Introduction – Swollen ankles
Swollen ankles are ankles that swell and appear thicker due to increased fluid retention. Swelling of the ankles, if not caused by an injury or infection, is known as “ankle edema”. They are the first symptom of various diseases, some of which are harmless, while others can be potentially life-threatening and require treatment. Treatment is highly dependent on the cause, but in most cases includes wearing support stockings and elevating the legs.
Symptoms of swollen ankles
Swollen ankles can occur in isolation or together with other symptoms. As part of chronic venous weakness, pain or a feeling of pressure often occurs in the area of the swelling. Over time, the water retention expands upward and affects the entire lower leg.
If the disease persists for a long time, skin changes occur: the skin develops brownish and whitish discolorations, may harden and thin. Even slight injuries can lead to deep, poorly healing wounds. If heart failure is the cause of the swelling of the ankles, water retention is often present in other parts of the body.
For example, abdominal fluid can cause discomfort in the gastrointestinal tract such as abdominal pain, nausea, bloating and flatulence. In advanced stages of cardiac insufficiency, shortness of breath, weakness, reduced performance, chest pain and dizziness may occur. If the drainage of lymph fluid from the leg is disturbed, a swollen foot or ankle is often the only symptom at the beginning.
In the course of time, pain may develop and, due to the permanently prevailing pressure, hardening may form in the affected area. If swollen ankles appear shortly after an infection of the neck, abdomen or urinary tract, this is an indication of so-called “reactive arthritis” or “rheumatic fever“. In the context of these diseases, high fever, heart and brain complaints, eye disorders and pain in other joints can also occur.
Causes of swollen ankles
Swollen ankles without prior injury can be a symptom of many diseases. They are particularly prominent in “chronic venous insufficiency”, also known as “venous congestion syndrome” or “chronic venous insufficiency”, and in right heart failure. In chronic venous insufficiency, blood from the legs cannot be effectively conducted to the heart due to damaged veins.
As a result, the blood sinks and its liquid components are pressed through the walls of the veins into the remaining tissue, causing swollen ankles. If right heart failure is the cause, blood can no longer be pumped effectively from the right part of the heart to the lungs. It accumulates in sections of blood vessels in front of the right heart and leads to ankle edema and water in the abdomen, among other things.
In addition, there is a whole range of other diseases that can cause water retention in the ankles. Examples are diseases of the kidneys and the liver, in which the amount of protein in the blood decreases through various mechanisms such as a disrupted protein production. Too little protein in the blood leads to swollen ankles among other symptoms.
In addition, swollen ankles can occur as a result of disturbed lymphatic drainage, injuries to the ankles, during or after various infections and after taking medication. A possible side effect of various drugs used in chemotherapy is the swelling of the ankles. Such swelling is caused, for example, by the damage to blood vessels caused by the respective medication.
Such swellings usually do not last long and do not leave any permanent symptoms. Ankle swelling can usually be brought under control quickly by compression therapy with stockings, by elevating the legs and by taking water-impelling medication. Depending on the medication used, chemotherapy can also increase the risk of leg vein thrombosis.
In some cases, such leg vein thrombosis manifests itself as ankle edema. It is therefore advisable to discuss any suddenly occurring swelling after chemotherapy with the treating physicians. Chemotherapy is usually administered in the presence of a tumor disease.Many tumors can cause swelling of the ankles or legs regardless of the therapy.
The causes can be, for example, a protein deficiency caused by the tumor or the destruction of lymph vessels. Surgery or radiation of the tumor can also lead to ankle edema. Chemotherapy is therefore only the most likely cause if it was administered shortly before the swelling occurred.
Heat can be an important factor in the development of ankle edema. Water retention in the feet often results from a combination of several factors. These often include a pressure load in the veins of the legs, favoured by a venous insufficiency or an incipient heart failure, provoked by strain on the muscles, heat or prolonged standing.
