There is a stereotype that swelling of the lower extremities is associated only with excessive fluid intake and a sedentary lifestyle. If your legs below the knees swell, the reasons for this may be more disturbing. In fact, the presence of this symptom can be a formidable harbinger of cardiovascular disease, kidney, liver, inflammatory vascular lesions, tumor compression of the iliac veins, and other serious diseases.
Correctly performed diagnostics allow you to identify the underlying disease in time and choose effective timely therapy.
Right ventricular failure
Swelling of the legs may be due to right ventricular failure. Wherein:
- Shortness of breath appears, the ability to perform the usual physical activities (climbing stairs, walking) decreases. Weakness and fatigue are caused by oxygen starvation of tissues due to poor blood supply.
- Swelling of the legs occurs.
Let us consider in more detail why the legs below the knees swell with right ventricular failure. Due to the deterioration of the contractility of the ventricles, adequate blood supply to organs and tissues is disrupted, the sympathoadrenal system is activated, the lumen of the venules and arterioles narrows, and the number of heart contractions increases. In response to vasoconstriction, blood pressure rises, the renin-angiotensin-aldosterone system is activated, renal blood flow is reduced, sodium and water are retained, blood vessels increase, hydrostatic pressure in the veins increases.
If the legs below the knees swell, the reasons for this may be that increased vascular permeability, a decrease in protein synthesis and its excretion in the urine due to joined kidney damage.
Cardiogenic edema develops gradually, most pronounced by the end of the day. Spread from bottom to top.
The feet swell first, complaints about the crampedness, inconvenience of shoes appear. Then swell the leg. The skin is cold to the touch, pale cyanotic. Traces of socks, elastic bands, shoe fasteners are noted. When pressed on the skin, a fossa remains for a long time.
Symmetry of edema is characteristic. With prolonged sitting, swelling of the lumbar region is possible.
With decompensation of right ventricular failure, edema becomes widespread. Ascites appears (filling the abdominal cavity with fluid). Perhaps the development of anasarca (extensive swelling of the skin and subcutaneous fat).
Left ventricular failure
For left ventricular failure, manifestations of cardiac asthma are more characteristic:
- Orthopnea (the patient cannot be in a horizontal position, due to increased blood supply to the pulmonary capillaries and the development of severe shortness of breath).
- Paroxysmal nocturnal dyspnea (severe shortness of breath that occurs during sleep, accompanied by wheezing, wheezing, severe cough, facial cyanosis).
- Wheezing in the lungs.
- Profuse cold sweat.
Diagnosis of left ventricular failure
- Electrocardiography (rhythm and conduction disturbances, the presence of pathological teeth are assessed).
- Echocardiography (cardiac output fraction, the thickness of the walls of the atria and ventricles, the presence of damage to the valves or stenosis, structural changes in the pericardium), daily monitoring of ECG (halter).
- Chest x-ray.
- A stress test to determine the functional class of heart failure.
- Examination of urine for protein content.
- A blood test to determine the markers of myocardial damage.
- Immunoglobulins M and G for cytomegalovirus and Epstein-Barr virus.
- Assessment of the level of natriuretic peptides.
Treatment
Therapy consists in the following measures:
- a salt-restricted diet according to the degree of heart failure;
- dosed physical activity, daily walking;
- drug therapy (diuretics, cardiac glycosides, angiotensin-converting enzyme blockers, beta-blockers, antiplatelet agents, antiarrhythmics).
With left ventricular failure, legs below the knees swell? The reasons and recommendations for treatment were reviewed by us.
Renal edema
Unlike cardiac edema, renal most pronounced in the morning, develop from top to bottom. Originally swollen eyelids, face. Closer to the afternoon, the legs (legs and ankles) swell, the swelling of the face is less pronounced. The skin is soft, warm, the fossa quickly disappears after pressing with a finger. The presence of cyanosis is not characteristic.
The ability of edema to “migrate” is an important diagnostic feature in kidney pathology.
There is a tendency to high blood pressure.
If the leg has a swollen leg below the knee, the causes, treatment, and other useful recommendations can be found below.
Edema is associated with toxic-immune damage to the glomeruli of the kidneys, a decrease in their filtration rate, fluid retention, an increase in blood volume, the release of plasma blood components in the tissue due to increased vascular permeability and reduced blood pressure due to pronounced loss of protein in the urine.
And yet, why do legs swell below the knees? The causes and symptoms of these discomfort are interrelated.
With the development of edema due to glomerulonephritis, a connection with a past infection, such as angina, is noted.
With nephritic syndrome, edema is less pronounced, hematuric syndrome is characteristic (urine acquires the color of meat slops).
Nephrotic syndrome is accompanied by massive loss of protein in the urine and severe swelling up to the anasarca.
Diagnosis of renal edema
- Protein in the urine.
- Urine for sterility.
- Determination of streptococcal and staphylococcal antibodies to blood serum.
- Ultrasound examination of the kidneys.
- Blood pressure control.
- Blood analysis.
