Swollen Legs and Ankles in Ajax: When Venous Ultrasound Helps

“It’s just my age.” “It’s the heat.” “I was on my feet all day.” People find many ways to explain away puffy ankles, and very often they are right. Fluid naturally pools in the lower legs when we stand or sit for long stretches, and plenty of healthy people end a long shift or a summer afternoon with sock marks pressed into their skin.

But swelling is also one of the body’s more general signals. It can come from the veins, from the heart, the kidneys, the liver, the lymphatic system, a medication, an injury or an infection. Some of those causes are minor; a few need prompt attention. A venous ultrasound is one of the tools providers use to sort through them, and it is good at answering certain questions and not designed to answer others.

This article is about that sorting process. It looks at the kinds of swelling providers think about, the signs that should never wait, and where a venous ultrasound at our Ajax clinic fits into the picture.

When swelling is an emergency

Some swelling needs same-day medical attention, not an imaging appointment.

Call 911 or go to the nearest emergency department if leg swelling comes with chest pain, sudden shortness of breath, coughing up blood, a racing heartbeat, or fainting. These can be signs of a blood clot in the lungs.

Also seek urgent care, through your provider, an urgent care centre or an emergency department, if you notice:

• swelling in one leg that came on suddenly, especially with pain, warmth or redness
• a leg that is red, hot, spreading and painful, with or without fever
• swelling after a significant injury, where you cannot bear weight
• rapid swelling of both legs together with breathlessness, especially when lying flat

A community imaging clinic is not equipped to assess emergencies. If you are unsure, it is always safer to be seen.

One leg or both: the first clue

One of the first things a provider notices is whether the swelling affects one side or both. This is not a diagnostic rule, but it tends to steer the conversation.

Swelling in both legs

When both ankles swell, providers often think about causes that affect the whole body or the circulation in general. Examples include:

• long periods of standing or sitting, heat, and travel
• veins that have become less efficient at returning blood over time
• pregnancy
• certain medications, including some blood pressure tablets, anti-inflammatory drugs and hormones
• heart, kidney, liver or thyroid conditions that change how the body handles fluid
• low protein levels in the blood

Swelling in one leg

When only one leg is swollen, a provider is more likely to think about something local to that limb, such as:

• a blood clot in a deep vein
• an injury, a sprain or a muscle tear
• a skin infection
• a cyst behind the knee that has leaked or become large
• a problem with lymph drainage on one side
• vein problems that happen to be worse on one side

Again, these lists overlap. Venous disease can affect one leg more than the other, and a whole-body cause can be more obvious on one side. That is part of why examination and testing matter.

What the veins are supposed to do

Blood travels down to your feet through arteries and has to make the return journey uphill through veins. Two things make that possible: the squeezing of the calf muscles each time you walk, and small one-way valves inside the veins that stop blood from sliding back down between squeezes.

When everything works, the lower legs drain well and fluid does not build up. When the return system struggles, pressure rises in the small vessels near the ankle and fluid seeps into the surrounding tissue. Gravity does the rest, which is why vein-related swelling is often:

• worse at the end of the day
• better in the morning or after the legs have been raised
• most noticeable around the ankles and lower shins

Two broad venous situations can lead to this kind of swelling:

1. A blockage, such as a clot in a deep vein, which stops blood from draining normally.
2. Valves that leak, sometimes described as venous insufficiency or reflux, which let blood pool in the lower leg.

Both can be looked at with venous ultrasound. If you would like the detail behind each, we have separate articles on blood clots and deep vein thrombosis and on varicose veins and venous reflux.

Other signs your provider may look for

Swelling rarely appears on its own. Before deciding on a test, a provider will usually look at the legs closely and ask about things you may not have connected with your ankles.

On the skin and legs:

• whether pressing a finger into the swollen area leaves a dent that slowly fills back in
• visible, twisted or bulging veins
• brownish discolouration around the ankles
• dry, itchy or thickened skin
• sores that are slow to heal
• whether the feet and toes are swollen too

Elsewhere in the body:

• shortness of breath with activity or when lying down
• needing extra pillows to sleep comfortably
• weight gain over a short period
• puffiness around the eyes or in the hands
• changes in urination
• tiredness or reduced exercise tolerance

Some of these point more toward the veins, and some point the provider toward the heart, kidneys or other systems. That is why swelling is sometimes investigated with blood work, urine tests, heart tests or other imaging rather than, or in addition to, a leg ultrasound. If a provider is concerned about the heart, our cardiology team, Durham Cardiology, offers tests such as echocardiograms by requisition.

