If you’re with-child, you may expect to be greeted by swollen ankles at the end of a long day. But otherwise, the cause of swollen ankles can feel more like a mystery to be solved. Ankles and their neighboring appendages swell, or retain water, for various reasons, and some are more concerning than others.
Meet the experts: Gillian Adams, M.D., a family practitioner and medical director of MedStar Alexandria; Steven Weinfeld, M.D., chief of foot and ankle surgery at New York City’s Mount Sinai Health System; Daniel Paull, M.D., founder and CEO of Easy Orthopedics; and Stephen Vogel, M.D., a family medicine physician with PlushCare.
Known in the medical world as edema, swelling in the feet, ankles, and legs can be incredibly annoying and alarming. It happens when fluid builds up between tissues and organs, explains Gillian Adams, M.D., a family practitioner based in Maryland. Those stores of fluid can leak into neighboring tissue and cause puffiness and swelling. The symptoms are commonly seen in ankles, feet, and legs because gravity pulls the fluid down.
Ahead, experts share what you need to know about fluid build-up and how to prevent it, plus, when to seek medical help about swollen ankles.
Reasons for swollen ankles
Below, doctors explain a few common reasons why you might be feeling puffier than usual in the feet area. They also note how serious the situation could get.
You’ve been sitting (or standing) all-day
There are definite health effects around sitting for too long. If you work a job that involves standing or sitting in one place for extended periods of time, you’ve probably experienced some swelling in your ankles as a result. “When you move around, the muscles involved in that movement actually help pump fluid and blood to and from your limbs,” explains Steven Weinfeld, M.D., chief of foot and ankle surgery at New York City’s Mount Sinai Health System. Without that extra help from moving muscles, though, blood and fluid can pool in the feet and ankles.
It may be a side effect of travel
Related to extended sedentary-ness: “Travel, in general, may involve a lot of sitting,” says Stephen Vogel, M.D., a family medicine physician with PlushCare. Whether you’ve been stuck in a plane, train, or car, long travel can create swelling in the ankles for the same reason as sitting or standing all day—blood and fluid pools up in the lower part of the legs from a lack of movement.
Your weight could be contributing
Overweight and obese people may experience swelling around the ankles for two reasons, says Dr. Weinfeld. First, the stress extra weight puts on joints can trigger fluid retention around those joints. And, storage of excess hormones in extra fat cells can contribute to hormonal shifts that also trigger fluid retention, he says.
You’ve undergone an injury
Injury is perhaps the most common cause of swollen ankles doctors see. When you hurt your ankle, your body sends extra blood to the area, explains Dr. Weinfeld. “Not only does this bring healing cells, but also contributes to swelling in order to stiffen and immobilize the injured joint,” he says.
Dr. Adams adds that a calf injury could also be to blame for ankle swelling because the fluid will pool at the base of the calf, causing inflammation and increased fluid. Additionally, damage to blood vessels or trauma can cause swelling, she notes. In the case of injury, swelling may also be accompanied by redness or bruising.
Certain medications can trigger swelling
Because of their complex interactions with the body, several medicines, both prescription and over-the-counter, can contribute to swollen ankles. “Some blood pressure medications, anti-inflammatory steroids, and even NSAIDs like Advil may have that effect,” explains Dr. Weinfeld. Some antidepressants can also leave you with balloon ankles.
Your veins may not be working effectively
Venous insufficiency, a state in which your veins don’t function normally, can impact the circulation of blood back toward your heart and leave it pooling in your feet and ankles, says Dr. Weinfeld. “Veins have one-way valves that can basically stretch out over time and allow fluid to leak out,” he explains. This happens when the valves become damaged or weak—say, due to aging or extended sitting. Much more common in people over 50, venous insufficiency slowly develops over time and is more common in women than in men.
You might have lymphedema
Our lymphatic system transports fluid called lymph (which contains white blood cells and waste products) throughout the body. In lymphedema, though, a damaged or blocked lymphatic system leaves fluid to pool in the extremities, per the National Library of Medicine. Though certain cancers (and cancer treatments) may cause lymphedema, infections can also spur swelling. Dr. Adams notes that cancer or a tumor can make it difficult for fluid to pump properly, causing lymphatic obstruction. Signs of lymphedema also include a heavy or tight feeling in the arms or legs, not being able to move freely, recurring infections, hardening or thickening of the skin, and trouble sleeping.
Or you could be dealing with arthritis
Arthritis, which includes a number of specific diseases, refers to a condition in which joints become swollen, painful, stiff, and difficult to move. Incredibly common among older adults, it can affect joints all over the body, including the ankles. “When I get an X-ray back and see that someone has bad ankle arthritis, it can certainly explain any swelling in the area,” says Dr. Weinfeld. Inflammation related to arthritis causes the joint to swell, he adds.
