Both My Legs Swell in the Summer - What Could Be Wrong?

Sarah is a 37 year old woman who has noticed only mild occasional swelling in the past during the summer, but she is concerned because the swelling is worse this year.  Sarah does clerical work and is at a desk most of the day. At the start of the summer she noticed swelling in both her ankles and calves and it is present everyday.  She has a sock line and shoe line at the end of the day, but it does go away completely by the next morning.  She is worried that something is going wrong.

Swelling is a common symptom for people, and nearly everyone experiences it at some point in their life. I see it every day in my practice since swelling is often due to a vein condition. In fact, swelling will occur in anyone under the right circumstances, and I’d like to share with you when swelling is normal and not a cause to worry.  

Swelling in both legs can be an indication of an underlying medical condition or it can be normal. When it is normal it is called physiologic swelling and the processes at work do not indicate any disease or medical problem. I usually recommend an ultrasound evaluation which can determine if there is vein reflux - a common cause of swelling. 

Here are a list of areas where you'll see signs of visible swelling. Keep in mind that, in virtually all cases, the swelling goes away overnight.

• a sock line 
• a shoe line
• pitting edema (you press the skin in and it remains depressed).
• swelling of the calf
• swelling of the ankle
• Swelling in the feet

Common Causes of Leg Swelling

• More salt in your diet. Sodium is the active part of salt and is listed on food labels.  Junk, fast, snack, frozen, canned or restaurant food are the usual culprits. These types of food have a lot of sodium in them which is the cause of the swelling. Your body takes about 2-3 days to eliminate the salt from your body, so even 2 exposures a week can leave you with swelling for most of the week. To see if this is the problem, I recommend eating home cooked food without any processed items, no salt or flavor rubs, fresh not processed meats and no canned or frozen prepared foods (which have a lot of salt in them.) You will need to do this diet for at least a week to sort it out. This kind of swelling always improves overnight but may not completely go away, and people usually notice swelling in their fingers as well.

• Sleeping in a recliner or chair. When you stand or walk, your muscles in your legs contract and squeeze the fluids out of your legs. When you sleep sitting up in a recliner or chair, your leg muscles are not working, and the fluid builds up over night. Obviously sleeping flat at night is the solution, but if you can’t do this, then wearing light weight compression stockings at night (10-20 mmHg strength) can help. You can try higher levels of compression but they may cause nerve injury leading to numbness. If you feel that they are pinching or hurting, do not wear them at night.
• Warm weather. This is probably the most common cause I see. When the hot weather starts up, the body naturally cools itself off by dilating the blood vessels on the skin. This increases blood flow to the surface which allows cooling to occur. With the higher blood flow there is also more fluid accumulating in the tissues. This fluid always goes away overnight and eventually resolves when the weather cools off. What can you do? Wearing compression stockings will help, and elevating your legs during the day can decrease the swelling as well.
   
• Pregnancy. During pregnancy the body increases the blood volume and certain hormones cause the blood vessels to dilate and enlarge. This causes not only swelling but also development of vein symptoms and varicose veins. This type of swelling improves but does not always go away overnight. Swelling can be worse in the right leg due to the uterus putting pressure on the right pelvic veins. Compression stockings can help and many pregnant women prefer the maternity pantyhose style. Most of these changes resolve after delivery.
   
• Standing or sitting immobile for long periods. If you stand in one spot at work or sit in a chair or at a desk without getting up to walk, after a period of time (usually hours), you will develop swelling in your legs. If you have ever been on a long car or plane ride without getting up for several hours, you look down and see the swelling. It is normal for this to happen because we are not using our calf muscles to pump the fluid out of our legs, and swelling develops. It is not dangerous and will resolve; however, this inactivity does increase risk of DVT blood clots which can occur without any visible swelling. The best antidote: move around and walk as much as possible every hour and wear compression stockings. Knee high stockings are best tolerated and I recommend starting with 20-30 mmHg.

In the case of Sarah, her ultrasound showed only very mild vein reflux, and the fact that it occurs only during the summer indicates that this is normal swelling related to hot weather. She did not need vein treatments and I reassured her that her swelling was a normal response to hot weather. I told her that since a vein condition always slowly progresses at some point when she gets leg symptoms and fatigue (the most common combination) she would benefit from treatments.