Swelling and pain in my left ankle and lower leg - venous insufficiency?

Hi @gailg and welcome to Connect.
How confusing when you get opposing advice. @spence had a venous ablation a while and may be able to share some insight. However he has livedoid vasculopathy, which you're not talking about here I don't think. You can see the message in this thread
https://connect.mayoclinic.org/discussion/livedoid-vasculopathy/?pg=1#post-15800
@mlemieux do you have any thoughts?

How have you been managing the swelling and pain thus far? Medication? Compression stockings?

Colleen
Connect Community Director

Thank you for your email/post. I take Norco 10-325 three times a day. I
tolerate it really well. I will say that I always still have at least some
pain and at the end of the day (I usually take the last one around 4 PM) I
am in a lot of pain. The LV sounds terrible. I am so skeptical of the
Venous Ablation. I have an appointment with a third doctor next week since
I have gotten conflicting advice. If I don't feel satisfied with him, I
may try to seek out someone at a teaching hospital closer to me such as
Baylor Medical Center or I think they also have a group that studies this
down at MD Anderson. I took leave this semester to try to deal with so I
am not going to have any procedures unless I know I need them. Sometimes
it is so painful that you are tempted to try just about anything but I am
trying to ​think this through carefully even though the pain is
increasing. I used compression in the past after my first ankle surgery
but have not used them recently. Went to my primary care doc yesterday and
she suggested that I try them again so am going to. I still have an
appointment for the venous ablation later this month with the first doctor
I went to. But he is called an Interventional Cardiologist (I think this
means they do a lot of catheters--does anyone know what this means?). I
would rather have a Vascular Surgeon do it but the vascular surgeon I
visited is one that said he would not do it on me. Does anyone have any
idea who would be better to evaluate whether venous ablation is necessary.
Appointment next week is with another Vascular Surgeon. I am so glad I
found this Group. It sure helps to know that I am not alone with this.
Thank you again.

Hello @gailg ,

Thank you for sharing that with us, it means a lot.

Have you had an ultrasound done on your legs? If not, I would recommend having that done 1st and foremost. Blood tests can't always "show" you problems you might have. I recommend this because anytime you have had a surgery, especially one repairing tendon's and ankle surgery, the connective tissue in the area is affected. Sometimes arteries can be bruised and possibly damaged.

Here in Canada, after any surgery, our first order of business is to send a patient to see a "Thrombo" specialist (Outpatient Care) who will review ultrasounds, give blood thinners as a prescription to prevent clotting from surgery complications.

Venous Ablation:
Did your cardiologist give you a good reason to have the venous ablation procedure? varicose leg veins is usually a sign and symptom of something else. Swelling of the arteries usually doesn't just happen, it normally is due to: surgery, blood type conditions, inflammation, etc.

I too have varicose veins, but it's never been an issue, nor has any specialist been concerned with them since they are very common.

Pain & Inflammation:
Inflammation is something I constantly deal with from my lower legs. I HIGHLY recommend getting "Compression Stockings" right away and wear them anytime you work. Being on your feet is the worst thing you can do to increase the swelling and pain. Compression stockings can help to regulate blood flow and keep the swelling to a minimum. At the same time, I would recommend taking Baby Aspirin (talk to someone prior) once a day. Baby Aspirin is highly recommend to prevent inflammation and to help with blood flow.

I'm not sure if you have a dress code at work, but the type of shoes you wear daily is also key to preventing pain and swelling. Having a proper fitting shoe that doesn't squeeze your feet and ankles can make a huge difference in your daily life.

Describe the pain:
Can you describe the pain? Do you feel burning sensations? Do you get spikes of pain all of a sudden? Is it concentrated behind the calf? ankles? or is it mainly in your upper thighs? Do your legs feel heavy after standing too long? Behind your knee, does it feel like an elastic band pulling your leg (wanting to bend the knee)?

I only ask because knowing your pain and the exact sensations can help a medical specialist to narrow down the type of pain-management you should have.

Here are the questions I would have for my specialists:
- Can we ultrasound my legs to ensure my arteries aren't damaged?
- It there any possibility that I have a DVT (Deep vein thrombosis)?
- Do you recommend a certain compression stocking?
- What makes you believe that the venous ablation is the key?
- What type of diet will help my inflammation?
- Am I able to take baby aspirin daily to help?
- Should I take something for inflammation (ie Naproxen)?

I hope this helps! Also, remember to elevate your legs daily above your heart when you get home. This will drastically reduce the discomfort and swelling.

Please keep us posted!

Martin Lemieux
@Martin_Lemieux - Tweet

I have CAD with LAD-stent for nearly 20 years. I have swelling of both feet, but, no pain. Diuretic therapy is not working. I do not know if any elastic stockings
will be of help. I had this stasis problem, with dependent oedema for several months, off and on. There are no signs of any venous problem. I am 72 y/o and have no other problems.

My left ankle has been swelling for 30 years or so. I am 70 and the swelling has been in both feet, ankles and legs for four years or so. I was diagnosed with venous insufficiency. I wore compression stockings for a few years but I couldn't withstand the pressure when I developed fibromyalgia. Over the years I was tested for DVT, various injuries, lymphedema, etc - to no avail. I have just recently been diagnosed by a pulmonologist with Diastolic Heart Failure (stiff heart syndrome). The swelling is now up to my abdomen. I suspect the swelling has been a symptom of my progressing heart disease. I will know more in a few days when I see a cardiologist. Has anyone else been able to connect their swelling to a failing heart?

I am terribly sorry that this has happened to you. There are several conditions that can cause edema in your legs. I have had swelling in my left foot and calf for several years. I use compression stockings every day. Do you have a primary care physician? If so, that is the best place to start. Also, regardless of what the cardiologist tells you I suggest you get opinions from two additional cardiologists and possibly a vein specialist. It is essential to get a proper diagnosis of what your problem is and it sounds like you don't have one yet. There are vein specialists who have developed procedures that deal with venous insufficiency ( Endovenous Radio Frequency Ablation, Mechano Chemical Ablation and Venoseal Closure System) but we don't know if any of these should be used on you). I have no direct experience with these procedures. They are done on an outpatient basis. I have read that they are about 70percent effective for venous insufficiency. I'm in the process of visiting cardiologists to get other options for myself. Since the compression stockings are too tight you might consider wraps that you can adjust that give you a compression level that you can tolerate. They are similar to an Ace bandage, but thinner. They have velcro at the ends to hold the wrap in place, no metal clips like traditional Ace bandages. I don't know what they are called. I got mine from a podiatrist. Good luck to you and and I hope you can get a proper diagnosis and treatment. Keep me posted