Leg swelling is common — but the cause is often not simple.
Many patients live with swelling for years because they were told:
“It’s just lymphoedema,”
“It’s probably venous,”
“Your scans are normal,” or
“There’s nothing to do.”
At Laurel Clinical, we specialise in understanding why swelling happens by assessing the entire circulation system — veins, lymphatics, connective tissue, and compression points — using advanced doctor-performed duplex ultrasound.
Our goal is to uncover the correct diagnosis and create a personalised plan to improve comfort, mobility & long-term skin health.
Lymphoedema occurs when the lymphatic system is unable to drain fluid effectively, leading to persistent swelling, heaviness, tightness, skin thickening and an increased risk of infections such as cellulitis. It may be primary, meaning the lymphatic vessels developed differently from early life, or secondary, developing later as a result of surgery, trauma, cancer treatments, recurrent infections, long-standing venous disease, obesity or significant venous reflux or obstruction. Importantly, swelling is not always purely lymphatic—many people experience a mixed venous–lymphatic disorder, where both systems contribute to the symptoms. This mixed pattern requires a tailored diagnostic and treatment approach rather than assuming lymphoedema alone is responsible.
Leg swelling may be due to:
Leaky valves, reflux, surface varicose veins.
May–Thurner, iliac vein narrowing, popliteal compression, pelvic congestion.
Primary or secondary lymphoedema.
Swelling that persists in the morning
A feeling of tightness or heaviness
Skin that becomes thick, firm or “spongy”
Shoes and clothing become tighter as the day goes on
Skin creasing or “buffalo hump” at the ankle
Only partial response to compression stockings
History of cellulitis
But lymphoedema often coexists with venous disease, which is why ultrasound is essential.
Based on physical examination, limb patterning, skin changes and functional testing.
We identify patterns, triggers, and progression — swelling is rarely random.
This is your biggest differentiator.
We assess:
superficial venous reflux
deep venous reflux
venous obstruction or compression
collateral circulation
calf pump function
tissue characteristics suggestive of lymphatic overload
Most clinics do not combine venous + lymphatic interpretation.
We do — and it changes everything.
Swelling is categorised as:
Venous-dominant
Lymphatic-dominant
Mixed venous–lymphatic
Compression-related
Hypermobility-associated pooling
This determines the treatment — not guesswork.
If venous reflux or obstruction is found:
endovenous laser ablation (EVLA)
ultrasound-guided sclerotherapy
targeted treatment of surface veins
management of pelvic congestion or compression findings
referral for endovascular intervention when appropriate
Treating the vein problem often reduces lymphatic overload.
For primary or secondary lymphoedema:
lymphatic massage / manual lymphatic drainage
compression garments (custom sizing if needed)
bandaging for advanced cases
skin care to prevent infection
exercise and movement therapy
We coordinate with lymphoedema therapists when needed.
Mixed disease requires:
targeted venous treatment
lymphatic management
compression strategies tailored to tissue elasticity
strengthening of calf pump function
long-term monitoring
Patients with hypermobility may experience:
pooling
vein collapsibility
compression susceptibility
valve dysfunction
tissue fragility
Management includes:
modified compression
gentle treatment techniques
staged intervention
long-term wellness planning
Many patients come to us after being told “nothing can be done.”
Often, there is a cause — it simply hasn’t been found yet.
Persistent ankle or leg swelling
Swelling worse by end of day
Post-pregnancy or post-surgery swelling
Swelling that did not respond to vein treatment elsewhere
Hypermobility patients with pooling or heaviness
People with recurrent cellulitis
Patients seeking a true diagnosis, not assumptions
Lymphedema is typically long‑term, but symptoms can be managed very effectively. With consistent care many people see less swelling, better comfort, and healthier skin
Both involve swelling. In phlebolymphedema, vein disease drives fluid overload that strains the lymphatics. We address both systems for lasting results.
Compression is a cornerstone of care. The type and schedule may change over time—our goal is to make it comfortable and sustainable.
All lymphedema is edema, but not all edema is lymphedema.
Edema is a general term for swelling that happens when fluid builds up in the body’s tissues. It can be caused by many things, such as heart, kidney, or liver problems, certain medications, or simply standing for long periods.
Lymphedema, on the other hand, is a specific type of edema. It happens when the lymphatic system—which normally drains fluid and helps fight infections—doesn’t work properly. This leads to a buildup of lymph fluid, most often in the arms or legs, and can cause long-term swelling that needs special care.
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