"Understanding the Causes of Swollen Ankles"

Swollen ankles—sometimes also known as peripheral edema—occur when there is an abnormal build-up of fluid in the tissues of the lower legs. Anyone can develop swollen ankles, but older people, those who have sedentary lifestyles, people who are on their feet all day, those who live with obesity, and pregnant people are more likely to experience swelling. In many cases, swollen ankles can also be a sign of an underlying health condition. So, it's important to seek treatment if you notice swelling.

You may not notice your swollen ankles immediately because the interstitial spaces, or the spaces between the tissues, can hold several liters of fluid. In fact, swelling in your ankles may not be visible until the tissues have about two to three liters of fluid—which is equivalent to about six bottles of water. Swelling may happen quickly if an acute condition like a blood clot causes it. But if a chronic condition is the cause of your swelling, it can take longer to develop.

Swelling can occur in one or both of your ankles. The skin around your ankles may also look stretched out or shiny. Ankle swelling is usually most noticeable in the lower legs because of the effects of gravity. The swelling can worsen after walking around, standing, or sitting for long periods. Pressing a finger into the swollen area may leave a small dent in the skin, which is known as pitting edema.

It's worth noting that swollen ankles don't always cause pain. But it is possible to experience some aches, heaviness, or difficulty moving around. In severe cases, walking may become increasingly challenging. But, assistive devices (such as a walker or cane) can offer support.

Your lymphatic system is responsible for managing the fluid levels in your body. When your lymphatic system isn't able to maintain excess fluid properly (such as due to an underlying condition) you may experience edema which can cause your ankles to swell.

Inside your veins, some valves keep your blood moving correctly toward your heart. Chronic venous insufficiency occurs when the walls of your veins have weakened, which causes these valves to become damaged. When this occurs, blood cannot flow correctly and ends up pooling (or, staying) in the veins. As a result, the pooling of blood can contribute to swollen ankles. While anyone can develop this condition, the most common risk factors include:

Chronic venous insufficiency is a lifelong condition that can become worse over time. But, with early treatment, you may notice an improvement in symptoms.

Side effects of some medications can cause edema to occur. Common medications that can contribute to ankle swelling include:

It's important to note that you should not stop taking any medications without approval from your healthcare provider. If you are worried that your medications are contributing to swelling, talk to your provider about your symptoms and see if they can adjust your treatment plan.

Heart failure is a condition that occurs when the heart is too weak to pump blood effectively. As a result, your blood can pool in places like your lower limbs (e.g., legs, feet, and ankles). If congestive heart failure is causing your swelling, you'll likely experience swelling in both legs.

It's also worth noting that edema due to heart failure can affect other parts of your body. For example, fluid can become backed up into the lungs, causing pulmonary edema (excess fluid in the lungs), which can lead to symptoms like shortness of breath or coughing.

Cirrhosis is a term that describes severe scarring of the liver. When cirrhosis occurs, the liver doesn't function as properly and obstructs blood flow. This obstruction can lead to swelling in the lower legs and abdomen. It's also important to note that if you notice ankle swelling and have a history of liver disease, it's essential to follow your treatment plan and tell your provider about your symptoms.

Without treatment, the risk of complications like portal hypertension (high blood pressure in the portal veins), urinary tract infections, pneumonia, liver cancer, and liver failure all increase.

Your kidneys are responsible for removing waste products and fluids from the bloodstream. But when you develop chronic kidney disease (CKD), your kidneys lose their ability to filter out your blood properly. As a result, excess fluid can build up in your body and cause your feet and legs to swell up. Unfortunately, most people don't know that they have CKD until their kidneys become severely damaged. In fact, providers usually discover that you have CKD when you undergo blood or urine tests for a different health reason.