Written and medically reviewed by Mohamed T. Hassan, MD, DABVLM, RPVI, on May 25, 2025
Leg swelling and leg pain are two of the most common reasons patients seek care at Center for Vein Restoration (CVR). While chronic venous insufficiency (CVI) is a leading cause of both leg pain and swelling, responsible for approximately 70 percent of all leg swelling cases, it’s not the only potential explanation. Many other conditions can cause similar symptoms, and treating the patient as a whole, rather than just focusing on their veins, is essential to finding the right diagnosis and improving their quality of life.
“The idea is to help the patient understand that I am treating the patient as a whole, and not just his or her veins. In medicine, we call this a "holistic approach." It reflects our main goal, which is "making life better" for the patient. For the referring physician, it reflects CVR’s credibility and the fact that patients are not numbers to be counted, but individuals we are honored to treat.”–Dr. Mohamed T. Hassan
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Leg swelling isn’t always caused by vein problems. In fact, a wide range of medical conditions can lead to fluid buildup in the legs, some of which are completely unrelated to the veins themselves. Understanding these potential non-venous causes is essential for accurate diagnosis and effective treatment.
Lymphedema – Often confused with vein-related swelling, lymphedema is caused by impaired lymphatic drainage. It doesn’t typically improve with elevation and can be primary (present from birth) or secondary (developing after cancer surgery, radiation, or severe infection). Patients with lymphedema often notice a heavy, swollen feeling in their legs that persists despite rest.
Congestive Heart Failure (CHF) – When the heart struggles to pump blood efficiently, fluid can back up in the veins, leading to swelling, especially in both legs. This type of swelling is often accompanied by shortness of breath, fatigue, and difficulty breathing when lying flat. CHF is more common in patients with coronary artery disease or hypertension.
Kidney or Liver Dysfunction – When the kidneys or liver aren’t functioning properly, fluid can accumulate in the legs. Low protein levels in the blood, known as hypoalbuminemia, can cause fluid to leak into surrounding tissues, leading to pitting edema.
Pulmonary Hypertension and Atrial Fibrillation – These heart conditions can reduce circulation efficiency, leading to fluid buildup in the lower extremities. Swelling may be one of the first noticeable signs of a more serious cardiac issue.
Hypothyroidism – An underactive thyroid can lead to non-pitting edema, as well as symptoms like weight gain, chronic fatigue, cold intolerance, dry skin, depression, and menstrual irregularities.
Medication Side Effects—Certain medications can cause or worsen leg swelling. These include amlodipine, gabapentin, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, hormone therapies, and some antidepressants like SSRIs. If swelling begins after starting a new drug, it’s essential to review a patient’s medication history.
Deep Vein Thrombosis (DVT) – A blood clot in a deep vein is a serious cause of one-sided leg swelling. It can present with pain, warmth, redness, and swelling and requires immediate medical attention. A ruptured Baker’s cyst can also mimic these symptoms.
Infections and Autoimmune Diseases – Conditions like cellulitis (a bacterial skin infection) can cause localized redness, heat, and swelling. Autoimmune diseases like lupus and vasculitis may present with systemic symptoms such as joint pain, fever, and rashes.
Obstructions and Anatomical Issues – Conditions like May-Thurner syndrome, pelvic masses, or large abdominal tumors can compress the veins, leading to persistent one-sided swelling. Patients often report pelvic pain that worsens with standing or physical activity.
Hormonal Changes or Hormone Therapy – Hormone fluctuations, including those related to estrogen or testosterone replacement, can contribute to swelling in some individuals.
Leg pain can stem from many sources beyond vein disease, each requiring a different diagnostic approach. From circulation problems to nerve damage, muscle disorders, arthritis, and even medication side effects, it’s important to consider all possible causes to identify the right treatment. Here are some common non-venous causes of leg pain that doctors should keep in mind.
Peripheral Artery Disease (PAD) – PAD results from narrowed or blocked arteries supplying blood to the legs. It typically causes cramping or pain during walking (claudication) that improves with rest. This pattern is the opposite of vein-related pain, which often eases with movement or elevation.
Neuropathic Pain – Damage to peripheral nerves, such as in diabetic neuropathy, can cause burning, tingling, numbness, or stabbing sensations, often worse at night. Other causes include hypothyroidism, vitamin B deficiency, alcohol use, and chronic kidney disease.
Muscle Disorders – Conditions like polymyositis or other inflammatory muscle diseases can cause muscle weakness and discomfort rather than traditional joint pain. These often come with systemic symptoms like fatigue or skin changes and require specialist evaluation.
Arthritis – Joint-related pain is another major cause of leg discomfort. Osteoarthritis often affects the knees and hips, while rheumatoid arthritis, psoriatic arthritis, and lupus can cause more diffuse pain. These inflammatory conditions often present with morning stiffness, swelling, and fatigue.
Medication Side Effects – Some medications, like statins for high cholesterol, can cause muscle aches or cramps. Diuretics may lead to electrolyte imbalances that trigger spasms, and certain psychiatric medications can alter nerve sensations.
Deep Vein Thrombosis (DVT) – Just like with leg swelling, a DVT should always be considered if pain is sudden, one-sided, and accompanied by swelling and warmth. This is a medical emergency and should not be ignored.
When vein disease doesn’t fully explain the severity or character of the swelling or pain, or when no venous reflux is found, it’s essential to dig deeper. This may involve additional vascular studies, neurologic assessments, lab work, or referrals to other specialists. A thoughtful, comprehensive approach ensures that no potential cause is overlooked and that patients receive the most accurate diagnosis and effective treatment possible.
Find the Right Treatment for Your Leg Pain and Swelling
At Center for Vein Restoration, our board-certified vein specialists take a holistic approach to diagnosing and treating leg pain and swelling. We understand that not every case is caused by vein disease, which is why we consider a wide range of potential causes, from nerve disorders to heart and kidney issues.
If you’re experiencing leg discomfort or swelling that hasn’t been fully explained, our experienced team at Center for Vein Restoration can provide the comprehensive evaluation and personalized care you deserve. Schedule your consultation today to take the first step toward finding the real cause of your symptoms.
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