Swollen Legs and Ankles - Causes, Diagnosis, and Treatment

Introduction:

Leg and ankle swelling, otherwise called peripheral edema, occurs when fluids get accumulated in these body parts. Unless it results from trauma, this accumulation of fluid is painless. It can occur at any age, but older adults are more prone. The swelling can be unilateral or bilateral, depending on the cause. Due to gravity, swelling in the legs and ankles are more visible.

Swelling after an injury is because of inflammation, but swelling in the lower extremities without any apparent cause can be a sign of some serious underlying health condition. So get immediate medical help if you notice swelling in your ankles or feet. Peripheral edema is usually treated by treating the underlying condition, or with the help of medication to remove excess fluid and by following a low-salt diet.

How Do Swollen Ankles and Feet Look?

The symptoms of peripheral edema are:

• The skin appears shiny or stretchy.

• A pit is formed on the skin when it is pressed for several seconds.

• Visible swelling in the feet.

If you have shortness of breath, chest pain, or breathing difficulty along with edema, consult a doctor immediately as it can be due to pulmonary edema or deep vein thrombosis.

What Causes the Ankles and Feet to Swell Up?

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

1) Pregnancy - It is normal for pregnant women to have some swelling in the feet. But, sudden excessive swelling, maybe due to a condition called preeclampsia. It is a severe complication of pregnancy, which results from high blood pressure and protein in the urine during the third trimester. Symptoms like stomach pain, headaches, infrequent urination, vision problems, etc., along with feet and ankle swelling can be due to preeclampsia.

2) Injury - Any injury or trauma to the foot or ankle can cause swelling. Injuries like fractures, strains, sprains, etc., in the legs, results in swelling because of blood rushing to this area. To reduce swelling after an injury, follow the R (Rest) I (Ice) C (Compression) E (Elevation) approach.

3) Lymphedema - The collection of lymphatic fluid due to damage or removal of lymph nodes is called lymphedema. The lymphatic fluid is rich in protein and normally flows through the vessels of the lymphatic system, and is filtered through the lymph nodes. Any problem in this system can result in this condition. The other symptoms of lymphedema are feeling heaviness, pain, skin fibrosis, and repeated infections. It is common in cancer patients undergoing radiation therapy, or patients who have gotten their lymph nodes removed.

4) Chronic venous insufficiency - It condition results from blood inadequately moving up the vessels from the legs to the heart due to prolonged sitting or standing or damage to the blood vessels. The valves in the veins that prevent blood from flowing upwards get damaged, which results in blood leaking back down and fluid retention in the soft tissue in the legs. The symptoms include leg pain, tiredness, varicose veins, itchy skin, and infections.

5) Blood clot - Blood clots in the veins of the legs can prevent the flow of blood from the legs to the heart, resulting in swelling. Blood clots in the deep veins of the leg (deep vein thrombosis) can block major veins, which can result in fatal complications. The other symptoms seen are leg pain, fever, and change in color of the leg. Treatment is usually done with blood thinners.

6) Infection - Foot infections can also swell up your feet and ankles. Diabetic patients with diabetic neuropathy (nerve damage due to high blood sugar) are more prone to foot infections. In such people, wounds in the feet from injury, insect bite, or blisters can cause severe infection. To prevent this, keep your blood sugar under control and learn how to care for your feet if you have diabetes.

7) Kidney disease - People with kidney impairment have too much salt in their blood, which results in water retention and swollen feet and ankles. The other symptoms include difficulty concentrating, loss of appetite, fatigue, sleep disturbances, muscle twitching, itchy skin, increased urination, chest pain, and hypertension.

8) Liver disease - Liver diseases can lead to excess fluid in the legs and feet, resulting in swelling. Liver problems can be due to alcoholism, genetics, obesity, or viral infection. The symptoms include jaundice, itchy skin, dark urine, pale stool, tiredness, poor appetite, and easy bruising.

9) Heart failure - Heart failure is when the heart is unable to pump blood correctly. This causes swollen feet as the blood is not reaching the heart correctly. You may also experience symptoms like tachycardia (fast heartbeat), severe shortness of breath, chest pain, difficulty exercising, swollen abdomen, and severe weakness.

10) Certain medications - The side effect of some drugs is swelling in the feet and ankles. The common medicines include:

• Hormonal drugs - Estrogen (oral contraceptives, hormone replacement therapy) and Testosterone.

• Calcium channel blockers - Nifedipine, Amlodipine, and Diltiazem.

• Corticosteroids - Prednisone.

• Non-steroidal anti-inflammatory drugs (NSAIDs).

• Antidiabetic medications.

• Antidepressants - Nortriptyline, Amitriptyline.

• Monoamine oxidase (MAO) inhibitors - Phenelzine, Tranylcypromine.

11) Alcohol - The body retains more water after drinking, which results in edema. This type of swelling usually goes away in a few days.

12) Hot climate - In hot weather, the veins expand and fluids go into the nearby tissues to cool you off. But sometimes, these veins are unable to carry blood to the heart, which results in swelling.

13) Anemia - Severe anemia may cause pedal edema.

14) Hypothyroidism - Thyroid problems like hypothyroidism usually cause edema.

When to See a Doctor for Swollen Legs and Ankles?

Along with swelling, if you notice the following signs or symptoms, it is best you consult a doctor:

• If the swollen areas feel warm.

• If you have a known heart, kidney, or liver disease.

• If you are diabetic.

• If you are pregnant and see severe swelling.

• If you have a fever.

• If your swelling is not getting better with home remedies.

• If you have chest pain, dizziness, confusion, and shortness of breath.

How Is the Cause of Swollen Feet and Ankles Diagnosed?

You might have to get the following test done to find the cause of edema:

• Blood tests - To check your complete blood count (CBC), kidney function test, liver function test, thyroid function test, and levels of electrolytes.

• X-ray - To look for fractures.

• Ultrasound - To check the blood vessels, tissues, and internal organs.

• Electrocardiogram - To check the heart function.

How Are Swollen Feet and Ankles Treated?

Your doctor will prescribe medicines after diagnosing the cause. They will prescribe antihypertensive medicines, antidiabetic medicines, diuretics, antibiotics (for infection), or any other medicine to treat the underlying cause.

Home Remedies:

• Elevate your legs so that the legs are above the level of your heart.

• Keep moving or stretching your leg.

• Limit salt intake.

• Do not wear clothes that restrict your thighs.

• Maintain a healthy weight.

• Wear compression socks.

• Avoid sitting for a prolonged period, and keep getting up in the middle.

For more information, consult a doctor online.