By Joseph Magnant, MD, FACS –
Patients may have to urinate frequently at nite, often have to loosen their shoes as the day progresses and often note restless legs when they lie down at nite. Elevation eventually relieves their discomfort as the fluid in the legs returns to venous circulation at the level of the collar bone where the thoracic lymphatic duct returns the clear serum back into the internal jugular vein. This returned fluid is then processed into urine by the kidneys, stored in the bladder and often necessitates frequent nighttime trips to the bathroom (nocturnal diuresis). This straight forward cycle repeats itself daily with increased venous pressure in the ankle area due to leaky vein valves, resulting in seeping of serum out of the thin-walled veins into the surrounding skin and fat (appearance of “cankles”) which progresses over the course of the day, until elevation and rest are possible. Over the course of many years the “cankles” appear to more permanent in nature as the net addition of liquid outpaces the body’s ability to rid itself of the extra water since we spend 2/3 of our 24 hour days upright (standing, sitting and walking) and only 1/3 in the bed with legs elevated. I agree with Dr Oz that effective conservative therapy includes exercise, as this helps the calf muscles pump at least some of the extra fluid back up to the jugular vein. However, unless the most common and TREATABLE underlying cause of “cankles” (venous insufficiency) is scientifically ruled out with duplex ultrasound examination, I would not encourage any of my patients to have liposuction of their “cankles”. In the younger population, first consider venous insufficiency. In the older population, one needs to consider heart failure, kidney dysfunction, excess salt intake, medication side effects as well as venous insufficiency. Venous insufficiency should be considered and ultrasound evaluation completed early in the evaluation of swollen ankles rather than as a last ditch diagnosis, grasping for the proverbial straw.
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Vein Specialists (Fort Myers Office)
1510 Royal Palm Square Blvd. Suite 101
Fort Myers, Florida 33919
P. 239.694.VEIN (8346)
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Email: info@weknowveins.com
Dr. Joseph Magnant, M.D., F.A.C.S.
Dr. Joseph Magnant earned his Doctorate in Medicine and performed his General Surgery internship and residency at the Medical College of Virginia Hospitals in Richmond, Virginia. He completed his Vascular Surgery fellowship at Dartmouth-Hitchcock Medical Center in Hanover, New Hampshire and is certified by the American Board of Surgery in Vascular Surgery.
He is an active member of The Society for Vascular Surgery, The American College of Phlebology, The Southern Association for Vascular Surgery and is also a Fellow of the American College of Surgeons.
Vein Specialists (Fort Myers Office)
1510 Royal Palm Square Blvd. Suite 101
Fort Myers, Florida 33919
P. 239.694.VEIN (8346)
F. 239.936.6272
Email: info@weknowveins.com