Vascular Surgeon
Expert in the treatment of varicose veins
Feeling of heavy legs?
What are the causes and how to relieve them?
How does heavy legs manifest themselves?
It is most often the sensation of having heavy legs, especially a heaviness in the calves, ankles or feet, very rarely in the thighs. It is not necessarily painful, it can be an unpleasant feeling of discomfort. It occurs more often at the end of the day, in summer and after more or less prolonged walking.
On the other hand, the heaviness can be painful, with an important sensitivity to the pressure of the skin and the subcutaneous tissues. You are then very sensitive to any contact on your legs. Physical activity, walking in particular, improves this sensation of heavy legs, especially if it is venous in origin.
The sensation of heavy legs is most often present on the side where varicose veins exist if they are at the origin, but it can also be bilateral if there are other origins to this discomfort.
What is the origin of heavy legs?
It can be a disorder of venous circulation, due to a bad venous return towards the heart (see How do the veins work) with the presence or not of varicose veins. In this case the heaviness is more important on the side where the varicose veins exist.
The heaviness can also be due to lymphatic congestion, again because of the blockage of lymphatic drainage towards the upper thighs. This is commonly called “water retention”.
There are more severe lymphatic diseases, often appearing after an intervention on the lymph nodes (lymph node curage) which cause very important swellings, sometimes disabling.
Weight gain can also cause the sensation of heavy legs, which is the most frequent case when the examination does not reveal any circulatory disorder.
In reality, all these factors are often more or less associated to explain the sensation of heavy legs.
A particular situation is that of lipedema where there is an accumulation of subcutaneous fat in the legs (different from cellulite), sometimes in the buttocks, or even in the arms, sparing the feet. This pathology is hereditary and often causes a functional handicap (pain, heaviness) and important aesthetic.
It should also be mentioned that any individual, even in perfect health, will have a feeling of heaviness and heavy legs in a situation of prolonged walking!
Are heavy legs always associated with swelling?
Most of the time yes, there is a swelling called edema, which accompanies the sensation of heavy legs. This edema most often concerns the calves and the ankle, more rarely the foot, especially when the edema is of lymphatic origin.
The study of the type of swelling during the manual examination by the doctor will give an idea of its origin. Sometimes there is no real visible swelling, it can just be an unpleasant sensation.
What should I do if I have chronic heavy legs?
The presence of repeated or permanent heavy legs should lead to a consultation with a vascular specialist, doctor or surgeon.
The clinical examination and especially the ultrasound-Duplex scan exploration will give a more precise idea of the origin of this heaviness by exploring the functioning of the veins and the state of the subcutaneous tissues.
An examination of the lymphatics (lymphoscintigraphy) will sometimes be necessary, but only in very specific cases.
A rapid and painful swelling must lead to an emergency or semi-emergency examination to eliminate the formation of a clot in a vein (phlebitis), especially if it occurs after a prolonged immobilization (bed rest for illness, postoperative period, presence of a plaster cast…), a long trip while seated or if phlebitis has already occurred.
What can I do to relieve my pain?
Simple maneuvers such as lying down with your legs up against a wall or taking a cool shower often bring quick relief. Wearing compression stockings is also very effective, but stockings must be prescribed by a doctor after a specialized consultation.
If there are venous disorders confirmed by an echo-Doppler examination, an intervention on varicose veins can provide a very effective solution. Manual lymphatic drainage performed by a physiotherapist is also highly recommended in the presence of lymphatic congestion. Weight loss is always effective in reducing and sometimes eliminating the sensation of heavy legs when a significant weight gain has occurred.
There are specific liposuction procedures to treat lipedema, which unfortunately very few plastic surgeons perform.
In conclusion
It is essential to have a specialized vascular opinion when you are a victim of repeated or permanent leg heaviness!
