Legs Feel Heavy: Causes, Evaluation, and Treatment

Published on September 07, 2023 .

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Person feeling their legs heavy — Image by ShotPrime Studio via Shutterstock

Many people experience symptoms of heavy legs and wonder about the cause. We'll discuss the causes of heavy legs, how you self-evaluate, and when to go to a physician for evaluation. In addition, we'll discuss when you can self-treat and when physician treatment is required.

Heavy legs are caused by different conditions, including varicose veins, peripheral artery disease, muscle fatigue, and medications.
You can self-diagnose the cause if specific conditions are causing the heavy legs.
Your doctor can order tests such as an ultrasound of the veins or arteries.

The leading causes of heavy legs are related to circulation issues — veins or arteries. However, additional causes are muscle fatigue and certain medications.

Circulatory causes of heavy legs

Two types of circulatory diseases that can cause heavy legs include varicose veins and peripheral artery disease.

Varicose veins

Varicose veins are caused by increased pressure in the veins of the legs, typically by the valves not working properly. The venous blood pools in the legs leading to increased pressure.

The image above shows how varicose veins are caused by valvular issues in the veins of the lower legs. As you can see, the valves do not close properly, and gravity causes blood backflow, leading to engorged and distorted veins. This blood pooling in the legs produces a sensation of leg heaviness.

Risk factors for varicose veins include age, female gender, increased body weight, and prolonged standing or sitting.

Peripheral artery disease (PAD)

Arterial blood is rich in oxygen and provides cells with the oxygen necessary for metabolic functioning. An interaction of cholesterol and cells of the blood vessels forms atherosclerotic plaques. These plaques cause narrowing of the arteries, leading to restricted arterial blood flow.

With restricted blood flow, the cells do not receive the necessary oxygen needed for functioning, which results in pain, aching, heaviness, or cramping. Risk factors for peripheral artery disease include the following:

Diabetes
High blood pressure (hypertension)
Tobacco use
High cholesterol
Age, especially when over 50 years old
A family history of peripheral artery disease, heart disease, or stroke

As a side note, people with arterial disease can develop a condition called claudication: pain with activity that resolves with resting.

Muscular causes of heavy legs

Muscle fatigue results when the leg muscles become tired, resulting in leg heaviness — especially if it's hard to move them. Resistance or intense cardiovascular training can cause microtears in the muscle fibers; it is the normal process of building resting muscle tone. However, it does produce muscle soreness two to three days later.

When exercising muscles do not receive the required oxygen, the body switches to anaerobic (without oxygen) metabolism, producing lactic acid. Some soreness and heaviness can result even after our bodies clear the lactic acid.

Medications causing heavy legs

Hypertension medications like calcium channel blockers can cause leg swelling, leading to heavy legs. Some medications can cause restless legs syndrome, a condition where it feels like your legs cannot stay still and need to be moving. A symptom of restless legs syndrome is heavy legs.

The medications that cause restless leg syndrome include:

Anti-nausea meds
Antipsychotics
Selective serotonin reuptake inhibiting (SSRI) antidepressants (Prozac and Zoloft)
Antihistamines (for allergies)

In addition, the statin class of cholesterol-lowering medication is known for causing muscle aches, pain, and fatigue; thus, heavy legs could be a side effect of using statins.

How to identify the cause of heavy legs

Before seeing your doctor, there are some steps you can take on your own to find the cause of your heavy legs:

Probable cause	Self-check steps	What to do
Varicose veins	Check your legs to see if you have any purple or blue bulges under the skin, indicating varicose veins. A milder form of varicose veins is called spider veins: red or purple lines under the skin without significant swelling.	Varicose veins often have no symptoms, and treatment is purely cosmetic. However, surgical treatment may be needed if you have heavy legs with noticeable varicose veins.
Peripheral artery disease	You can check the pulses on your feet to see if you have peripheral artery disease. The dorsalis pedis pulse can be felt on top of the foot, while the posterior tibial pulse is behind and below the medial malleolus (the bump on the middle aspect of the ankle).	Severe peripheral artery disease can result in a cold limb with bluish discoloration, a condition called peripheral cyanosis. If this occurs, it is a medical emergency, and you must go to the nearest emergency room.
Muscle fatigue	No specific self-check steps.	If you suspect you have muscle fatigue causing heavy legs, you can change your exercise routine. Muscle fatigue is the most likely cause if the heavy leg sensation resolves.
Medications	You can search online to see if your medications can cause heavy legs or other lower extremity symptoms.	Do not stop any medications without consulting your physician, who may have an alternative medicine.

Why it's important to see a doctor

Your physician will examine your legs. If they find varicose veins, they can order a venous ultrasound (sound wave test) to check the patency of the venous valves. Your physician can also order a Doppler ultrasound test to check for arterial blood flow and pulses.

In addition to routine lab work, your doctor should order a lipid panel to see if there are risk factors for causing peripheral artery disease.

Treating heavy legs involves finding and eliminating the cause. If nothing else works, try drinking a glass of tonic water since it contains quinine. Even though there is no scientific evidence to confirm the use of quinine for restless legs or other leg symptoms, many people have reported its usefulness.