Have you noticed your socks leaving deep marks around your ankles by midday, or found that your favourite shoes suddenly feel too tight? Lower-limb swelling, known medically as peripheral oedema, is a common concern among older adults.
While it can be tempting to dismiss swelling as a normal part of ageing or the result of a hot day, persistent leg swelling deserves closer attention. It can have several causes, ranging from fluid retention to circulation problems or changes in the lymphatic system.
But how can you tell the difference between these conditions, and when should you seek professional advice?
Understanding the possible causes of swollen legs can help you recognise changes, know what to look out for and take the appropriate next steps.
Understanding the Main Causes of Swollen Legs
Although general fluid retention, chronic venous insufficiency and lymphoedema can all cause swelling in the legs, each condition affects the body differently.
1. General Fluid Retention (Peripheral Oedema)
General fluid retention occurs when excess fluid builds up in the body's tissues. In older adults, this may appear as pitting oedema, where pressing a finger into the swollen area leaves a temporary indentation.
What should you look out for?
Several factors can contribute to fluid retention, including:
Prolonged sitting or standing: Remaining in one position for extended periods can encourage fluid to accumulate in the lower legs, particularly when the calf muscles are not moving regularly.
Medication side effects: Some medications, including certain blood pressure medicines and non-steroidal anti-inflammatory drugs (NSAIDs) used for pain and inflammation, can contribute to swelling.
Underlying health conditions: Swelling in both legs can sometimes be associated with conditions affecting the heart, kidneys or liver, which may interfere with the body's ability to regulate fluid balance.
Although pressing on a swollen area can provide a useful observation, it cannot determine the underlying cause. Persistent or unexplained swelling should be assessed by a healthcare professional.
2. Chronic Venous Insufficiency
Chronic venous insufficiency is a circulation problem that occurs when the veins in the legs struggle to return blood efficiently towards the heart.
The veins contain one-way valves that help move blood upwards against gravity. When these valves become damaged or do not function properly, blood can pool in the lower legs. This increases pressure in the veins and can cause fluid to move into the surrounding tissues.
Common signs include:
Swelling that becomes more noticeable throughout the day and may improve with leg elevation.
A dull ache, heaviness or cramping in the calves.
Visible varicose veins.
Brownish skin discolouration around the ankles.
Skin that becomes unusually dry, thickened or irritated.
These symptoms can overlap with other conditions, so a clinical assessment is important to establish the cause of the swelling.
3. Lymphoedema
Lymphoedema develops when the lymphatic system, which helps drain excess fluid from tissues and supports the body's fluid balance, becomes damaged or does not function effectively.
Unlike some other forms of swelling, lymphoedema can become firmer and less likely to leave an indentation when pressed as the condition progresses.
Possible signs of lymphoedema include:
Changes in the feet and toes: Swelling may affect the toes and the tops of the feet before extending further up the leg.
Persistent or firm swelling: The affected area may feel tight, heavy or increasingly difficult to move comfortably.
Uneven swelling: One leg or foot may be noticeably larger than the other, although both sides can be affected.
Changes in skin texture: The skin may become thicker or feel different over time.
Relevant medical history: Lymphoedema can develop following lymph node removal, certain cancer treatments, surgery or infections that affect the lymphatic system.
A clinician may also check Stemmer's sign, which involves assessing whether a fold of skin at the base of a toe or finger can be gently lifted. Difficulty lifting the skin can support a suspicion of lymphoedema, but this sign alone cannot confirm or rule out the condition.
Because these three conditions can produce similar symptoms, it is important not to rely on appearance alone to identify the cause.
When Should You Seek Immediate Medical Attention?
Although some leg swelling develops gradually, certain symptoms can indicate a more serious medical problem and require urgent assessment.
Seek urgent medical attention if you notice:
Sudden swelling in one leg, particularly when accompanied by pain, redness or warmth. These symptoms can indicate deep vein thrombosis (DVT), a blood clot in a deep vein.
Swelling accompanied by chest pain or shortness of breath. These symptoms may indicate a serious condition and require immediate medical attention. Call 000 in Australia if symptoms are sudden or severe.
Signs of a possible skin infection, such as spreading redness, rapidly worsening swelling or skin that feels unusually hot to the touch.
Do not assume that sudden or worsening swelling is simply related to ageing. Prompt medical assessment can help identify the cause and determine whether urgent treatment is needed.
How Is Persistent Leg Swelling Assessed and Managed?
The most appropriate way to manage swollen legs depends on identifying the underlying cause.
A healthcare professional may review your medical history and medications, examine the affected area and arrange further investigations where necessary. This may include an ultrasound to assess the veins in your legs if a circulation problem or blood clot is suspected.
Depending on the diagnosis, management may involve:
Reviewing medications with the prescribing healthcare professional.
Appropriate movement and physical exercises.
Compression therapy when clinically indicated.
Specialised lymphatic drainage and other lymphoedema management strategies.
Treatment of an underlying medical condition.
Physiotherapy may also form part of a management plan when swelling affects mobility, strength or everyday activities. A physiotherapist can assess physical function, recommend appropriate exercises and help support safe movement as part of your broader care.
However, unexplained swelling should be medically assessed before starting compression treatment or attempting to manage it independently, as the appropriate approach depends on the cause.
Supporting Your Mobility and Everyday Independence
Persistent leg swelling can make walking, standing and completing everyday activities more challenging. Discomfort, heaviness and restricted movement may affect how confidently you move around your home and participate in activities you enjoy.
Identifying the cause of swelling is the first step. From there, appropriate treatment and support can help address the underlying condition while supporting your mobility and daily function.
At Your Health Your Way, we provide mobile physiotherapy for older adults across Sydney's Northern Beaches and North Shore. Our physiotherapists work with individuals in their own homes to support strength, balance, mobility and independence.
Where physiotherapy is appropriate, we can help you work towards your personal movement goals through tailored exercises and practical strategies suited to your abilities and home environment.
If you or someone you care about is experiencing persistent leg swelling, speak with your GP to establish the cause and discuss the most suitable treatment options.
Understanding what is happening in your body can help you take the next step towards feeling more comfortable, moving with confidence and maintaining your independence.
References
Healthdirect Australia. Fluid Retention.
Healthdirect Australia. Lymphoedema.
Healthdirect Australia. Deep Vein Thrombosis (DVT).
Lymphoedema Association Australia. The Importance of Early Diagnosis.