As you are gearing up for the holiday season you will probably be using your legs quite a bit. Even if you are one of those Internet shoppers and had your work done and delivered in August, you probably will still hit the pavement for that one last gift. There are some important facts to know about your legs before hitting the malls—an owner’s manual if you will.
Normal Legs Can Swell
Legs swell when you are standing. This is due to the density of water and the law of gravity. Water travels in the blood in your arteries. As the channels get smaller and smaller, the pressure pushes water out of the vessels and the cells bathe in the liquid.
On the other side of the capillaries, the protein in the blood draws the water back into the cell and back to the heart. When you stand or sit for long periods of time the protein cannot pull all the water back and your legs swell over time.
This can happen in people with totally normal leg veins. After a busy day at the mall while you sleep and dream of sugar plum fairies, the extra water is moved out of the legs via the lymphatic system.
Most seasoned holiday shoppers know their limits. Problems with knees, ankles and muscles show up gradually and folks usually have some idea what causes the pain and what makes it better.
Abnormal Swelling
The swelling is sometimes more serious. Pain in the limbs is an obvious concern. Legs can have different pains and sorting them out requires an expert. Despite that, it is still a good idea to educate yourself about the types of pain. Pain can be muscular, vascular, orthopedic, neurologic, infectious, traumatic and so on.
Venous Reflux
In the previous example, pressure generated by the heart drove water into the tissues. All the veins of your legs have valves in them which allow the blood to travel from your feet to your heart when the process reverses. The valves close when the blood tries to be pulled back down by gravity.
Under some conditions, the valves stop working and the blood is allowed to fall back down to the feet. Because blood is mostly water, it has a significant weight. The pressure pushes the water into the tissues, but to a much greater degree than normal.
Again, when we are sleeping, the extra fluid is moved out of the legs by the lymphatic system. This cycle continues every day and over time the swelling and discomfort get worse. This is called venous reflux and although usually not dangerous, it has the potential to make you miserable.
Venous reflux can cause pain but not always. The type of pain is usually an ache or a throbbing during the day which gets better at night or when the legs are elevated. The chronic stretching of the veins can lead to spasms or cramps at night. These can be severe enough to wake you up and make you jump out of bed.
Infections and Injury
Deep Vein Thrombosis
Other things that can make your legs swell usually are painful and include infections and injury. If you have swelling and pain in an area of your leg, it is best to seek medical advice as soon as possible.
Deep vein thrombosis can cause swelling and pain. This is the most dangerous condition and needs to be worked up by your physician.
Lymphedema
The exception to the pain rule is a condition called lymphedema. This is painless swelling that occurs because of some injury or obliteration of the channels that carry the extra water out of your legs. This condition can happen spontaneously or it can follow some type of injury, surgery or infection.
Lymphedema is impossible to cure. The goal of therapy is to control the swelling and maintain the function of the limb. In my practice, I advocate the use of lymphatic drainage massage to help work the fluid out of the tissues, plus some type of external compression device to help maintain this state in the limb.
Arterial Insufficiency
Peripheral Arterial Disease
The other type of pain I deal with often is related to arterial insufficiency. The term used for pain in the calf muscles when walking a certain distance is called claudication. This is pain in a muscle when the demand to the muscle exceeds the supply. The muscles spill acid which results in pain.
This pain is relieved by stopping the activity and resting. After a few minutes the person is able to resume the activity.
This type of pain is very reproducible. For example, if it occurs after two blocks, it will occur every time after two blocks. The distance will be shorter when you go uphill and longer when you go downhill due to the changes in work requirements.
This type of pain indicates peripheral arterial disease and should be evaluated by a vascular surgeon. If claudication is present it signifies that you have arterial disease and the narrowing or occlusions are significant.
The chance this will require loss of a limb is low—only 0.5 percent. But the risk is not zero and appropriate evaluation by a qualified vascular surgeon is in your best interest.
Most of the time folks who have more serious vascular disease are not going to embark on a marathon mall shopping spree. As vascular disease progresses you start to experience the pain in your legs when walking shorter distances.
As it advances further, you can experience pain in your calves or feet when sleeping and the only way to make it better is to get out of bed and walk around or simply hang your leg off the side of the bed. If you are experiencing these types of symptoms, you need to see a vascular surgeon as soon as possible.
Knee Pain
Knee problems are very common as our population ages. The cartilage in your knees can deteriorate over time. When you walk, two cushions per knee act as shock absorbers with every step. Each shock absorber is called a meniscus.
As the meniscus thins out, the bones in your knee rub together, resulting in increased pain and decreased mobility.
When you have good blood flow down your legs but are experiencing knee pain, your primary care physician should evaluate you for osteoarthritis of your knee. When the damage becomes severe enough it is often necessary to replace the knee joint through a surgical procedure.
If the arthritis continues for a prolonged period of time there can be inflammation inside the knee joint. This causes the lubricating lining of the knee to become inflamed and to weep excess fluid. This excess fluid can cause outpouchings of the inner lining, resulting in a cystic structure located behind your knee. This can cause further pain and swelling. The term for these outpouchings is a Baker’s cyst. Sometimes the inflammation can be treated and the symptoms from these can go away.
During this season, your legs will become important as you become the emissary for holiday treats and gifts. Your legs need to be strong as you embark on the journey to find the perfect gift for each of those on your list. You have many more holidays to forge through, so it’s always a good idea to listen to your legs. If you take care of them they will take care of you.
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Dr. Albaugh is board certified in both General and Vascular surgery. He has been with Coastal Vascular Center since 2004 with offices in both Camarillo and Oxnard. He is currently the Director of Peripheral Vascular Lab at St. John’s Regional Medical Center and the Director of Hyperbaric Oxygen Treatment and Wound Care Center at St. John’s Pleasant Valley Hospital. For more information, visit www.coastalvascularcenter.com
