Swollen Ankles

1 Swollen Ankles Summary

Swollen ankles occur when fluid is retained in the space between cells in the tissue. Foot and ankles are the most common areas where fluid retention can be noted.

Swelling of the leg, foot and ankle are referred to as peripheral edema and is usually not painful. It is more commonly seen in elderly people when compared to others.

Edema or swelling may be localized or generalized. Generalized edema is characterized by fluid retention in most regions and organs of the body. Localized edema is specific to certain parts like legs or ankles. Swollen ankles are one of the most common forms of localized edema.

Edema or swelling occurs due to two reasons. Firstly, an increase in pressure and permeability in capillaries cause leakage of fluid into the interstitial space. Another mechanism by which swelling occurs is due to retention of sodium and water by the kidneys. This may be caused by certain renal diseases or kidney failure.

Swollen ankle or feet is usually not a cause for concern, but when accompanied by other symptoms swollen leg and ankle may indicate a serious health issue. It is most commonly seen in people who stand or walk a lot.

The swelling may resolve on its own in most of the cases, within few days. In some cases, the feet and ankle may gradually swell as the day progresses, while in some others swelling may develop early in the morning and worsen gradually. Persistent swelling or edema may cause pitting, a condition in which pressing of swollen region results in an indentation.

Some other symptoms that accompany swollen ankles include hypertension, headaches, increased frequency of urination, palpitations, swelling in other parts of the body like hands, puffiness around the eyes, and gain in body weight. Persistent swelling of ankles can result in discoloration of the skin and pain in the limbs.

Lifestyle factors like being overweight and standing or sitting for a long time are the two common causes of swollen legs and ankle. Certain medications are also known to cause edema of ankles. This includes steroids, estrogen and non-steroidal anti-inflammatory drugs (NSAIDs).

Many medical conditions are also an important cause of swollen ankle, this includes: 

Physical examination and tests are used to diagnose the underlying cause of swelling in the ankles. Blood tests and imaging techniques like x-ray, ultrasound, and electrocardiogram are the common diagnostic measures.

Many home remedies may help in alleviating swelling in the feet and ankle. Reducing salt intake, regular exercise, keeping the legs in a raised position, avoiding restrictive clothing around the ankles, wearing support stockings, and maintaining a healthy body weight are important among them.

Swollen ankle, though not a serious issue, may warrant medical attention if:

  • You have kidney or liver disease
  • The area is red in color and is warm to touch
  • You are pregnant
  • Home remedies are not successful in controlling swelling
  • Swelling is persistent and worsens over a period of time

The accompanying symptoms that should be taken seriously include: 

2 Causes

There are a number of factors that cause swollen ankles. In most of the cases, swollen ankles are seen with foot swelling. As one can gauge, the swollen ankle is not a disease in itself, but a symptom of an underlying condition.

Some of the common causes of swollen ankle and foot are: 

Complications in pregnancy – swollen ankles are considered to be common in pregnancy. Sudden swelling may be a sign of preeclampsia, a condition characterized by high blood pressure and high levels of protein in the urine. This usually starts after a 20th week of pregnancy.

Ankle injury – swelling may also be caused by an injury to the ankle. Sprain in the ankle caused by overstretching of the ligaments in the ankle may also lead to swelling in the region. It usually reduces with time, but persistent swelling should be given medical attention.

Lymphedema – Problems in lymph vessels result in the collection of lymphatic fluid in the interstitial space resulting in edema. If left untreated, lymphedema may affect healing of the wound. It may also lead to infection.

Venous insufficiency – swollen ankle is one of the symptoms of venous insufficiency, a condition characterized by inadequate movement of blood from the legs back to the heart. It is usually caused by weak or damaged valves in the veins of the leg.

Infection – swollen ankles can be a sign of infection. This is particularly true of people who have diabetic neuropathy or other problems in the nerves of feet.

Blood clots in legs – these clots inhibit the flow of blood from the legs back to the heart, resulting in swelling of leg and ankles. The clots in legs may be superficial or deep. Clots in deep veins may block some major veins in the legs. Clots in the legs can become potentially life-threatening if it separates and moves to the heart or other organs.

Diseases in other organs – problems in kidney, liver, and heart also have to swell in ankles and feet as one of the associated symptoms. Heart failure may cause swelling of the ankles, mostly in the evening, due to retention of salt and water.

Kidney disease also results in swollen ankles. Liver disease that affects the production of albumin, causes leaking of fluid into the interstitial space leading to swelling. Pericarditis, an inflammation of the pericardium, causes breathlessness and swelling of ankle and legs.

Certain medications – some medications are known to have swollen ankle as one of the side effects. This includes hormones like estrogen, calcium channel blockers, steroids, antidepressants, NSAIDs, and medications used for controlling diabetes.

Many of these medications reduce the circulation of blood and increase the thickness of blood. This results in swelling of feet and ankles.

Lifestyle factors like excess body weight can decrease blood circulation and trigger fluid retention in the body. Feet, legs, and ankles are the most affected parts due to the swelling.

Standing or sitting for a long period of time can make the muscles inactive and affect the pumping of fluids back to the heart. This causes retention of fluid in the interstitial spaces.

3 Diagnosis and Treatment

Swelling in the ankle and feet is diagnosed with the help of physical examination. More tests and investigations are recommended based on the probable cause of swelling.

The physician may ask about the onset of swelling, the progress of swelling through the day, other symptoms accompanying swollen ankle, and also factors that improve or worsen this symptom.

Some tests recommended diagnosing the cause of the condition are:

Blood tests – this includes complete blood picture, kidney function tests, liver function tests, and electrolytes

Imaging tests – x-rays, ultrasound and electrocardiogram are recommended based on the suspected cause of the condition. X-ray images are helpful in checking the condition of bones and other tissues.

It helps to locate fractures, while MRI is suggested to assess the internal tissue damage. Ultrasound scans are recommended to view the organs and blood vessels. An electrocardiogram helps to assess the functioning of the heart.

In most of the cases, description of the symptom may indicate the possible cause of swelling in the ankle. For example, swelling in the ankle that was twisted, is probably due ankle sprain.

Similarly, ankle swelling in a patient with heart disease who missed the daily dose of diuretics is probably due to poor fluid management in the body. Treatment of swollen ankle depends on the underlying cause of swelling.

Some simple home treatment may help in alleviating swelling in most of the cases: 

  • Regular exercise or any other physical activity. Include more of stretching exercises during daily activities.
  • Maintain a healthy body weight
  • Lose extra weight, if BMI is high
  • Keep the legs in a raised position while resting. In this case, the legs should be raised above the heart.
  • Reduce the intake of salt. This will reduce the chances of fluid retention in the body.
  • Avoid wearing tight clothing around thighs.
  • Avoid long-term use or abuse of diuretics
  • Avoid abuse of laxatives
  • Use support wears stockings. These support wear can be customized based on the pressure gradient needed for a person. Further, the length of the wear can also be changed depending on the level of edema.
  • Use proper fitting shoes. It is said that one should choose the shoes in the afternoon for the best fit.

If you are in a job that requires you to sit or stand for long hours, ensure that you move around at least once in an hour. This will keep proper circulation.

Swollen ankles may not be a serious issue in most of the cases, but needs medical attention if it is accompanied by symptoms like: 

These are indications of potentially life-threatening conditions and needs to be monitored and treated immediately. Some cases of edema may not have any specific cause and are known as idiopathic edema. This also can be prevented or treated by regular exercise and simple lifestyle modifications.

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