Night Leg Pain

Heavy Legs

Heavy legs are common. Some people will complain that their legs ache at night. Heavy legs are more common at the end of the day, or after spending time sitting or standing. The most common cause for heavy legs is vein disease. But other causes exist, such as increased fluid or fat in the legs.

Heavy Legs Causes

There are many reasons for heavy legs. Vein disease is probably the most common cause. But some people accumulate fluid, fat or other material in their legs. These will also cause the legs to feel heavy.

Venous Insufficiency

Vein disease is very common. More specifically, venous in sufficiency is very common. In this condition the vein valves do not function properly, and pressure builds up in the legs. This pressure causes a heavy legs sensation.

Venous insufficiency can result in a range of symptoms. In fact, most people who have venous insufficiency will not have any symptoms at all. But, some people will have swollen feet, swollen ankles or swollen legs. Sometimes, visible veins appear in venous insufficiency. When they are small, they are called spider veins. Larger veins are called reticular veins. And larger veins still are called varicose veins.

Varicose veins and reticular veins can cause heavy legs
Reticular veins on the left thigh and varicose veins mostly on along the right leg

Not everybody who has venous insufficiency will also suffer from heavy legs. But many will. The heaviness will appear mostly at the end of the day, after pressure has built up throughout the day. That is why venous insufficiency is a reason for night leg pain. Other times heaviness occurs will be after prolonged standing or prolonged sitting.

Other Causes of Fluid Accumulation

Venous insufficiency is not the only reason for swollen legs. In fact, there are other more important reasons to consider. Leg swelling, or edema, can be part of diseases of the heart, liver and kidneys. As long as the fluid is in the legs, they will swell, and they might feel heavy.

Dependent Edema

The most common cause of leg swelling, is also probably the least well known. And this cause is called dependent edema. Many people suffer from dependent edema. This is when fluid accumulates in the legs with seemingly no good reason. In fact, dependent edema is why many people have swollen legs after sitting, swollen ankles after flying and leg swelling after eating too much salt.

Dependent edema swollen legs
These legs are swollen and heavy. Notice the lines from the shoes.

Lipedema

Lipedema is when fat accumulates in specific areas of the body. The most common locations are the legs and the arms. There are several types of lipedema. But all of these types share an accumulation of fat. This is not obesity. In fact, people with lipedema might lose weight everywhere else, but still have fat in their legs. Obviously, these large legs will often feel heavy.

Lipedema is a cause for heavy legs
Severe lipedema. Notice the feet are not swollen. This amount of fat will be heavy.

An important tip to diagnosing lipedema is that the feet are not swollen. This condition has a nickname which is “skinny feet syndrome”. Take a look at the picture above and see what that looks like.

Lymphedema

Lymphedema is when fluid called lymph accumulates in the legs. At first, the swelling might be reversible. But as the lymphedema progresses, fluid and other materials will stay stuck in the legs. That is when the swelling will be come more permanent.

Lymphedema can cause heavy legs
In advanced lymphedema the swelling is permanent. Notice that the feet and even the toes are swollen.

Lymphedema can be primary or secondary. Primary means the problem is inborn. There are just not enough lymphatics or they have not matured. But, lymphedema can also be secondary. For instance, surgery, burns, infections and cancer can damage the lymphatics. For this reason, never ignore new-onset lymphedema.

Blocked Veins

A blood clot in the veins might cause chronic blockages and symptoms. These symptoms are called post thrombotic syndrome. Not everyone who had a blood clot will suffer from post thrombotic syndrome. But some of these people will have significant symptoms including significant discomfort in their legs.

Heavy Legs Treatment

The treatment of heavy legs should follow the causes. Sometimes, treatment is as easy as elevating your legs. But sometimes, treatment requires procedures, or medications that will treat the underlying cause.

Elevation: The Easiest Solution for Heavy Legs

Everyone knows that when your legs feel heavy, you should put them up. But not everyone knows why this helps. Elevating your legs will help remove excess fluid and pressure. In essence, when you elevate your legs, gravity is on your side.

We usually recommend that people elevate their legs when they are immobile anyway. We do not think that leg elevation should prevent you from being mobile. In fact, being mobile is part of the solution. Keep reading.

Stay Mobile to Escape Heavy Legs

When we walk, our feet, ankles and calves pump fluid out of our legs. This will improve swelling, and reduce pressure in the lower parts of our legs. Obviously, reducing pressure will make you feel better. So, staying active is important.

We usually recommend getting up and moving around regularly. Also, consider incorporating a walk into your schedule. If you can, think about swimming. Swimming (and water aerobics) are great to relieve a heavy sensation because water will press on the legs from all sides.

Reduce Your Salt Intake

Not everyone is sensitive to salt. But some people are. If you are one of those people, reducing the salt in your diet will reduce the swelling in your feet. As you can imagine, reduced swelling can also reduce discomfort.

By the way, there may be an added benefit to restricting salt in the diet. Too much salt has been linked to excess heart disease and a higher chance of premature death (though to be honest, not all studies have shown this connection).

Compression

Compression stockings are woven in such a way that the bottom compresses more than the top. This creates a gradient, pushing fluid upward, and combating gravity. By pushing the fluid upward, compression stockings reduce swelling and reduce pressure.

Not everyone likes compression stockings. But consider this. First, compression stockings are like any other piece of clothing. Sometimes it takes a few tries until you find the best fit for you. Also, you don’t have to wear them all the time. You might decide to wear them when you know you will be on your feet a lot. Finally, compression stockings come in many degrees of compression. If the ones you have tried are too tight, perhaps a lighter pair will work better for you.

Procedures

Some of the procedures that contribute to heavy legs can be treated with procedures. Of these, the most procedures are available for venous insufficiency. It is not hard to find vein centers or vein doctors who will offer procedures to fix your veins. Sometimes these are minor procedures. For instance, injecting spider veins. But sometimes they are more elaborate, including vein ablation, and ligation.

If the cause for heavy legs is an obstructed deep vein, opening it might offer relief. But, these procedures are not simple. In fact, they are quite involved. If you happen to need such a procedure, make sure you find an appropriate doctor with the relevant expertise to take you through this.

Identify and Treat the Underlying Cause

In the end, the secret to solving heavy legs is to identify the cause. Remember that the treatment of most causes is simple. But other causes will require complex intervention and expert medical care.

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