What a venous ultrasound can tell your provider

A venous ultrasound uses sound waves to show the veins of the leg and the blood moving through them. It does not use radiation. During the exam, the sonographer looks at both the structure of the veins and the way blood flows.

For a swollen leg, the scan can help answer questions such as:

• Is there a clot in the deep veins? The sonographer checks whether the veins compress normally with gentle pressure and whether blood flows freely.
• Are the valves leaking? In a reflux study, the sonographer looks for blood flowing backward when it should not, often while you stand, or after a squeeze of the calf or a change in breathing.
• Is there something near the veins? The scan can sometimes show other findings in the area, such as a fluid-filled cyst behind the knee or swollen tissue under the skin.

What it cannot tell them

A venous ultrasound is focused on the veins. It does not:

• measure how well the heart is pumping
• assess kidney or liver function
• diagnose a lymphatic problem on its own
• explain swelling that is caused by medication

A normal venous ultrasound is useful information. It can help a provider move on to the next likely explanation rather than leaving a question hanging. It is not a sign that your symptoms have been dismissed.

Two kinds of venous scan, two kinds of question

It is worth knowing that a “leg vein ultrasound” is not always the same exam. Your requisition may ask for one of two broad types, and the experience can differ slightly.

A scan to look for a clot

This is focused on the deep veins, from the groin down toward the calf, checking compression and flow. It is usually done lying down, with your leg turned slightly outward and your knee a little bent. It tends to be the faster of the two.

A scan to look for reflux

This is focused on how well the valves are working, often in both the deep and the surface veins. Because gravity matters here, you may be asked to stand or sit with your legs hanging down for part of the exam. The sonographer may gently squeeze your calf to push blood upward and then watch what happens when they let go. This type can take longer.

Your provider decides which question they want answered. If you are unsure which one you have been booked for, the clinic will confirm the preparation when you book.

Getting ready for the appointment

Preparation for vascular ultrasound is confirmed at booking, and for most leg vein exams it is simple. Practical tips that help:

• Wear loose, comfortable clothing. Shorts underneath, or trousers that are easy to remove or roll up, make things easier. You may be offered a gown.
• Skip lotion on your legs that morning so the gel and probe move smoothly.
• Remove compression stockings before the scan, or wear ones that are easy to take off, unless you have been told otherwise.
• Bring your health card and requisition.
• Bring a list of your medications, including over-the-counter ones and supplements.
• Note your symptoms: when the swelling started, whether it comes and goes, and what makes it better or worse.

The exam involves warm gel and gentle pressure from the probe. Pressing on a swollen or tender leg can be uncomfortable for a moment, so tell the sonographer if anything hurts and they can adjust.

The sonographer captures images and measurements during the scan, and a report is sent to the provider who ordered the test. They will discuss the findings with you.

Questions worth asking your provider

If swelling is something you have been living with for a while, a few direct questions can help you understand the plan:

1. Do you think my swelling is coming from my veins, or from somewhere else?
2. Is the venous ultrasound looking for a clot, for leaky valves, or both?
3. Are any of my medications known to cause ankle swelling?
4. Should I raise my legs, wear compression stockings or change my activity while I wait for results, or is that something to decide afterward?
5. Which changes should make me seek care urgently?

Only your provider can advise on compression stockings, medication changes or other treatment, because these depend on the cause and on your overall health.

Key takeaways

• Ankle swelling is common and often harmless, but it can come from the veins, heart, kidneys, liver, lymph system, medications, injuries or infections.
• Sudden swelling in one leg, or swelling with chest pain or breathlessness, needs urgent care, not a scheduled scan.
• A venous ultrasound looks at the veins only. It can check for a clot or for leaky valves, depending on what your provider asks.
• A normal result still helps by narrowing down the possibilities.

Booking a venous ultrasound in Ajax

Rossland Diagnostic Clinic offers vascular ultrasound at Unit 102, 300 Rossland Road East, Ajax, with free parking and a ground-floor entrance, which is helpful when legs are sore or swollen. We welcome patients from Ajax, Pickering, Whitby and across Durham Region, Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm.

If your provider has given you a requisition, call 905-426-3111 or request an appointment, and our team will confirm any preparation for your exam.