Abstract

Leg edema is a common problem in the elderly and requires further evaluation and
management. Method: From October 1990 to July 1992, 245 patients presented to
the Cleveland Clinic Florida with leg edema. All patients were counseled about the
benefits of twenty-minute, three-times-a-day raised-leg exercises. Fifty seven (57) of
the 245 patients were not compliant with this regimen (nonexercise group). Although
not true controls, they formed a comparison group for those who performed the
exercise regimen. The exercise group was composed of 188 patients with a mean
age of 73 6.8 years, 25 (13%) men and 163 (87%) women; the nonexercise group
was composed of 57 patients with a mean age of 71.9 4.3, 19 (33%) men and 38
(67%) women. Workup for leg edema included: comprehensive history, clinical
examination including prostate or pelvic examination, complete blood count,
chemistry profile, thyroid profile, electrocardiogram, chest radiograph, and, when
indicated, pelvic or leg ultrasound and pelvic computed tomographic scan. The
circumference of the leg with the maximum amount of edema was measured initially
and on the fourth week.

Results: In this study, the common causes of leg edema in the elderly population
were venous stasis (63.2%), drug induced (13.8%), and heart failure (15.1%).
Postphlebitic syndrome, cirrhosis, lymphedema, lipedema, prostate carcinoma (CA),
and ovarian mass were the less frequent findings. Upon comparison of the
circumference of leg edema on initial visit and four weeks after, both the exercise and
nonexercise groups showed significant decreases in the measurement of the leg
edema (P < .001) except those caused by lymphedema. The amount of change
when compared between those who exercised and those who did not was significant
only in venous stasis.

Conclusion: Causes of leg edema in the elderly are multiple. Twenty-minute, three-
times-a-day raised-leg exercises were significantly more effective in the management
of leg edema due to venous stasis (P < 0.0001) but did not produce significant
differences in other etiologies such as heart failure, drug induced, and other
conditions, which include lymphedema, prostate and ovarian CA, and postphlebitic
syndrome. Successful management of leg edema is based on adequate and
thorough assessment to identify the cause.

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