prolonged sitting, standing, walking
mechanical (e.g. constricting clothing)
Chronic venous insufficiency (varicose veins)
Congestive cardiac failure
Drugs (e.g. calcium antagonists, NSAIDs)
Serious disorders not to be missed
kidney disease (e.g. nephrotic syndrome)
liver disease (e.g. cirrhosis)
skin allergy (e.g. angioneurotic oedema)
Idiopathic (periodic or cyclic) oedema
Protein-losing enteropathy (e.g. Crohn)
Lipoedema (fat and fluids) of legs
Drugs (multiple; see list)
Thyroid/endocrine (hypothyroidism, Cushing syndrome)
Past history (esp. liver, heart, kidney disease), travel, drugs, occupation, recent trauma. Circumstances of swelling (e.g. prolonged walking, long journey).
Cardiovascular, abdomen (signs of liver disease), legs including circulation, varicose veins and evidence DVT
Not all swollen legs require investigation.
If the onset of oedema is acute (often <72 hours) suspect DVT.
Pitting oedema is a feature of venous thrombosis or insufficiency, not lymphatic obstruction.
The significance of leg swelling varies according to the age group, whether it is bilateral or unilateral and whether the onset is sudden or gradual.
Drugs that can cause leg and ankle swelling include calcium antagonists, NSAIDs, corticosteroids, glitazones, beta blockers.