The heat can cause a strong relaxation of the venous blood vessels, which then dilate. As a result, more blood accumulates in the venous vessels, which disrupts the return transport of blood to the heart. The increased pressure inside the veins causes fluid to escape from the vessel into the surrounding tissue.
The fluid typically collects first at the ankles of the lower leg in accordance with gravity. If you have a pre-existing tendency to edema or a weak heart, strong heat influences or sauna visits should therefore be treated with caution. Many women experience swelling of ankles, legs and hands during pregnancy.
This is usually normal. In the first few days after giving birth, these water accumulations can increase somewhat. The cause is the change in the maternal circulation, which has to get used to the new situation without a child.
Even in women who did not suffer from swollen ankles or feet before the puerperium, edema can develop in the days after giving birth. They usually disappear without consequences after a few days. In some cases, normal ankle swelling after birth is difficult to distinguish from the symptoms of thrombosis of the leg veins.
For this reason, swelling of the ankles, especially if it is accompanied by pain, is only visible on one side or occurs after a long period of lying down, should be examined by a doctor. If, in addition to the ankle swelling, swelling of large parts of the skin, headaches or eye fibrillation occur, a doctor should also be consulted due to the risk of “eclampsia”. Swollen ankles during menopause are a typical and common symptom that can be attributed to various processes in the body.
At the beginning of the menopause, the hormone progesterone may initially drop, resulting in an excess of estrogen. Oestrogen causes the body to store more water, which can result in swollen ankles and shiny, smooth skin. As the menopause progresses, however, estrogen levels decrease, which can also improve water retention.
At the average age of the menopause, many women also suffer from venous weakness, which in turn causes swollen ankles. Concomitant diseases of the heart or kidneys are also more likely to occur after menopause and lead to leg edema. The thyroid gland produces the vital thyroid hormones and thus has a significant influence on numerous body processes.
Both over-functioning and under-functioning can be accompanied by numerous symptoms and swollen ankles. The typical water retention is described as a symptom of increased turnover during hyperthyroidism but also during hypofunction. Another cause of swollen ankles is the so-called “myxedema” as a typical symptom of hypothyroidism.
Here, certain sugar molecules are deposited in the subcutaneous fatty tissue and cause swelling. It is typical that, in contrast to water retention, the swelling does not leave a dent after being pressed in. Initially, the swelling occurs mainly in the eyes, hands and feet.
Insect bites can in turn be accompanied by significant swelling and considerable accompanying symptoms, up to and including an anaphylactic reaction. Often, there are no venous insufficiencies or organic accompanying diseases. Insect bites often transmit toxins, pathogens or other substances at the site of the bite, which can lead to inflammation, irritation or allergic reactions.
The localization at the ankle is typical here as a frequently uncovered and exposed body part.The allergic swelling at the ankle can be accompanied by unpleasant itching. Local antiallergic ointments or medication antiallergics can reduce the swelling of the ankles. Various blood pressure medications can be associated with ankle swelling.
Often, blood pressure medications directly or through several metabolic processes cause the blood vessels to relax in order to lower blood pressure throughout the body. This can also relax the veins in the legs, causing blood to collect in these vessels according to the force of gravity, which can lead to leg edema. In these cases a combination of blood pressure medication with light diuretic, draining medication is common and useful.
Walking places a relatively heavy strain on the leg muscles over many hours. This increased activity can be the decisive factor in the development of swollen ankles. Often there is already a tendency to ankle edema with a weakness of the veins and possibly a heart failure.
Already the increased muscular activity and the subsequent increase in blood circulation in the legs can increase the pressure in the veins to such an extent that the fluid passes into the tissue. After a while, the swollen ankles often recede by themselves if the legs are spared and elevated. A swollen, painful ankle often occurs after an injury such as bending or bumping.
Although most injuries do not cause permanent damage, a doctor should be consulted if there is severe swelling and pain. To be on the safe side, a doctor should rule out a broken bone and torn ligaments. If one or both ankles swell painfully without prior injury, a whole range of illnesses can be the cause.
