Leg Edema (Swelling): Causes, Diagnosis, and Treatment
Leg edema refers to the abnormal accumulation of fluid in the tissues of the lower limbs. It may affect one or both legs and can develop suddenly or gradually. Common causes include venous insufficiency, lymphatic dysfunction (lymphedema), heart disease, kidney disease, and deep vein thrombosis. Identifying the pattern, timing, and associated symptoms is essential to determining the underlying cause.
Leg edema is a common vascular complaint that may indicate venous disease, lymphatic dysfunction, or more serious underlying conditions requiring specialist assessment.
What is Leg Edema (Leg Swelling)?
Chronic venous insufficiency (CVI) is the leading cause of leg edema, accounting for approximately 70% of cases.
Venous insufficiency occurs when leg vein valves become weak or damaged, leading to blood pooling and increased pressure in the veins.
This leads to fluid leakage into surrounding tissues, resulting in swelling, heaviness, and discomfort.
Other common causes of leg edema include lymphatic dysfunction, heart failure, kidney disease, liver cirrhosis, and medication side effects.
Common Causes Of Leg Edema
Is leg swelling caused by venous insufficiency?
Yes. Chronic venous insufficiency is one of the most common causes of leg swelling, particularly in adults who spend long hours standing or sitting.
Swelling related to venous insufficiency typically:
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Worsens toward the evening
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Improves with leg elevation or overnight rest
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Is often bilateral, though one leg may be more affected
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Is associated with skin changes, including pigmentation around the ankles, eczema, visible veins, or skin thickening
This occurs when damaged vein valves allow blood to flow backward and pool in the legs, increasing venous pressure and leading to fluid leakage into surrounding tissues.
Can lymphedema cause leg swelling?
Yes. Lymphedema is a common cause of chronic leg swelling, particularly when swelling is persistent and does not fully resolve with elevation.
Lymphedema-related swelling typically:
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Is non-pitting in later stages
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May affect one or both legs
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Often involves the foot and toes
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Is associated with skin thickening, tightness, or recurrent infections
It occurs when the lymphatic system cannot adequately drain fluid, often due to prior surgery, infection, obesity, cancer treatment, or congenital lymphatic disorders.
Could leg swelling Be a sign of a blood clot (DVT)?
Yes. Deep vein thrombosis (DVT) is an important and potentially serious cause of leg swelling, particularly when swelling develops suddenly.
Swelling due to DVT is usually:
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Sudden in onset
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Unilateral
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Associated with pain, warmth, or redness
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May worsen when walking or standing
Because DVT carries a risk of pulmonary embolism, urgent medical assessment and duplex ultrasound are required if this cause is suspected.
Can heart problems cause leg swelling?
Yes. Heart failure is a recognised cause of bilateral leg edema, especially in older adults or those with known cardiac disease.
Cardiac-related swelling typically:
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Is bilateral
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Worsens by the end of the day
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Is associated with shortness of breath, fatigue, or weight gain
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May improve partially overnight
This occurs when the heart cannot pump efficiently, leading to fluid accumulation in the lower limbs.
Can kidney or liver disease cause leg swelling?
Yes. Systemic conditions such as kidney or liver disease can cause leg edema due to changes in fluid balance and protein levels in the blood.
This type of swelling:
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Is usually bilateral
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May involve other areas, such as the face or abdomen
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Is often associated with generalised fluid retention
Management focuses on treating the underlying medical condition rather than the legs alone.
Can leg swelling be caused by prolonged sitting or standing?
Yes. Dependent edema is common after long periods of immobility, such as desk work, long flights, or standing for extended hours.
This type of swelling:
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Is usually mild and bilateral
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Improves with movement or elevation
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Is not associated with skin changes or pain
It is caused by gravity-related fluid pooling rather than underlying disease.
Can leg swelling occur after surgery or injury?
Yes. Post-operative or post-traumatic swelling is common and usually temporary.
It typically:
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Occurs near the affected limb
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Improves gradually with healing
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May worsen toward the end of the day
Persistent or worsening swelling after surgery should be evaluated to exclude complications such as infection or DVT.
Can leg swelling be caused by lipedema?