You might have gout
“Gout is a form of arthritis where uric acid crystals leave the bloodstream and collect in joints, including ankles,” says Dr. Vogel. “A swollen, often red, and painful ankle could be caused by gout.” These signs may “also be from infection or other serious issues, so it’s best to get checked out by a doctor if you experience those symptoms,” he concludes.
It could be a sign of a blood clot
One of the most alarming causes of swelling around the ankle (which often spreads further up the leg) is a blood clot, says Daniel Paull, M.D., founder and CEO of Easy Orthopedics.
“If you have swelling on one side that continues to rise up your leg, you need to get it checked out,” Dr. Paull says. In some cases, blood clots can move into the lungs and cause a potentially life-threatening pulmonary embolism (a.k.a. blocked lung artery). If you notice other signs of a blood clot—like pain, shortness of breath, feeling lightheaded, red or discolored skin, or warmth in the area—in addition to your swelling, head to the emergency room ASAP.
It could be a symptom of other heart problems
In congestive heart failure—a result of coronary artery disease or high blood pressure—at least one of the heart’s chambers can no longer pump blood properly. Heart failure is one of the first things a doctor will consider if a patient is experiencing swelling in both ankles, Dr. Adams adds. “If the heart can’t pump enough fluid, that fluid can back up,” Dr. Paull explains.
Often, this occurs in the feet and ankles, leading to swelling. In more severe cases, it can progress up the legs. Other signs of heart failure include shortness of breath, rapid or irregular heartbeat, persistent cough, concentration problems, and chest pain, which could also be signs of a heart attack.
It’s a side effect of pregnancy
Among the many changes the body undergoes during pregnancy, swollen feet and ankles are one of them. This is mainly due to all of the extra blood and fluid a person produces when expecting, which softens the body and helps it expand as the baby grows, according to the American Pregnancy Association. Hormonal changes and extra pressure on the veins can also contribute to swollen ankles during pregnancy, the association says.
You may have an infection
An untreated wound around the ankle joint can infect the joint itself, however, any bacteria that gets into your bloodstream can end up in one of your joints and cause swelling, accompanied by tenderness, warmth, and redness.
Children and older adults are particularly susceptible to septic arthritis, in which a bacterial or fungal infection causes joint inflammation, along with redness, pain, and fevers. Skin conditions, like cellulitis—a fast-spreading bacterial infection that gives skin a red, blistery appearance—can also cause the ankle area to look swollen, as it often shows up on the lower leg in adults, according to the American Academy of Dermatology.
Liver or kidney issues may be present
Dysfunction of the kidneys and liver, two organs that regulate the amount of fluid in the body, can also contribute to fluid retention that causes swollen ankles, explains Dr. Adams. In the case of kidney disease, the organs leave either too much fluid and sodium or not enough protein in the blood, which can lead to fluid accumulation throughout the body—especially in the lower extremities, according to the Mayo Clinic. “At the point of kidney failure, swelling and tenderness can affect the entire leg below the knee,” Dr. Weinfeld notes.
Liver disease also involves low levels of protein in the blood that can make fluid “leaky” and cause swelling in the lower body, he says. Dr. Adams adds that liver disease can leave the liver scarred and obstruct blood flow, causing swelling.
How to relieve swollen ankles
The best thing you can do to help with ankle swelling is to elevate your legs and keep an eye out for additional symptoms, Dr. Adams says. For example, you can put your feet up on an ottoman and elevate them by at least two pillows to help drain the excess fluid from your feet. She adds that avoiding salty foods, wearing overly tight clothing, or standing or sitting for long periods can also be helpful. Exercise can also be a great tool in encouraging proper fluid movement, she adds, as can avoiding compression socks if you haven’t discussed using them with your doctor.
When to see a doctor about ankle swelling
If you’ve never experienced ankle swelling before and you suddenly notice it, especially if it’s only in one leg, it’s best to check in with your doctor to ensure there’s nothing serious going on, Dr. Adams suggests. Additionally, the degree of swelling or the presence of other concerning symptoms can help determine whether you should see your doctor. “Although a small amount of swelling you notice on your sock line from a long day of standing or travel may not be a concern, a very swollen joint or one with skin redness, pain, or weakness would be worth a doctor’s visit,” Dr. Vogel explains.
Ankle swelling that occurs after injury or trauma should always be evaluated by a doctor as soon as possible, Dr. Vogel adds. If your ankle swelling is accompanied by serious symptoms such as shortness of breath, chest pain, fever, or skin redness, he recommends going to the nearest emergency room.
What to expect at your doctor’s appointment
When you see your doctor for swollen ankles, you can expect a thorough physical examination that may include diagnostic testing, explains Dr. Vogel. Your doctor will likely check your vital signs and ask about any recent injuries, current medications, or chronic health issues. Tests like bloodwork, X-rays, CT scans, and MRIs may be recommended. “The level of testing depends on the symptoms and list of possible causes of concern, and treatments will be tailored to the diagnosis,” Dr. Vogel explains.
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