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Ask the doctor: Why do my ankles swell and what can I do to stop it happening?


Pumping your calf muscles and going for regular walks can help swollen ankles

Pumping your calf muscles and going for regular walks can help swollen ankles

Pumping your calf muscles and going for regular walks can help swollen ankles

Question: I am a woman in my mid-30s. Recently, I’ve noticed swelling in my ankles. This happens mainly after exercise, but also after shopping or walking around town. I drink two litres of water per day, so I don’t think it’s anything to do with hydration. I’m worried that I may be developing oedema or poor circulation. What are the likely causes, and is there anything I can do to prevent it from happening? I’m concerned the warmer weather will only exacerbate it.

Dr Grant replies: This is a very common complaint and in your age group is often nothing serious. When it comes to lower limb swelling, my first question is always: ‘’Is the swelling present first thing in the morning?’’ If the answer is no, then it’s most likely a physiological variant of normal. If you feel your legs are almost back to normal in the morning, this is reassuring. My second question, ‘‘Is there a family history of this complaint?’’

Some people experience mild ankle or foot swelling towards the end of the day, particularly those who spend much of the day standing. This is often a familial trait, known as ‘dependent oedema’. Basically, with prolonged sitting or standing the effect of gravity causes fluid to accumulate in the feet and ankles. It’s exacerbated by certain medication, long flights or being overweight/pregnant. If you have a history of trauma or surgery to the legs this also increases your risk of swelling due to minor damage to the venous and/or lymphatic drainage in the affected leg.

The best way to combat dependent oedema is to elevate the legs whenever possible, wear compression socks to the knee level, or ideally tights, and to ‘pump your calf muscles’ by contracting them as much as possible during the day — simply point your foot upwards and downwards when sitting. An even better way to improve the venous and lymphatic drainage of your legs is to go for a walk during the day.

I know you seem to notice your ankle swelling mostly after exercise, which is a little unusual as pumping the calf muscles during exercise tends to improve venous return to the heart. So consider additional lifestyle changes such as reducing salt intake in your diet, managing stress and losing weight (if you are overweight) as these can improve the swelling in your legs.

More severe ankle swelling, particularly if present first thing in the morning and occasionally associated with other symptoms such as fatigue, loss of appetite, weight gain or shortness of breath can be caused by a medical condition. Mild forms of failure of important organs, the heart, the liver or the kidney can be underlying factors. Any organ failure can lead to fatigue, loss of appetite, reduced ability to exercise or weight gain due to fluid redistribution.

Other conditions that may be considered include disorders of the lymphatic or venous drainage in the lower limbs, such as varicose veins or lymphoedema. By visiting your GP you can get blood tests to assess your heart, liver and kidney function, and your doctor can perform a physical examination to assess for signs of the conditions mentioned above. You might find your doctor pressing on your foot or shin bone for about 30 seconds to determine if this leaves an indentation known as ‘pitting’ oedema or swelling. Your doctor will often work their way up the shin until there is no further pitting.

This is a simple clinical test that provides information on how extensive the fluid retention is. By putting your clinical history, blood results and physical examination findings together, your doctor will have a good understanding of the potential underlying cause and may order some scans to help firm up a diagnosis if necessary.


Dr Jennifer Grant is a GP with Beacon HealthCheck

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