Dr. Lee Wittenberg is a 3 year surgically trained Podiatrist. Dr. Wittenberg is trained in all elements of foot and ankle surgery, wound care and limb salvage, and general Podiatric medicine. Dr. Lee Wittenberg is Board Certified by the American Board of Lower Extremity Surgery, as well as the American Board of Foot & Ankle... more
Venous Insufficiency: Why are my ankles and feet swollen?
People often ask me as a Podiatrist, ‘why are my ankles, legs and feet swollen?’ The most common reason for ankle and foot swelling is venous insufficiency. What is venous insufficiency? It is a problem of pooling of fluid or retention of fluid in the legs, feet, and ankles resulting from poor venous return of blood to the heart.
As we get older, or sometimes secondary to certain medical conditions, the veins are not as ‘competent’ and cannot return the blood back to our heart as efficiently as it should. The result is the over-filling of the veins in the legs and feet. When the veins get too full, the veins become distended or stretched out. When this happens, the veins can no longer contain the excess blood and the fluid begins to leak from the veins into the surrounding tissues. This causes swelling in the legs and ankles.
Veins, as opposed to arteries that carry blood away from the heart and to the surrounding tissues, have no internal muscle and they do not ‘pump’ as arteries do. The veins rely on our skeletal muscles, the muscles that move our bodies, to squeeze them to push the blood back toward the heart for re-oxygenation. There are little valves, or cup-like structures, that are meant to catch the blood as the skeletal muscles relax to try to prevent the blood from falling back down to the lower segments, and so the blood continues to travel toward the heart. But as the veins become incompetent, the valves are no longer effective or can break down. Then the blood goes toward the heart but just falls back down to the feet and ankles secondary to gravity.
People with venous insufficiency may notice that the ankles and feet are not as swollen in the morning as they are in the afternoon. That is because when you are lying flat at night, the blood can more easily travel back to the heart, and the swelling goes down. But as you stand and walk all day, gravity takes over and pulls the blood toward the feet and ankles, and it stays there.
People suffering from venous insufficiency may notice that they have spider veins around the ankles and legs. Patients may also have larger varicose veins in the thighs, legs, or ankles. Also, as the problem progresses, there may be a dark discoloration of the skin in the legs. This is secondary to Hemosiderin deposition; a breakdown product of the pigments in the blood cells that might die within the tissues as the fluid leaks out of the veins. This will be a brown or reddish-brown discoloration. It may never go away.
There are several ways to treat Venous insufficiency. Conservatively, you can wear compression stockings to increase the efficiency of the broken veins. Secondly, you may take diuretics, or water pills, that will help the body to rid itself of excess fluid. Thirdly, you can see a vein specialist. There are procedures that may be done to improve the efficiency of the more viable veins in the legs and ankles.
Swelling in the legs may also result from a more serious problem, Congestive Heart Failure (CHF). This may be a life-threatening issue, and if you are short of breath or are having difficulty breathing, or if you cannot walk very far without becoming winded and needing to rest, you should go immediately to your physician or local Emergency Room.
Lee Wittenberg, DPM
Apache Foot & Ankle Specialists, Las Vegas, NV