Causes of Leg Swelling: A Real Patient Story

When Your Legs Feel Heavy, Tired, and Tight

“At First I Thought It Was Just Age…”

James, 58, started noticing something strange. By 3 p.m., his lower legs felt heavy. By evening, his ankles were swollen and his shoes were tight. His doctor checked his heart, ran some labs, and told him everything looked normal.

But it didn’t feel normal.

After two months of worsening symptoms, James was referred for imaging — and finally got answers. The real issue? Chronic venous insufficiency, not just aging.

What Are the Common Causes of Leg Swelling?

Swelling (edema), heaviness, or cramping in the legs can come from:

• Venous insufficiency – weak valves cause blood to pool in the legs
• Deep vein thrombosis (DVT) – a clot blocks circulation
• Lymphedema – buildup of lymphatic fluid
• Heart, kidney, or liver disease
• Medication side effects or inactivity

The key to figuring it out is targeted imaging — especially a duplex ultrasound of the veins.

Venous Insufficiency vs DVT: What’s the Difference?

Both can cause leg swelling and fatigue, but they’re very different problems:

• Venous insufficiency happens slowly and gets worse with standing or long days. You might notice varicose veins or skin changes.
• DVT comes on more suddenly. One leg may become swollen, warm, and painful. It can be dangerous if the clot travels to the lungs.

An ultrasound can spot valve failure, slowed flow, or clots — all major causes of leg swelling.

How Interventional Treatment Helped James

After being diagnosed with venous insufficiency, James underwent endovenous laser ablation (EVLA) — a minimally invasive procedure that closed off damaged veins and rerouted blood flow.

He returned to normal activity within days. Within a few weeks, his legs no longer felt heavy, and the swelling was nearly gone.

Other treatment options include:

• Radiofrequency ablation (RFA)
• Clot-directed therapy (CDT) for DVT
• Sclerotherapy for cosmetic relief
• Compression therapy and lifestyle changes

Learn how EVLA helps treat chronic vein disease — Mayo Clinic

When to Ask About Imaging

Ask your doctor for a vascular workup if you have:

• New or worsening leg swelling
• Fatigue, pressure, or cramping with standing
• Discoloration or skin changes near the ankle
• A history of DVT or varicose veins

The causes of leg swelling are treatable — but only if you know what you’re dealing with.

The story above reflects a common patient scenario. Names and details have been changed for privacy.

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