Summer is a time for fun, relaxation, and adventure. But for many people, it's also a time when their legs start to swell more than usual. If you've noticed your legs looking and feeling puffier this summer, you're not alone. Why does this happen? Is it something to worry about? And most importantly, what can you do about it?
As a vein specialist, I see patients with leg swelling every day. Let's dive into this common summer concern and explore what your swollen legs could be telling you.
Swelling, also known as edema, occurs when excess fluid gets trapped in your body's tissues. Some degree of leg swelling is quite common and normal, especially after a long day on your feet. This is called physiologic swelling.
Here is 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.
However, leg swelling can also be a sign of an underlying health issue, particularly when it's persistent, severe, or accompanied by other symptoms. One often overlooked cause of problematic leg swelling is chronic venous insufficiency or vein reflux disease.
In healthy veins, tiny valves help push blood back up to the heart. But if these valves weaken or fail, blood can pool in the legs, causing the veins to stretch out and allowing fluid to leak into surrounding tissues. This leads to swelling that tends to worsen as the day goes on, along with other symptoms like tired, achy, heavy-feeling legs.
So how can you tell if your puffy legs might be due to a vein issue rather than just normal swelling?
Here are some clues to look for:
Importantly, major leg swelling can occur even if you don't have any visible varicose veins. That's why evaluation with a specialized vein ultrasound is key to determining if a venous condition is contributing to your symptoms.
While vein problems are a leading cause of swollen legs, they're not the only factor that can make matters worse during the summer months. Some other common contributors include: Common causes of physiologic, or normal, swelling I see in patients include the following:
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.
When you stand or walk, the 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 overnight. Sleeping flat or elevating your legs at night is the solution, but if you can’t do this, then wearing lightweight 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.
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.
During pregnancy, a woman's body increases the blood volume, and certain hormones cause the blood vessels to dilate and enlarge. Pregnancy causes not only swelling but also the 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 are resolved after delivery.
If you stand in one spot at work or sit in a chair or at a desk without getting up to walk, after some time (usually hours) of inactivity, 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 the 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.
The good news is that there are some simple steps you can take to get relief and prevent fluid buildup in the first place.
If you're dealing with uncomfortably puffy legs this summer, try these tips:
Sarah was a 37-year-old woman who noticed only mild occasional swelling in the past during the summer, but she was concerned because the swelling was getting worse Sarah did clerical work and was at a desk most of the day. At the start of the summer, she noticed swelling in both her ankles and calves and that it was present every day. She had a sock line and shoe line at the end of the day but also noticed that it did go away completely by the next morning. She was worried that something was going wrong.
In the case of Sarah, her ultrasound showed only very mild vein reflux, and the fact that it occurred only during the summer indicates that this was 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 to pay attention to her symptoms and to notice if they worsened over time. Since a vein condition always slowly progresses, and if she noticed a combination of leg symptoms along with fatigue, she should return and have another vein screening done. If the ultrasound revealed vein reflux, then treatments would help.
Remember, occasional mild leg swelling is usually nothing to worry about. But if swelling becomes a persistent problem that's interfering with your comfort, mobility, or quality of life, it's important to get evaluated by a qualified vein expert. Today's minimally invasive vein treatments are quicker and easier than ever, with little to no downtime.
Don't let swollen, achy legs weigh you down this summer. Take charge of your vein health so you can look and feel your best all season long!