Approach to Leg Edema of Unclear Etiology

John W. Ely, MD, MSPH; Jerome A. Osheroff, MD; M. Lee Chambliss, MD, MSPH; Mark H. Ebell, MD, MS


J Am Board Fam Med. 2006;19(2):148-160. 

In This Article

Summary and Recommendations

  • In the approach to leg edema of unclear etiology, the physician should first rule out lipidema (fat maldistribution with sparing of feet) and lymphedema (marked foot and toe involvement, verrucous thickened skin, nonpitting when chronic) because subsequent evaluation and treatment are different for these disorders.

  • If systemic disease is considered unlikely, the most common causes of bilateral leg edema are idiopathic edema (in young women) and chronic venous insufficiency (in older patients).

  • In patients with chronic bilateral edema, the physician should consider the most common systemic causes (cardiac, renal, hepatic) and decide, based on history and physical examination, which of them need to be ruled out with further testing. Pulmonary hypertension is a common cause and should be suspected in patients who may have sleep apnea (eg, neck circumference >17 inches, loud snoring or apnea noted by sleep partner).

  • If the patient presents with sudden onset (<72 hours) of leg swelling, a deep vein thrombosis should be ruled out using a Doppler examination.

  • Evidence ratings for the major recommendations in this article are included in Table 6 .