Patient information · General health
Swollen ankles and legs
one leg or both makes all the difference
Swelling of the legs is common and often harmless — the result of standing, heat or gravity. The single most useful distinction is whether it affects one leg or both, because that separates a possible clot from the heart, kidney, liver and venous causes almost immediately.
Call 999 or seek urgent care if there is
- swelling of one leg that is painful, warm or red — possible DVT
- leg swelling with breathlessness or chest pain
- sudden severe swelling, or swelling of the face, lips or tongue
- rapid weight gain of more than 2kg in two to three days with breathlessness
- a leg that is pale, cold, numb or intensely painful
- fever with a hot, red, spreading area
One-sided leg swelling with pain or warmth may be a deep vein thrombosis, which can travel to the lungs. Swelling with breathlessness suggests heart failure or pulmonary embolism. Both need same-day assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
One leg
- Deep vein thrombosis — calf swelling, pain, warmth, sometimes redness. Risk raised by recent surgery, immobility, long flights, cancer, pregnancy, the combined pill and HRT.
- Cellulitis — hot, red, spreading, tender, often with fever.
- Ruptured Baker's cyst — sudden calf pain and swelling, mimicking a DVT.
- Chronic venous insufficiency — long-standing, worse by evening, with skin staining.
- Lymphoedema — firm swelling including the toes, after lymph node surgery or radiotherapy.
- Injury, and less commonly a pelvic mass obstructing drainage on one side.
Both legs
- Dependent oedema — from standing or sitting still for long periods, particularly in hot weather. The commonest cause overall.
- Heart failure — with breathlessness, waking at night short of breath, and needing more pillows.
- Kidney disease — often with frothy urine, and swelling around the eyes in the morning.
- Liver disease — with abdominal swelling and sometimes jaundice.
- Low protein, from malnutrition or gut disease.
- Underactive thyroid, obesity, and pregnancy.
- Medicines — a very common cause.
Check your medicine list first
Several extremely common medicines cause leg swelling: amlodipine and other calcium channel blockers (probably the commonest cause of all), anti-inflammatories such as ibuprofen, steroids, pioglitazone, gabapentin and pregabalin, and some hormone treatments. Amlodipine-related swelling is dose-dependent, does not respond to diuretics, and resolves on switching to a different class. It is worth reviewing your list before anything else is done.
What assessment involves
- Examination of both legs, the abdomen, the heart and the chest, plus blood pressure and weight
- Blood tests — kidney and liver function, albumin, full blood count, thyroid, and NT-proBNP if the heart is in question
- Urine test for protein (ACR) — essential, and frequently omitted
- D-dimer and ultrasound where a DVT is suspected
- Echocardiogram where heart failure is suspected
- Ankle-brachial pressure index before any compression is applied
What helps
Do
- Elevate legs above heart level when sitting — genuinely raised, not on a footstool
- Walk regularly; the calf muscle pumps fluid upwards
- Ankle pumps and circles when sitting for long periods
- Compression stockings — but only after arterial circulation has been checked
- Reduce salt, and moisturise the skin daily to prevent breakdown
Avoid
- Diuretics bought or borrowed without assessment
- Standing still for long periods, and crossing the legs
- Compression on a leg with poor arterial supply
- Scratching — broken skin over swollen legs ulcerates readily
- Ignoring one-sided swelling, which is never dependent oedema
Why come to us. Swollen legs need someone to work out which of several very different causes is responsible, and that is one appointment. We examine you, take kidney, liver, albumin, thyroid, blood count and NT-proBNP in-house with a urine ACR, perform ECG, echocardiography and leg ultrasound on site, measure the ankle-brachial index before recommending any compression, and review your medicines. Results are explained the same visit. Seven days a week, no referral needed.
Ultrasound, echo and bloods in one visit
Doppler before compression, results the same day. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.