Don’t suffer in silence from common health condition in hot weather

Who doesn’t enjoy a bit of sunshine? But, when temperatures soar to near subtropical levels, as they have over the last week, the heat can trigger some unpleasant side effects. As well as sunburn and sleepless nights, the relentless heat can also lead to swollen feet, ankles and legs, leaving many people feeling puffy, uncomfortable and struggling to fit into their shoes.

While this can seem worrying, it’s actually very common for feet, ankles and legs to swell slightly in response to hot weather. But, why does it happen and what can you do to alleviate the discomfort? We asked leading experts to share their top tactics on how to tackle summer swelling.

“Heat causes blood vessels to expand,” says Mr Zola Mzimba, Consultant Vascular Surgeon, who specialises in venous disease. “This is a natural process as the body tries to cool down and maintain a core temperature at around 37 degrees C. What happens is that blood vessels widen, or dilate, allowing more blood to flow close to the skin where excess heat can escape.

“At the same time, your sweat glands become more active. Even if you’re not dripping in sweat, your skin will be moister than normal. As sweat evaporates, it cools the skin, helping to lower body temperature. Together with the increased blood flow, this helps to stop you from overheating. But, there’s a downside, as blood vessels dilate, fluid is more likely to leak from the bloodstream into the surrounding tissues. This can lead to swelling, particularly in the lower legs, ankles and feet.”

Why does it affect some people more than others?

While some swelling in hot weather is perfectly normal, this effect can be exacerbated in some people. “In people with chronic venous insufficiency (CVI), where the valves inside the leg veins don’t work as efficiently as they should, heat-related swelling tends to be more pronounced,” says Mr Mzimba.

“Most people don’t even know they’ve got CVI. This was highlighted in two landmark studies. In the Edinburgh Vein study in Scotland, 1,566 people were randomly selected from the general population and scanned. The study showed that CVI – where blood flows backwards, because the valves don’t close properly – was surprisingly common. Yet, most people with abnormal vein function are unaware there is a problem.

“The Bonn Vein study, in Germany, found that early stage (mild or asymptomatic) chronic venous disease affects around 90% of adults. Both studies showed that venous disease is usually progressive, and begins long before it becomes clinically obvious. Early symptoms of venous disease include achy, tired legs, itching, and cramps, which get worse towards the end of the day.”

If you suffer from varicose veins, this can also make summer swelling worse. Varicose veins are swollen, twisted and enlarged veins that bulge just under the surface of the skin, usually on the legs. “Varicose veins are incredibly common,” says Mr Alastair Lewis, Consultant Vascular Surgeon, who specialises in the treatment of varicose veins. “They can develop for a variety of reasons. Spending long periods standing, for example, increases pressure inside the veins of the legs, making them more prone to becoming enlarged and twisted.”

Varicose veins can also cause other symptoms such as pain, aching, throbbing and heaviness. For most people, varicose veins don’t lead to serious problems. But, they can cause swelling in the legs, especially in the summer.

This happens because blood begins to pool in the damaged veins, increasing the pressure within them. As that pressure rises, fluid leaks out of the tiny blood vessels, known as capillaries, into the surrounding tissues. “It is this build-up of fluid that causes the legs and ankles to swell,” adds Mr Lewis. “Compression therapy may help prevent further complications.”

Treat the underlying problem

“If varicose veins are causing leg swelling, treating the underlying vein problem almost always leads to an improvement,” says Mr Lewis. “Although, the swelling doesn’t always disappear completely. That’s because the veins may have been under increased pressure for years, and the surrounding tissues can take time to recover.”

Medical-grade compression stockings can help to reduce swelling, ease symptoms such as aching and heaviness, and can also slow the progression of venous disease. Most varicose veins never cause serious problems, but if venous disease is left untreated it can gradually damage the skin.

“One of the earliest signs is venous eczema, which may come and go,” adds Mr Lewis. “But, over time, permanent brown staining can appear, and in more advanced cases, the skin becomes fragile and damaged. In fewer than one per cent of people this can lead to venous ulcers.”

“Today, most procedures are minimally invasive keyhole treatments,” says Mr Lewis. “This means the vast majority of people no longer need traditional vein-stripping surgery. The most common option is endovenous laser ablation (EVLA), which uses heat to seal the faulty vein from the inside.

“Smaller veins can often be treated with sclerotherapy, an injection that damages the vein’s inner lining so it closes down and is gradually absorbed by the body. Bulging veins can also be removed through tiny incisions in a procedure called a mini phlebectomy. These procedures are usually performed under local anaesthetic. Side effects are typically mild and temporary, with some bruising, tenderness, small lumps or inflammation around the treated veins for a few weeks.

“The most significant potential complication is venous thrombosis (a blood clot), but this is uncommon, occurring in fewer than 1% of patients. Those with additional risk factors, will be prescribed anticoagulant medication as a precaution.

Now the good news

Around nine out of ten people with varicose veins will never develop serious complications. “For the minority who do, early treatment and simple measures such as compression stockings can significantly reduce symptoms and help prevent progression,” says Mr Lewis. “Many people also choose treatment simply, because they dislike the appearance of their veins. Age is a major factor, and both thread veins and varicose veins become more common over time. Women are more likely to develop them than men, partly because hormonal changes weaken vein walls. Pregnancy, in particular, can accelerate the process, as hormonal changes combine with increased pressure on the veins.”

Exercise regularly: “Regular movement is crucial for healthy circulation,” says Mr Mzimba. “Your veins contain one-way valves that stop blood flowing backwards, but they also depend on something known as the calf muscle pump. Every time you walk, your calf muscles contract and squeeze the veins, pushing blood upwards through the leg. If you’re not moving, you’re not using your calf pump. Standing still or sitting for long periods means blood isn’t being pushed efficiently back towards the heart. The result is increased swelling.”

Watch your diet: “Excess sugar, processed foods and alcohol can increase inflammation and make swelling feel worse,” says Mr Lewis. “So, eating a healthy, nutritious food is important.”

Herbal support: A recent review (Phytotherapy Research, 2020) showed that red vine leaf extract can have a therapeutic beneficial effect on CVI and help to support healthy leg-vein function. Try: Healthspan Vein-Vine Leg Vein Support (£19.99 for 90 tablets) – contains red vine leaf extract (5400mg), vitamins B1 and C. Available via healthspan.co.uk

Elevate your legs: “If you’re relaxing, lying down with your legs elevated is much better than sitting with your feet hanging down. The closer your legs are to the level of your heart, the less pressure there is inside the veins.”

When should you see a doctor? “Visible veins alone aren’t always a reason for treatment,” says Mr Lewis. “But, if you’re experiencing aching, throbbing, heaviness, tired legs, swelling or worsening symptoms – it’s worth getting your veins assessed by a specialist.”

Stay hydrated: “Not drinking enough fluids can contribute to muscle cramps, particularly in people with venous insufficiency,” says Mr Mzimbi. “Hot weather also increases the risk of electrolyte imbalances, which may trigger painful night-time leg cramps.”

When travelling: “If you’re sitting for long periods on a plane or train, make sure you get up and walk up and down the aisle regularly during the flight,” says Mr Mzimbi. “You can also do some simple exercises while sitting – eg: ankle circles, heel raises. Wearing compression stockings can also help to reduce swelling.”