Usually swelling of the lower extremities results from weakened veins. Veins that do not have enough elasticity tend to allow more fluid to pool in the lower legs and ankles. If you are overweight this could be one cause for the veins to be less elastic and weaker. If you have a family history of what we call venous insufficiency this can cause the poor veins too.
It is actually a very common problem.
If both legs swell it is less likely something concerning like a blood clot and surely after years of this problem you have had ultrasounds of the leg to evaluate for that.
The other concern when only one leg swells is some sort of blockage from above that causes compression on that side making it difficult for the fluid to move. Usually a ct scan of the abdomen and pelvis with contrast is ordered to rule out any mass that could be doing this.
If this has all been done and there is no concerning findings then it is likely you simply have venous insufficiency that is just worse on one side than the other.
The accompanying rash that presents is not surprising. When people have chronic swelling of their leg the skin becomes stretched and is easier to be broken down. It can become itchy and is more likely to become infected. Venous stasis ulcers are a common result usually on the insided or outside of the ankle an ulcer will form. This can turn into a cellulitis.
The only treatment for venous insufficiency is weight loss, elevating the feet, and as long as your arteries are good compression stockings are a must!!!! This helps push the fluid back up into the circulatory system and away from pooling in the legs. Diuretics such as lasix and hydrochlorithizide are rarely helpful with this kind of problem.
The other thing to consider is a heart evaluation. If you have poor cardiac output then blood can pool in the lower extremities from congestive heart failure. Again, I would assume they have done an echocardiogram to evaluate your heart and rule this out as a cause.
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