Lower Leg Swelling

[Sondra Elmore]

Hello.  I'm 35 years old, female, approximately 75 pounds overweight.  Last January my GP noticed some mild pitting edema so I followed up with a cardiologist who performed an echo, and felt that my swelling was from veinous insufficiency.  My GP ran blood tests and found kidney and liver functions to be fine.  I became pregnant about a month after these tests and by week 20 had significant pitting edema with no other symptoms, but ultimately at week 30 ended up hospitalized with mild preeclampsia, ultimately delivering my child just short of 36 weeks gestation.  Since my discharge for the pregnancy nine weeks ago, I battled high blood pressures briefly that resolved without medication, my kidneys are no longer spilling protein and I have had 2 sets of blood tests to check both liver and kidney functions, all normal.  My blood sugar is also normal.  At my check up last week my GP again mentioned the pitting edema, it is not in my ankles or feet at all, only on my lower leg in front of the bone.  My GP prescribed Lasix 20mg 1x daily, and this had no effect.  I have taken up walking 4 miles daily to lose weight. So my ultimate question is; all information I find on leg swelling always mentioned heart failure - I have no shortness of breath or anything else besides the swelling.  I can walk the 4 miles and don't have any fatigue beyond the normal "mommy" tiredness at day's end, and that is minimal.  Elevating my legs doesn't seem to make a difference with the swelling, and it is just the same in the morning as in the evening.  If I drive for long it does get worse and ocassionaly show up in my feet, but quickly resolves there. I'm curious if this can just be weight-related?  I was on bedrest for 5 weeks prior to delivery.  I would call the piting edema mild, and is not noticeable unless I apply pressure.  I'd like to know if this were heart failure wouldn't I have other symptoms, and ankle and feet swelling? And what else could this be?  Thank you.

[eddyk]

A related discussion, lower leg swelling was started.

[Mom of Four]

Thank you.  I did have thyroid testing that was normal.  I have been walking 3 to 4 miles a day and the fluid has gone down.  I also just purchased compressions stockings to help.  I was interested in the pitting edema definition that you gave me, my pitting does not last more than 5 seconds.

Thanks,
Sondra

[B_Johnson]

The type of swelling you are describing sounds like pre-tibial myxedema which occurs on the anterior aspect of the lower extremities just overlying the tibia.

Although dependent edema (from heart failiure, kidney dz, lymphatic and venous drainage issues) can mimick this, I see that you have no clinical presentation consistent with these anomalies.

Pre-tibial myxedema is a symptom of graves disease which is an auto-immune disorder that results in over activity of the thyroid gland.

I would advise you to have a thyroid panel at your next doc's visit.

Have you had any symptoms of hyper-thyroidism?  Any family history?  Any abnormalities in your menstrual cycle?

Although you did state that the edema was pitting, poorly trained clinicials often label edema as pitting without allowing enough time for the depression to clear.  If they press down on you leg and the depression resolves within 5 seconds it is non-pitting.

[B_Johnson]

Just to add.. The pitting edema that you had while you were pregnant was an entirely seperate entitiy related to your pre-eclampsia.

[Kevin Pho, MD]

It is possible that weight may exacerbate the lower extremity swelling.  

Congestive heart failure would be diagnosed with an echocardiogram - if normal, it will be unlikely that this is present.  

I agree with the kidney and liver evaluation - since diseases here can lead to lower extremity swelling.  

You can also consider doppler ultrasounds of the legs to ensure there isn't clot - as well as examining the legs to ensure there isn't a skin infection present.  

If the tests remain negative, you can consider compression stockings, in addition to the medication which can improve the edema.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b