Question: My ankles keep swelling, and get worse as the day goes on. What can I do about it?
The simple (but often not practical) answer is ’sit down and put your feet up’! There are many reasons for swollen feet that get worse as the day goes on. The most common causes are advancing age with dilated veins in the legs, prolonged standing in one position (eg. hairdresser, shop assistant), a slowly weakening heart, hormonal changes before periods and with menopause, and failure of the kidneys.
There are many other rarer (and more serious) causes too, so the first step is to exclude any of these nasties by having the appropriate tests arranged by your general practitioner.
If a specific cause is found, that will be treated, but most people with this problem have swollen feet because of their age, hormones or occupation. In these situations, a fluid tablet can be prescribed that is taken when necessary to remove the excess fluid from the legs.
If you can, keep your feet elevated when sitting and wear support stockings that exert some pressure on the slack veins in the leg.

Question: My doctor has told me that I have Milroy’s disease of the leg. Could you please explain this to me?
Milroy’s disease is a rare condition in which the lymphatic system in one or both legs is faulty, and fails to remove the waste products from the leg. As a result, the leg becomes swollen, puffy and uncomfortable. The condition is hereditary (tends to pass from one generation to the next), and usually starts at puberty (12 to 14 years of age). It is far more common in women than men.
The lymphatic system is an incredibly fine network of tubes that parallel the veins throughout the body, and take some forms of waste from every cell back into the bloodstream. The lymphatic system eventually drains into a main vein near the heart.
The only treatment is elevation of the leg as much as possible, and wearing a firm elastic stocking. The main complication is infections of the swollen tissue, which must be treated with antibiotics. Some patients require constant antibiotics to prevent these infections.

Question: I have severe cramps in my legs at night. I have been told various remedies, including eating bananas at night and taking large doses of magnesium tablets. What do you think of these remedies, are they safe?
Magnesium has been known for many years to help nocturnal cramps, and provided it is not taken in extremely high doses, is quite safe. The main side effect of excessive magnesium compound ingestion is diarrhea, and it should not be used in the elderly who have poor kidney function. Bananas are, of course, quite safe—I cannot imagine anyone eating enough of them to cause any harm.
This is one situation where doctors have to use common sense. If the patient finds that a particular, unorthodox treatment helps, then the patient should be encouraged to continue the treatment—provided there are no long-term side effects or dangers of which the patient may not be aware. The doctor may even try the treatment on other patients, and if they also find the treatment successful, s/he may write a paper for a medical journal so that other doctors are made aware of the breakthrough. In this way, apparently unorthodox treatments become accepted into mainstream medicine.

Question: Every night, I am woken between midnight and 2 am with agonizing pain in my left leg. I can’t cope with this any more, and nothing seems to help. What can cause my leg muscles to go into spasm?
Night time leg cramps are a very common problem. It worsens with age and pregnancy, and most commonly they occur after heavy exercise during the day. Some hours after ceasing the exercise, the muscles in the leg go into painful spasm, causing you to leap from your chair or bed. Stretching the affected muscles by standing on tip toe or pushing against an immovable object often eases the pain.
The spasms are caused by a combination of minor muscle injury, a build up of waste products in the muscle and dehydration—all of these problems being caused by the exercise. Prevention is better than cure, and taking adequate amounts of fluid during and after the activity may wash away excess waste products and prevent dehydration.
If this simple measure is insufficient, medications can be prescribed to be taken after sport to prevent the cramps. Quinine and Akineton are the drugs most commonly used. The two methods of prevention can be simply prescribed if tonic water or bitter lemon is drunk after exercise. These drinks contain quinine to give them the bitter taste, and so acts to prevent dehydration and muscle spasms.