Q The calves of my legs swell up during the day. I have an office job and spend most of the day sitting down. I don't eat salty foods excessively and exercise three to four times a week. I also commute to work - so more sitting. They depuff mostly after a night's sleep. Is it anything to be alarmed by and is there anything I can do to help?
A In relation to lower-limb swelling my first question is always: "Is the swelling present first thing in the morning?'' If the answer is no, then it's most likely a physiological variant of normal. You feel your legs are almost back to normal in the morning time, which is reassuring. My second question: ''Is there a family history of this complaint?'' Some people find that towards the end of the day, there is mild ankle or foot swelling, particularly in people who spend much of their day standing. This is often a shared familial trait and is known as 'dependent oedema'. Basically, with prolonged sitting or standing the effect of gravity causes fluid to accumulate more in the feet and ankles. It is exacerbated by taking certain medication, going on a long flight or by being overweight/pregnant. If you have a history of trauma or surgery to the legs, this also increases your risk of swelling in the affected leg due to minor damage to the venous and/or lymphatic drainage of the leg.
The best way to combat dependent oedema is to elevate the legs whenever possible, wear compression socks to the knee level or ideally tights and to 'pump your calf muscles' by contracting them as much as possible during the day.
The latter you can do by simply pointing your foot upwards and downwards when sitting. An even better way to improve your venous and lymphatic drainage of your legs is to go for a walk during the daytime or engaging in any form of exercise. Additional lifestyle changes such as reducing salt intake in your diet, managing stress and losing weight (if you are overweight) can improve the swelling in your legs.
More severe ankle swelling, particularly if present first thing in the morning and occasionally associated with other symptoms such as fatigue, loss of appetite, weight gain or shortness of breath, can be caused by a medical condition. Mild forms of failure of important organs, the heart, the liver or the kidney can be underlying factors. If you have an element of organ failure, you might be finding it difficult to sleep on just one pillow at night. You might notice a cough, shortness of breath or wheeze in your chest due to fluid collecting in the lungs. Any organ failure can lead to fatigue, loss of appetite, reduced ability to exercise or weight gain due to fluid redistribution.
Other conditions that may be considered include disorders of the lymphatic or venous drainage in the lower limbs such as varicose veins or lymphoedema.
By attending your GP practice you can get blood tests to assess your heart, liver and kidney function and your doctor can perform a physical examination to assess for signs of any of the conditions mentioned above. You might find your doctor pressing on your foot or shin bone to determine if this leaves an indentation.
By putting your clinical history, blood results and examination findings together, your doctor will have a good understanding of the potential underlying cause.
⬤ Dr Jennifer Grant is a GP with the Beacon HealthCheck