Swollen Ankles and Swollen Feet

Swelling of the ankle and feet is a frequent symptom. It does not represent a disease but the symptom of an underlying disease.

• Causes of swollen ankles and feet:

• Dependent swelling (edema)
• Pregnancy
• Medications
• Injuries
• Diseases (congestive heart failure, alcoholism, liver failure)
• Infections
• Lymphedema
• Blood clots (deep vein thrombosis [DVT])
• Varicose veins
• Others (infrequent causes)

What signs and symptoms are associated with swollen feet and ankles?

The symptoms of swollen feet and ankles depend on the underlying causes mentioned above.

• Swelling caused by dependent edema, pregnancy, medications, and most diseases produce bilateral swelling that begins as soft, puffy skin enlargement in the feet and spreads rapidly to the ankles.
• The skin indents when pressed down and slowly returns to its puffy state when the finger pressure is removed.
• Indentations seen in the puffy skin when shoes or socks are removed are signs of swelling.
• The skin color with this swelling is often normal or slightly pale; indentation marks are slightly darker than the surrounding swollen tissue.
• Many individuals can elevate their feet and ankles higher than their hearts and after some time, the swelling may resolve completely. However, in some chronic diseases and with some medications, the swelling becomes chronic and the skin becomes more rigid, reddish, and sometimes mildly discolored or mottled and will not return to normal after elevation. For example, people with chronic congestive heart failure (CHF) will have chronic bilateral swelling of the feet and ankles with skin changes.

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What are common causes of swollen feet and ankles?

Pitting edema is a swollen area that causes an indentation that persists for some time.

Swollen ankles and swollen feet have numerous causes. Medically, "swollen" means protuberant or abnormally distended. If an ankle or foot is swollen, it means it is increased in size.

In most common situations, when referring to swollen feet and ankles, the user implies the distention or size increase is due to an increase of fluid in the tissues (edema). However, the broad definition includes any factors that increase ankle or foot size (increased or excess fluids, inflammatory cells, or both).

Because most factors that cause foot swelling also cause ankle swelling, this article will discuss swelling as a general topic to cover both foot and ankle swelling. Some exceptions where only foot or ankle swelling occur without both being involved will be discussed.

Swollen feet and ankles usually are a symptom or sign of an underlying problem, most of which are not a major cause for concern. However, in some instances, foot, ankle, and toe swelling may warn a person that an underlying problem needs immediate medical attention.

The causes of swollen feet and ankles are numerous; examples of the major causes include:

• Dependent swelling (edema): swelling due to standing or walking
• Pregnancy: normal swelling in most pregnant women
• Medications (side effects): Many medications have the side effects of fluid retention that causes swelling.
• Injury: Any trauma to the foot or ankle (sprains or fractures)
• Diseases: heart disease, liver disease, kidney disease
• Infection: localized or diffuse infection
• Lymphedema: swelling due to lymph vessel or lymph node blockage
• Blood clot(s): blockage of blood vessels causing fluid leakage

What are risk factors for swollen feet and ankles?

A large number of people are at risk for swollen ankles and feet. Below are listed the causes and those people at risk:

• Dependent swelling (edema): people who stand or walk for long periods
• Pregnancy: most pregnant women, especially in the last trimester.
• Medications (side effects): people taking certain medications
• Injury: any person with foot or ankle trauma
• Diseases: Patients with heart disease, liver disease, kidney disease
• Infection: any person with foot or ankle infection
• Lymphedema: Persons with lymph vessel or lymph node blockage
• Blood clot(s): People with blood vessel blockage
• Other less frequent and intermittent causes (for example, gout or hairline ankle fractures).

What medical conditions cause symptoms of swollen feet and ankles?

Occasionally, specific medical problems show additional or relatively unique symptoms, for example:

• Symptoms of gout include swelling of the big toe with redness, warmth, and pain, arthritis with joint pain, or electrolyte imbalance causing foot and leg cramps.
• The sudden appearance of bilateral feet and ankle swelling during pregnancy can be the first symptoms noticed in females with preeclampsia.
• Unilateral swelling of the foot or ankle usually has the same symptoms described above if the underlying cause is unilateral lymphedema, venous insufficiency, or blood clots. However, with blood clots, there is often pain when pressure is applied. Chronic venous insufficiency often has skin changes in color and texture as described above but may also develop skin ulcers or secondary infections.

Injury or infection of the ankle is usually unilateral but can be bilateral. Injury or infection is often, in the early stages, limited to either the foot or the ankle, but may spread. Swelling due to trauma usually is localized to the injured area (ankle sprain or plantar fasciitis); in some instances, the swollen skin area may be damaged by abrasion, laceration, or bruising.

Pain usually accompanies a traumatic foot or ankle injury. Some infections of the foot or ankle may show localized swelling due to abscess formation while other infections show generalized swelling and warm skin, often with redness. Pain is present where the infection is located.

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How do medical professionals diagnose swollen feet and ankles?

Clinical observation and examination diagnose swollen feet and ankles. A health care professional will likely ask questions to obtain specific information and gain insight into the underlying cause of the swelling; once the cause is determined, treatments can be designed to help the patient. Simple observation and a patient’s verbal description of the swollen area may be enough to presumptively diagnose the cause. For example:

• A swollen ankle that the patient "twisted" a day ago is probably due to a sprain;
• A swollen foot that is warm with reddish skin in a person with diabetes, with a small cut on the foot is likely caused by an infection;
• Bilateral foot and ankle swelling in a cardiac patient who did not take the prescribed diuretics is probably caused by a combination of dependent edema, poor fluid management, and decreased cardiac function.

Laboratory tests are usually not used to diagnose feet and ankle swelling; however, they may be needed in some patients to diagnose underlying causes of the swelling. X-rays may be used to determine underlying fractures while CTs or MRIs may reveal the extent of tissue damage.

Which specialties of doctors treat foot and ankle swelling?

Some mild hand and/or foot swelling can resolve without treatment, while other patients can be treated by their primary care doctors. Depending on the underlying cause of the swelling, specialists such as internal medicine, orthopedics, sports medicine, infectious disease, OB/GYN, and cardiologists are some examples of specialists that may be consulted.

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