Why Do I Get Swollen Feet and Ankles?

Understanding Circulation and Swelling

Blood is pumped from the heart to all parts of the body via the arteries and it comes back to the heart via the veins. Some fluid from the blood seeps into the tissues of the body, which is a normal process. The fluid then comes back into the veins and also the lymph vessels (which are quite similar to veins), and all of this goes back into your circulation. If more fluid remains in the tissues than is normally the case, that causes swelling.

Blood is actively pumped around the body by the heart, but it comes back to the heart by passively flowing (in other words, it is not pumped back to the heart, only away from the heart). This process is helped by a series of one-way valves in the veins, which help the blood to keep moving towards the heart.

One of the disadvantages of walking and standing on two feet is that gravity works against us, and so it is easier for the blood to pool in our feet and legs, which can make swelling more likely. Some swelling (as in the swelling that occurs around an injury site) is a normal response of the body when it is trying to repair something.

Common Causes of Swollen Ankles

Hot Weather

When you are hot, your blood vessels dilate (get bigger) as part of the process of trying to cool yourself, and some fluid seeps from the vessels into the surrounding tissues. If your circulation isn't as good as it could be, it may take longer for the fluid to get back into the circulation, which can cause swelling.

Venous Insufficiency

Sometimes the efficiency of your circulation gets worse with age. This can result in pooling of blood and swelling in the feet and ankles. Venous insufficiency means that the veins are not working as well as they should. Chronic (long-term) venous insufficiency also leads to changes in the skin, and sometimes infections and ulcerations.

The Menstrual Cycle

Some women get swelling in their feet and ankles as a normal part of their menstrual cycle.

Pregnancy

It is not uncommon to get swollen ankles and feet during pregnancy, especially as the baby gets bigger. This is because of increased pressure on the veins that come back up from the legs into the body, behind where the baby is. Sudden or severe increases in foot and ankle swelling during pregnancy needs an immediate medical assessment, as it can be a sign of preeclampsia. This needs to be treated promptly.

Injury

When you injure your foot or ankle (for example, when you sprain your ankle), you can get swelling in the short term from bleeding in the area, but also afterwards, as your body tries to repair the damage caused by the injury.

Infection

When you have an infection the body causes an inflammatory reaction to fight off the infection and repair any damage. This can include swelling, redness, heat and discomfort. If you have spreading inflammation, red lines going up your legs, tenderness in the back of your knee or groin, then seek medical advice immediately.

Blood Clot (Deep Vein Thrombosis, or DVT)

Blood clots in the legs can occur after prolonged periods of sitting (especially in aeroplanes), after surgery or sometime for no obvious reason at all. A DVT can cause swelling in the leg (but not always). Other signs can include discomfort or a sense of heaviness in the back of the calf and veins under the skin which are more noticeable on one leg than the other. If you suspect that you have a DVT then you should see a doctor immediately. A DVT can be quickly diagnosed with an ultrasound scan of the legs.

Medical Conditions

Heart, liver and kidney disease can all cause swelling as a side effect. Consult your doctor for further information and assistance if this applies to you.

Medication Side Effects

Lots of medicines can cause swelling of the feet and ankles as a possible side effect. The amount of swelling as a side effect can vary from person to person. Some examples include:

• Some blood pressure drugs (calcium channel blockers)

• Some antidepressants (tricyclics and monoamine oxidase inhibitors)

• Steroids

• Non-steroidal anti-inflammatory drugs

• Some drugs used to treat diabetes

• Some hormones (for example, oestrogen and testosterone)

If you notice swelling as a side effect, do not stop taking the medication abruptly, but seek medical advice as soon as possible.

Lymphoedema

Lymphoedema refers to swelling that is caused by problems with the lymphatic system, either the lymphatic vessels themselves or the lymph nodes which are part of the lymphatic system. There are two broad categories of lymphoedema:

• Primary lymphoedema, which occurs from a problem with the lymphatic system itself. This can happen at any age and is often hereditary.

• Secondary lymphoedema, which occurs from injury to the lymphatic system from another cause. A common example is oedema that occurs after lymph nodes have been removed during surgery.

Managing Swollen Feet and Ankles

General Treatment Options

If there is a medical cause for your swelling then your doctor will advise you on ways to help with this. For example, you may be prescribed a type of medicine called a diuretic, which helps to get rid of extra fluid.

Swelling from any cause may be helped by one or more of the following:

• Elevation

• Compression Stockings/Socks

• Exercise

• Cold Laser Therapy

• Other more specialised equipment, such as an intermittent pneumatic compression pump

Treating Injury-Related Swelling

Right after an injury, then the following four steps are recommended:

• Rest - Exactly what it says. Stop using the injured area and rest it

• Ice - You can put an ice pack over the affected area. Protect your skin from getting an ice burn by putting something between the ice pack and your skin

• Compression - Use an elasticated bandage or similar to exert some gentle compression to the area

• Elevation - If you lie down and elevate your foot and leg so it is higher than your heart, then you have gravity working in your favour

When to Seek Medical Help

You should consult a doctor immediately if any of the following apply:

• Sudden or severe swelling of feet (or hands)

• Spreading inflammation of the area (warmth and redness, heat and pain)

• Swelling of one foot/ankle for no obvious reason

• Swelling that is accompanied by other symptoms, such as fever, shortness of breath or chest pain

Apart from that, seek advice for any swelling which is not mild and does not go away by itself. Our team can help to assess the cause and provide a treatment plan that is customised to your needs.