Yes. Lipedema is a chronic fat distribution disorder that commonly affects women and can cause bilateral leg enlargement that is often mistaken for edema. Unlike typical fluid-related swelling, lipedema is caused by abnormal fat accumulation rather than excess fluid.
Key features that suggest lipedema include:
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Symmetrical swelling of both legs, usually sparing the feet
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Disproportionate fat accumulation in the hips, thighs, and calves
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Tenderness, pain, or easy bruising
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Minimal or no improvement with leg elevation
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Poor response to diuretics
Lipedema can coexist with venous insufficiency or progress to lipo-lymphedema, where true fluid swelling develops. Duplex ultrasound is useful to assess for associated venous disease and to exclude other causes of leg edema.
Accurate diagnosis is important, as lipedema does not respond to standard edema treatments and requires a different management approach.
When should leg swelling be medically assessed urgently?
Leg swelling should be evaluated by a specialist if it:
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Appears suddenly
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Affects one leg
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Is associated with pain, redness, or warmth
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Is accompanied by skin changes or ulceration
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Does not improve with elevation
A clinical assessment and duplex ultrasound help identify the underlying cause and guide appropriate treatment.
Signs and Symptoms of Leg Edema
Patients with leg swelling in Dubai should be aware of the following
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Swelling in the feet, ankles, or legs that worsens throughout the day.
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A heavy or tight sensation in the legs.
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Skin stretching, shininess, or discoloration in severe cases.
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Pitting (indentation when pressed) or non-pitting swelling
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Reduced mobility and stiffness in the legs.
Diagnosis of Leg Edema
1- Clinical assessment and medical history
Your doctor will assess swelling patterns, associated symptoms, and medical history to determine the cause of leg edema.
2- Leg edema investigations
Investigations for leg edema include:
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Doppler ultrasound of your legs: Check for blood clots (DVT) and venous insufficiency.
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Echocardiogram: To evaluate heart function in suspected heart failure.
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Kidney and liver function tests: To identify fluid retention due to organ dysfunction.
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Lymphoscintigraphy: To assess lymphatic drainage in suspected lymphedema cases.
How Doppler Findings Affect Treatment
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If swelling is worse by evening and Doppler shows reflux, edema may be venous and improve with venous treatment + compression.
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If Doppler shows no venous cause, you may need evaluation for lymphatic or systemic causes.
What Happens After Identifying the Cause of Leg Swelling
Management depends on the underlying cause and may include reassurance, compression therapy, venous treatment, or referral for systemic causes.
Leg Edema Treatment in Dubai
Dr. Soroush Sohrabi, conducts a comprehensive assessment to determine the underlying cause of leg edema.
1- Exercise and Lifestyle Adjustments
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Leg elevation: To improve circulation and minimize swelling, try elevating your legs above the level of your heart for 15 to 30 minutes daily.
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Exercise & movement: Walking and stretching boost circulation.
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Reduce salt intake: Lower sodium to prevent water retention.
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Stay hydrated: Drinking enough water helps flush excess sodium.
2- Compression therapy for leg edema
Compression therapy to improve circulation and prevent fluid buildup.
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Graduated compression stockings (for mild to moderate edema)
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Medical-grade compression therapy (for chronic venous insufficiency)
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Custom-fitted compression garments
3- Medical treatments for leg edema
Further assessment by other specialties may be required depending on the medical cause of leg edema.
For edema related to liver disease, kidney dysfunction, or heart failure, seeking advice from a hepatologist, nephrologist, or cardiologist is essential for a complete and coordinated treatment approach.
4- Surgical treatment for leg edema
If leg edema is caused by venous insufficiency, treatments such as laser therapy (EVLA), radiofrequency ablation (RFA), and mechanochemical ablation (ClariVein®) can improve circulation and reduce swelling.
These minimally invasive procedures target the underlying venous dysfunction, providing long-term relief with minimal downtime.
When Should You See a Vascular Specialist for Leg Edema?
You should seek specialist assessment if leg swelling is persistent, worsening, or associated with pain, skin discoloration, ulceration, or asymmetry between the legs. Sudden swelling, especially when painful or accompanied by redness or warmth, requires urgent evaluation to exclude deep vein thrombosis. Early vascular assessment helps identify the underlying cause and prevents progression to chronic complications.
