Ankle Edema - Causes, Diagnosis, and Management

Introduction

In general, swelling in the ankles is not a cause for concern, especially when one is standing or moving about a lot. But, persistently swollen ankles or those that come together with other symptoms could be a sign of a significant medical condition.

What Are the Causes of Ankle Edema?

Some possible causes of ankle edema are:

• Complications Related to Pregnancy: Throughout pregnancy, some ankle and foot swelling is common. Preeclampsia (a dangerous condition that appears after the 20th week of pregnancy and is defined by high blood pressure and protein in the urine) could be the cause of abrupt or excessive swelling. Call the doctor right away if anyone develops severe edema or swelling that is accompanied by other symptoms like headaches, nausea, vomiting, infrequent urine, stomach discomfort, or changes in eyesight.

• Ankle or Foot Injury: A foot or ankle injury may cause edema. The most frequent type is a sprained ankle, which happens when an accident or mishap causes the ligaments holding the ankle in place to extend further than they should. Use ice packs, compress the foot or ankle with bandages, elevate the foot on a stool or cushion, and rest to minimize walking on the injured foot or ankle to reduce swelling. See the doctor if the swelling and pain are extreme or are not getting better with home remedies.

• Lymphedema: This is a buildup of lymphatic fluid in the tissues that can happen when there are abnormalities with or a lack of lymph vessels, as well as when lymph nodes have been removed. Normally, a huge network of arteries and capillaries transports lymph, a protein-rich fluid, along those paths. Lymph nodes, which catch and get rid of undesired materials like bacteria, filter it. But when there is a problem with the lymph nodes or veins, the fluid may become clogged. If neglected, lymph buildup can prevent wound healing, result in infection, and lead to deformity. Lymphedema is a common side effect of radiation therapy and lymph node removal in cancer patients. See the doctor immediately if one has undergone cancer treatment and is experiencing swelling.

• Venous Insufficiency: A common early sign of venous insufficiency, a disorder in which blood cannot adequately travel from the legs and feet to the heart, is swelling of the ankles and feet. Typically, one-way valves in the veins keep blood moving upward. The soft tissue of the lower legs, particularly the ankles and feet, retains fluid when these valves are injured or weakened because the blood flows back down the capillaries. Skin abnormalities, skin ulceration, and infection can result from chronic venous insufficiency. See the doctor if one exhibits symptoms of venous insufficiency.

• Infection: Ankle and foot swelling might be a sign of an infection. Those who suffer from diabetic neuropathy or other problems with the foot nerve are more susceptible to getting foot infections. While nerve damage can numb the pain, it is crucial to check the feet for blisters and sores every day for those with diabetes because foot problems can advance quickly. See the doctor straight away if there is a blister that looks infected or a foot that is enlarged.

• Blood Clots: Ankle and foot swelling can be brought on by blood clots that develop in the veins of the legs and block the blood flow from the legs back up to the heart. Blood clots can be deep (known as deep vein thrombosis or DVT) or superficial (occurring in the veins just below the surface). One or more of the main veins in the legs may become blocked by deep clots. If these blood clots escape and reach the heart and lungs, they may be fatal. Call the doctor right away if patients experience swelling in one leg accompanied by pain, a low-grade fever, and maybe a change in the color of the afflicted leg. Blood thinner therapy can be required.

• Kidney, Liver, or Heart Problems: Swelling may occasionally be a sign of a condition, such as liver, renal, or heart problems. Evening swelling of the ankles could indicate a right-sided heart failure-related salt and water retention. Ankle and foot swelling can also be caused by kidney illness. When the kidneys are not functioning properly, fluid can build up in the body. Liver disease can affect albumin, a protein made by the liver that stops blood from spilling into the tissues around blood vessels. Fluid leakage may result from inadequate albumin synthesis. Fluid can build up in the abdomen and chest, but it also tends to accumulate more in the feet and ankles due to gravity. See a medical professional right away when there is swelling along with other symptoms, including weariness, loss of appetite, or weight gain.

• Adverse Effects of Medication: Swelling in the feet and ankles is a common adverse effect of several medications. They consist of the following:

  1. Hormones like estrogen and testosterone are present in oral contraceptives and hormone replacement therapy.

  2. One class of blood pressure drugs known as calcium channel blockers consist of Nifedipine, Amlodipine, Diltiazem, Felodipine, and Verapamil.

  3. Steroids, such as anabolic, androgenic, and corticosteroid drugs like Prednisone.

  4. Tricyclic antidepressants like Nortriptyline, Desipramine, and Amitriptyline, as well as monoamine oxidase (MAO) inhibitors such as Phenelzine and Tranylcypromine, are among the antidepressants available.

  5. NSAIDs, or non-steroidal anti-inflammatory drugs.

  6. Drugs for diabetes.

What Are the Different Diagnostic Tests Done?

The following diagnostic procedures may be done:

• Blood tests, such as a complete blood count (CBC) or blood chemistry.

• Chest X-ray or extremity X-ray.

• Doppler ultrasound examination of leg veins.

• Electrocardiogram (ECG).

• Urinalysis.

How Is Ankle Edema Managed?

An underlying disease that makes edema production more likely may serve as the basis for treatment. Pulmonary edema is the only type of widespread edema that poses a life-threatening risk. As a result, it is the only kind that calls for immediate treatment. The patient is not as risky in any other edematous state. Hence, it is possible to remove the extra fluid more gradually.

• Diuretics: The preferred therapy for CHF, liver, and renal failure is diuretics. Patients who are not taking diuretics may have relief from edema with a salt and carbohydrate-restricted diet (about 90 g/day).

• Anticoagulant Therapy: Patients with DVT receive anticoagulation therapy with either low molecular weight heparin or more recent anticoagulants such as Rivaroxaban or Apixaban. Because newer anticoagulants carry a lower risk of bleeding, Warfarin is not being used frequently. Compression stockings should also be worn in addition to anticoagulation to avoid post-thrombotic syndrome.

• Mechanical Therapy: Patients with chronic venous insufficiency benefit from mechanical therapy such as leg elevation and compression stockings. Since it can worsen blood flow, compression treatment is contraindicated in peripheral arterial disease. Complex decongestive physiotherapy, including manual lymphatic massage and multilayer bandages, is used to treat lymphedema. In maintenance therapy, compression stockings and pneumatic compression equipment are used. When drugs are the cause of a patient's condition, they should be stopped and replaced with drugs from a different class.

Conclusion

Ankle edema is a widespread condition with a wide range of causes. Although the various edema treatment options may be beneficial for the majority of patients, it is usually preferable to address the underlying cause of the edema to stop the progression of future edema.