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Swelling of the legs is abnormal and should be evaluated by a physician if it occurs more than occasionally after a long day of sitting or standing. Pain or tenderness in the legs associated with swelling is an especially important reason to seek evaluation. While some of the causes of leg swelling may be minor self-limiting conditions, others require very urgent medical care to reduce the likelihood of major complications or death. Untreated leg swelling may lead to other complications such as infection, poorly-healing wounds, or clots in leg veins.

Evaluation of leg swelling begins with a review of symptoms, personal and family medical history, and a clinical exam which may include heart, lungs, abdomen, pelvis, legs, and nerve/muscle function in the legs. Further testing is based upon the clinical assessment and may include ultrasound, X-ray,CT, or MRI imaging in the legs or evaluation of the heart or blood vessels in the abdomen or pelvis. The most common failure of diagnosis occurs due to a venous ultrasound study which is performed in a manner to rule out clots, known as deep vein thrombosis, in the deep veins of the legs and does not evaluate for failure of one-way valves in the leg veins (venous insufficiency). It is common for patients with chronic leg swelling to be told that the ultrasound is “normal” or “was negative for clot” while failing to test for treatable venous insufficiency.

 

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