General principles of treatment
In therapy are used:
- salt, protein, and fluid restriction diets;
- bed rest;
- systemic antibiotic therapy;
- the appointment of diuretics;
- lowering blood pressure;
- antihistamine therapy;
- the use of non-steroidal anti-inflammatory drugs;
- anticoagulants and antiplatelet agents (for the prevention of microthrombosis and further glomerular damage);
- glucocorticosteroids and cytostatics in the treatment of nephrotic syndrome.
Liver damage
Why do legs swell below the knees? The causes and symptoms of these unpleasant sensations can talk about liver diseases.
Decreased protein synthesis in the liver due to severe damage to its tissue (end-stage hepatitis, cirrhosis, fatty degeneration, hepatocellular carcinoma) is accompanied by severe, widespread edema, up to the anasarca. Hepatic edema is accompanied by severe itching of the skin, combs, spider veins, fragility of capillaries, yellowness of the skin and visible mucous membranes.
Diagnosis of liver damage
- Urinalysis
- The study of feces.
- A blood test, determination of the level of total protein, liver samples (ALAT, ASAT, GGT, bilirubin, alkaline phosphatase), the thymol sample, the level of urea and creatinine are examined.
- Ultrasound
- Markers of viral hepatitis, immunoglobulins M and G to cytomegalovirus and Epstein-Barr virus.
- Blood for HIV.
Varicose veins
What else has such a phenomenon as swelling of the legs below the knee, causes? Redness and peeling of the skin is characterized by varicose veins on the legs, which is accompanied by dull aching pain, rapid fatigue, heaviness in the legs.
With severe lesions, trophic changes in the skin are possible: dermatitis, ulcers, hyperpigmentation. On examination, contoured venous patterns, pronounced edema, expansion and swelling of veins, trophic changes in the skin are visible. Edema is asymmetric, of varying severity, depending on the degree of damage to the veins.
The presence of edema on the legs is isolated and cannot be combined with other clinical symptoms (shortness of breath, cough, swelling on the face and body, fever, etc.).
If you are concerned about varicose veins, leg edema below the knee, causes, photos and other useful information are available in this article. Perhaps this will help you.
Varicose vein treatment
In severe cases, surgical treatment (phlebosclerosis) is used.
Medication includes the use of venotonics and antiplatelet agents.
Phlebothrombosis
For what reason do legs below the knees swell besides the diseases mentioned above? Swelling of the legs can occur including phlebothrombosis. With deep vein thrombosis, the initial stages proceed without signs of inflammation of the vein wall.
Redness of the skin edema is rare. The skin is glossy, the venous pattern is clearly contoured. Swelling of only the affected leg appears. The spread of pain on the inner thigh is characteristic. The pain intensifies when walking.
Venous insufficiency
Let us consider in more detail why the legs below the knees swell in chronic venous insufficiency. A constantly progressive lesion of the venous system is accompanied by symmetrical edema, disappearing in the morning and appearing in the evening. Redness of the skin of the legs is observed (against the background of severe swelling). It is extremely rare that a unilateral lesion occurs.
Arthritis and systemic diseases
Arthritis pain and swelling are associated with exudation into the joint cavity. The joint is increased in size. Redness of the skin is characteristic.
The debut of juvenile arthritis (up to 16 years) is accompanied by acute onset, fever, rash on the skin of the face, trunk, buttocks, over the joints. The internal organs are affected. Rheumatoid arthritis is characterized by morning stiffness in movements.
Shenlein hemorrhagic vasculitis - Genoch
If you have revealed Shenlein-Genoch hemorrhagic vasculitis and you are concerned about the question of why the right leg is swollen below the knee, we will consider the reasons below.
A characteristic connection with the infection, the use of antibiotics, the presence of severe allergic reactions.
The articular form is characterized by swelling, swelling of the knee joints, muscle pain, hemorrhagic rash on the extremities, hips and buttocks.
Hemophilia
Due to coagulation disorders, hemorrhages in the muscles and joints are possible, associated with minor trauma. The affected joint is edematous, sharply painful during movement and palpation, the skin is hyperemic, hot to the touch.
The occurrence of edema on the legs, not associated with the presence of pathologies
If the legs below the knees swell, the reasons for this are not always associated with pathology. The occurrence of edema can be a consequence of:
- alcohol abuse;
- excessive consumption of salty foods that cause fluid retention;
- a protective reaction to overheating of the body;
- increased load on the foot and spine associated with wearing uncomfortable shoes, too high heels;
- congestion and increased pressure in the veins due to a sedentary lifestyle;
- physiological edema with prolonged physical labor;
- overweight;
- edema during pregnancy (the threat is only massive, rapidly increasing edema, accompanied by nausea, increased blood pressure and headache - the threat of eclampsia);
- edema in premenstrual syndrome.
So, you need to worry if your legs below the knees often swell. The causes and types of edema can be different.
For prophylactic purposes, it is recommended: to normalize body weight and balance nutrition, stop drinking alcohol, regularly undergo preventive examinations by a therapist, and include dosed and regular physical activity in the daily regimen. In the absence of pathology from the kidneys and the cardiovascular system, yoga (inverted asanas) and physical therapy (exercise "birch") are effective for normalizing the venous outflow.
What to do if the legs swell below the knees? Reasons, how to treat, how to get rid of it - all this interests those who are faced with a problem. Our article provides answers to all these questions.