Edema of the Leg is the accumulation of excess interstitial fluid in one or both legs, ranging from mild swelling in the foot and ankle to severe, pitting or nonpitting edema extending to the thigh. It can result from venous disorders, trauma, cardiac or bone conditions, systemic illnesses, or prolonged immobility.

Pathophysiology

Leg edema develops when fluid balance between intravascular and interstitial spaces is disrupted. Mechanisms include:

• Increased hydrostatic pressure: Seen in heart failure, venous insufficiency, or prolonged standing.

• Increased capillary permeability: Trauma, burns, infections, or envenomation.

• Lymphatic obstruction: Post-surgical (e.g., vein removal, lymph node dissection).

• Reduced plasma oncotic pressure: Hypoalbuminemia due to nephrotic syndrome, liver disease, or malnutrition.

Severity and distribution depend on the underlying cause, with pitting or nonpitting edema reflecting tissue involvement.

Signs and Symptoms

• Swelling of foot, ankle, calf, or entire leg

• Pitting or nonpitting edema

• Skin changes: taut, shiny, or thickened; “orange peel” appearance in cellulitis

• Pain, tenderness, warmth, erythema

• Discoloration or venous patterns in chronic venous insufficiency

• Systemic signs: dyspnea, fatigue, weight gain in heart failure

Clinical Assessment

History

• Onset, duration, progression

• Symmetry, positional variation, relief with leg elevation

• Pain or tenderness

• Recent trauma, surgery, infection, or immobility

• Cardiovascular, renal, hepatic history

• Medications and drug history

Physical Examination

• Inspect and palpate legs for pitting edema

• Assess peripheral pulses and Doppler studies if arterial compromise suspected

• Observe color, venous patterns, warmth, tenderness, cords

• Check for Homans’ sign in unilateral edema

• Examine skin for ulceration or thickening

Medical causes of Leg Edema

Other Causes

Special Considerations

• Administer analgesics and antibiotics as indicated

• Elevate legs, avoid prolonged sitting/standing, avoid crossing legs

• Use compression therapy (e.g., Unna’s boot) if needed

• Monitor intake/output, weight, and leg circumference daily

• Prepare for diagnostic tests (blood/urine studies, imaging)

• Consider dietary modifications: fluid and sodium restriction

• Monitor skin integrity to prevent breakdown

Patient Counseling

• Teach proper use of antiembolism stockings or bandages

• Instruct on appropriate leg exercises

• Educate on fluid and dietary restrictions to minimize edema

Pediatric Pointers

• Leg edema is uncommon but may result from trauma, osteomyelitis, nephrotic syndrome, or heart failure

• Bilateral edema often accompanies polyuria and periorbital swelling in nephrotic syndrome

References

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2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35(Suppl 1):S64–S71.

3. Rockson SG. Lymphedema. Am J Med. 2001;110(4):288–295.

4. Pappas A, Grigoriadis N, Cholevas V. Chronic venous insufficiency: pathophysiology and management. Vasc Health Risk Manag. 2010;6:839–849.

5. McDonagh TA, Gardner RS. Heart failure. Lancet. 2021;398:1357–1375.