifest as tenderness and mild pain with faintly pink to bright red skin. Frequently, conservative measures are helpful and these often are started before the cause of the swelling is fully evaluated.
Resolving lower extremity swelling, if possible, prior to extremity surgery is an important means of reducing the chances of wound healing complications including bleeding, hematoma, wound breakdown, or infection. More common causes include thrombophlebitis (vein inflammation related to a blood clot), chronic venous insufficiency, and the general trapping of fluids in the legs. Venous Insufficiency can be treated with foam sclerotherapy, endovenous thermal ablation, and microphlebectomy. It’s also possible to have two different causes of leg swelling in two different legs, and it’s not unusual for swelling to be caused by more than one factor – like Deep Vein Thrombosis AND obesity. In some cases, the high pressure in the veins causes fluids, proteins and blood cells to seep through the vein wall into the soft tissues, particularly around the ankle.
This exam is not generally available except in specialized vein centers and is very different from the exam usually performed through emergency rooms and general medical clinics. The easiest way to prevent and fend off future issues with leg swelling is to maintain a healthy weight and stay active. Often the stocking is old or does not compress sufficiently to reduce the swelling as is the case here. While some of the causes of leg swelling may be minor self-limiting conditions, others require very urgent medical care to reduce the likelihood of major complications or death.
The most common failure of diagnosis occurs due to a venous ultrasound study which is performed in a manner to rule out clots (deep vein thrombosis) in the deep veins of the legs and does not evaluate for failure of one-way valves in the leg veins (venous insufficiency). Frequently, leg swelling is caused by more than one factor such as venous insufficiency, obesity, and previous saphenous vein harvest for heart bypass surgery. This causes pitting edema, swelling which will leave a temporary indentation in the skin with pressure from a shoe, sock, or intentional pressure such as a squeeze with a finger. Obesity also accelerates the stretching of the leg veins due to the effects of gravity, thus contributing to the progression of venous insufficiency. Chronic swelling of the legs with discomfort or a heavy feeling to the legs often contributes to inactivity which worsens the problem since the calf muscle pumping of blood out of the legs with walking is an important means of getting venous blood back to the heat.
Most people manage the condition with compression therapy before and after treatment, often with compression hose or socks. Many times, the patient is told that the exam is normal when no testing was done for Venous Insufficiency!
A specialized evaluation for the causes of leg swelling, pain, or tenderness is an investment in protecting your health keeping you active as years and gravity affect your legs. Untreated leg swelling may lead to other complications such as infection, poorly-healing wounds, or clots in leg veins. It is common for patients with chronic leg swelling to be told that the ultrasound is “normal” or “was negative for clot” while failing to test for treatable venous insufficiency.

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