Podiatrist (Foot and Ankle Specialist) Questions Swelling

Why are my ankles swollen?

My ankles usually look fine when I wake up, but by the end of the day they are very swollen. I have no other known health conditions and no foot problems. They do run in my family, though. What could this be?

8 Answers

Hello, veins carry blood back to your heart from your feet and legs. They have valves that let the blood flow one way and depend on surrounding muscles to aid in the blood flow. They can become insufficient and the valves do not close properly causing blood to back flow and be responsible for the fluid and swelling. When you are off your feet sleeping they are elevated but throughout the day gravity works against us. Have your circulation checked with venous studies. Compression hose, elevation and range of motion exercises can help along with fluid management if indicated. Hope that helps!
Swelling in the ankles is a result of fluid build up in the tissues. When you are on your feet for extended periods of time, or have feet in a dependent position, gravity pulls the fluid in your body down, causing your ankles to swell. This is oftentimes a normal condition that can be relieved by elevating your feet, wearing light compression stockings, and even by contracting the muscles in the back of your leg (called the gastrocnemius muscles) via toe raises, to help push the fluid up.
Excessive swelling can also be caused by too much salt intake, certain medications, vascular conditions, or even kidney and heart abnormalities. It is important for you to identify whether your swelling is "normal", or due to an underlying medication issue. This can be done by contacting your health care provider for evaluation.
sound like venous insufficiency. Try wearing support stockings. My start with 18-21 mm compression knee high. If issue continues to persist see your internist.
There are many reasons for swollen ankles. The most common one is dependent edema. This condition is simply having employment that engages in prolonged standing, sitting or walking. By wearing support socks or stockings will help to eliminate these symptons.
Your problem is most likely due to Venous insufficiency.

Venous Insufficiency: Why are my ankles and feet swollen?
People often ask me, ‘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’ like 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 break down 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
Hi, this sounds like your veins are not returning blood to the heart efficiently and gravity is helping it pool in your legs the longer you stand. I'd speak to your primary doc about this.
Hello! Thank you for your question. The easy answer is gravity. The longer we have our feet in a dependent (down) position gravity is continually pulling the blood back down the extremities. Now the more complicated answer involves the vascular system, the veins in particular, and the lymphatic system. The veins are responsible for returning our blood that gravity has pulled down back up to the heart. They do this in coordination with our leg muscles. As we use our muscles they contract and compress the veins, squirting the blood up through the veins. There are small bivalves within the veins that then catch the blood to prevent it all from falling back down the leg. Thus, the blood is laddered back up the leg to the heart. The lymphatic system is a system that collects lymph fluid throughout the body (basic cellular fluid that is found throughout our body) and that collected fluid is, for the most part, then dumped back into the veins. The older we get (or certain medical conditions which can precipitate this) the less effective our body becomes as performing both of these actions. When that happens fluid collection (edema) occurs in our legs as gravity continue to have it's way with us. The most effective way to combat this is by wearing compression suck that go at least to below the knee. These stocking provide just enough compression to help the lymphatics more effectively collect that fluid and also bring the vein walls closer together, making those valves more effective. The other way to combat this is easy, just kick up your legs and take it easy once in awhile! Elevating the legs will assist with fighting the effect of gravity and bringing the fluid back up toward the heart. Thank you again for your question and please let me know if you have any other follow up questions!

Best regards,

Dr. Riley
This is rarely a problem arising from the feet or ankles. More often this is a problem with the veins and venous circulation. Sometimes it can be caused by problems with the heart.
You need to be evaluated by your primary care physician for a definitive systemic cause.