Do My Swollen Legs Need Compression?

I recently had a patient who came into the office telling me that his feet and ankles hurt. When I asked him to describe his pain, he described it as “not really painful anywhere in particular, just uncomfortable because they are tight all over”. He also mentioned that “my legs get tired”. Well, the foot bone is connected to the leg bone, as is all the skin and what’s underneath as well!

Looking at this guy’s legs, feet and ankles, what was most obvious was the swelling! His exam showed no issues with bone, tendon or ligament. He just had some swelling!

Swelling (aka edema) is an excessive collection of fluid in the soft tissues of your body. In the legs, it can cause that dull, achy, heavy and tired feeling. This feeling gets worse towards the end of the day or after standing for a long period of time. Does this sound familiar? Though you might have gotten use to it, this is not normal and should really be treated.

There are many causes of swelling in the lower extremity. Some of these include high blood pressure, congestive heart failure, liver or kidney problems, medications and varicose veins.

It is important that you visit with your primary care physician to try and nail down the cause of your swelling. Once you have done so and are being treated for the underlying condition, your podiatrist can help you to get some of the fluid off of the legs. The best way of doing this from our end is with the use of compression socks or stockings.

Compression (the amount of pressure or tightness you will feel) of the sock/stocking is listed in the form of “mmHg”. You should see this on every compression garment you purchase. The lightest form of compression is in the 15-25 mmHg range and goes up from there. The amount of compression and the actual length (knee-high to thigh-high) is chosen depends of how bad your edema is and to where it is most evident. Your podiatrist will typically start you on a low level of compression and work up to a higher level as needed.

A few things to keep in mind:

1. If you have heaviness in the legs and have noticed that you have less hair growth on your legs, cramping, pain and/or cold feet /legs, this could be a sign of arterial disease. If you area not sure whether or not you have arterial disease because you have never been checked for this, it is important to discuss testing for this with your podiatrist prior to using compression.

2. Remember to wash your garment preferable daily or at least every two days allowing them to air dry out of the sun or a dryer, both of which can break down the fabric. Have at least two pairs of compression garment to trade them out.
3. Inform your podiatrist the minute you notice any bruising in the lower extremity or any bluish discoloration to the toes.

4. Let your podiatrist know if the garment feels loose. As the swelling improves, the garment will feel looser. Depending on the level of swelling you have at that stage and your tolerance, your podiatrist may recommend a higher level of compression.