Clinical insight from Dr. Soroush Sohrabi
Leg swelling is one of the most common reasons patients seek vascular assessment, yet it is frequently misattributed to ageing or lifestyle alone. In clinical practice, the pattern of swelling — whether it worsens by evening, improves with elevation, or is associated with skin changes — often provides more diagnostic value than the swelling itself.
A structured vascular assessment, supported by duplex ultrasound, allows accurate differentiation between venous insufficiency, lymphatic disease, and acute conditions such as deep vein thrombosis. Early identification of the underlying cause is essential to prevent progression to chronic skin changes, ulceration, or recurrent infection.
Dr. Soroush Sohrabi is a UK-trained Consultant Vascular & Endovascular Surgeon practicing in Dubai.
Related vascular conditions that may cause leg swelling
Chronic Venous Insufficiency
Persistent leg edema is commonly linked to chronic venous insufficiency, where damaged vein valves allow blood to pool in the lower limbs. This often progresses alongside varicose veins, skin discolouration, and venous eczema.
Deep Vein Thrombosis (DVT)
Acute or sudden leg swelling may indicate deep vein thrombosis, particularly when associated with pain, warmth, or asymmetry. This requires urgent medical assessment including a Doppler ultrasound.
Lymphedema
Long-standing, firm swelling that does not improve with elevation may suggest lymphedema, especially following surgery, infection, or cancer treatment.
Venous Leg Ulcers
In advanced cases, untreated venous disease can lead to venous leg ulcers, recurrent infections, and chronic skin changes.
Lipidema
Lipedema is a chronic fat distribution disorder that can resemble leg swelling. It typically causes symmetrical enlargement of both legs while sparing the feet and is often associated with pain, tenderness, and easy bruising. Unlike venous edema, lipedema does not improve with elevation and may coexist with venous disease or progress to lipo-lymphedema.
Common questions about leg edema
When should leg swelling be a cause for concern?
Leg swelling should be assessed when it is persistent, worsening, painful, asymmetric, or associated with skin changes such as redness, pigmentation, or ulcers. Sudden swelling, particularly in one leg, may indicate a blood clot and requires urgent medical review.
Does leg edema always mean a blood clot?
No. While deep vein thrombosis is an important cause of acute leg swelling, most cases of chronic leg edema are related to venous insufficiency or lymphatic dysfunction rather than a clot.
Can leg swelling be normal?
Mild leg swelling can occur after prolonged standing, long flights, or exposure to heat and may resolve with rest and elevation. However, swelling that persists or recurs frequently should be medically evaluated.
Why does leg swelling worsen by the end of the day?
Gravity increases venous pressure throughout the day, especially in individuals with valve dysfunction. This leads to fluid accumulation in the lower legs, which typically improves overnight with leg elevation.
How is the cause of leg edema diagnosed?
Diagnosis involves clinical assessment and targeted investigations such as duplex ultrasound to evaluate venous flow, valve function, and to rule out thrombosis or underlying venous disease. Other causes of leg edema, including cardiac or renal conditions, may be assessed through appropriate heart and kidney investigations when clinically indicated.
When should leg swelling be a cause for concern?
Leg swelling should be assessed when it is persistent, worsening, painful, asymmetric, or associated with skin changes such as redness, pigmentation, or ulcers. Sudden swelling, particularly in one leg, may indicate a blood clot and requires urgent medical review.
Expert Assessment for Leg Swelling in Dubai
Leg edema due to venous insufficiency can be effectively managed with the right lifestyle changes, compression therapy, and surgical treatments. If your symptoms persist, seeking professional care is essential. Contact Dr. Soroush Sohrabi, a consultant vascular surgeon in Dubai and Endovascular Surgeon, for expert care in varicose veins and leg edema treatment.
Leg edema is often a presenting symptom of underlying venous disease, and accurate diagnosis allows targeted treatment of conditions such as varicose veins, venous insufficiency, or thrombosis.
Medical Review & Clinical Oversight
This page is written and reviewed by Dr. Soroush Sohrabi, Consultant Vascular & Endovascular Surgeon. Clinical content is based on current vascular guidelines, duplex ultrasound assessment, and evidence-based treatment principles.