Monthly Archives: March 2016

Swollen Ankles and Swollen Feet

Image result for swollen feet and ankles

Swollen ankles and swollen feet have numerous causes. Medically, the word swollen means protuberant or abnormally distended. Thus, if an ankle or foot is swollen, means it is increased in size. In most common situations, when the word swollen is used in reference to feet and ankles, the user implies the distention or size increase is due to an increase of fluid in the tissues (also termed edema). However, the broad definition includes any factors that increase ankle or foot size (for example increased fluids, increased inflammatory cells or both). Because the majority of factors that cause foot swelling also may cause ankle swelling, this article will discuss swelling as a general topic to cover both foot and ankle swelling. Some of the few exceptions where only foot or ankle swelling occur without both being involved will be presented. Swollen feet and ankles are usually a symptom or sign of some underlying problem, the majority of which are not a major cause for concern. However, in some instances, foot, ankle, and toes swelling may warn a person that an underlying problem needs immediate medical attention.

The causes of swollen feet and ankles are numerous; the following is a list of most of the major causes with some examples.

  • Dependent swelling (or edema): swelling due to standing or walking (usually over some time period that varies from person to person)
  • Pregnancy: the normal swelling that mostpregnant women experience during pregnancy
  • Medications (side effects): Many medications have the side effect of fluid retention that manifests as swelling. Although the reader is advised to check their individual medications for side effects of swelling, general categories that may cause swelling include anti-inflammatory drugs (steroids andNSAIDs), hormones, medications for people with diabetes, antidepressants, and manycalcium channel blockers (anti-hypertensive and cardiac medications).
  • Injury: any trauma to the foot or ankle (usually sprains or fractures) can result in swelling
  • Diseases: heart disease, liver disease, kidney disease (all of these diseases can influence fluid mobilization in the body by physical, metabolic and electrolyte-water interactions)
  • Infection: any infection, either localized (abscess) or diffuse (cellulitis)
  • Lymphedema: swelling due to lymph vessel or lymph nodeblockage of lymph fluid
  • Blood clot(s): blockage of blood vessels (usually venous) that cause fluid to leak out of vessels into tissue.

Image result 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 (or edema): people who are standing or walking for extended periods like salespersons, mothers with children, construction workers, obeseindividuals, and individuals with underlying health problems (see below)
  • Pregnancy: most normal pregnant females, especially in the last trimester.
  • Medications (side effects): people taking anti-inflammatory drugs (steroids and NSAIDs), hormones, medications for people with diabetes, antidepressants, and many calcium channel blockers (anti-hypertensive and cardiac medications).
  • Injury: any person with trauma to the foot or ankle
  • Diseases: Patients with heart disease(especially congestive heart failure), liver disease, kidney disease (all of these diseases can influence fluid mobilization in the body by physical, metabolic and electrolyte-water interactions)
  • Infection: any person infected, either localized (abscess) or diffuse (cellulitis)of the foot or ankle
  • Lymphedema: Persons with lymph vessel or lymph node blockage of lymph fluid, due to infections, trauma or surgical procedures
  • Blood clot(s): People with blockage of blood vessels (usually venous) that cause fluid to leak out of vessels into tissueThe symptoms of swollen feet and swollen ankles depend on the underlying causes mentioned above.
  • In general, swelling caused by dependent edema, pregnancy, medications, and most diseases produce swelling that is bilateral (present in both feet or ankles ) and usually begins as a soft, puffy skin enlargement in the feet that spreads rapidly (often within hours) to the ankles.
  • The skin is easily indented when pressed down with a finger and slowly returns to its more puffy state when the finger pressure is removed.
  • Indentions seen in the puffy skin when shoes or socks are removed are classic 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 simply position themselves on their backs, elevate their feet and ankles higher than their hearts, and after some time (often a few hours), the swelling may resolve completely. However, in some chronic diseases and with some medications taken for long time periods, the swelling becomes chronic and the skin becomes more rigid, reddish and sometimes mildly discolored or mottled and will not return to normal after a few hours of elevation. For example, many people with chronic congestive heart failure (CHF) will have chronic bilateral swelling of feet and ankles with skin changes.
  • Occasionally, specific medical problems will show additional or relatively unique symptoms, for example: 
  • Symptoms of gout include swelling of the big toe with redness, warmth and pain, arthritiswith swelling and joint pain, or electrolyte imbalance with low magnesium causing foot and leg cramps.
  • Sudden appearance of bilateral feet and ankle swelling during pregnancy (usually after 20 weeks) 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 unilaterallymphedema, venous insufficiency or blood clots. However, with blood clots there is oftenpain generated when the swollen area has pressure applied to the area. Venous insufficiency, when chronic, 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 to each other. Swelling due to trauma usually is localized to the injured area (for example, ankle sprain or plantar fasciitis in the foot); in some instances, the swollen skin area may be damaged by abrasion, laceration, or bruised. Pain usually accompanies traumatic foot or ankle injury. Some infections of the foot or ankle may show localized swelling due to abscess formation (tight smooth skin, warm, and sometimes oozing pus) while other infections (cellulitis) show generalized swelling and warm skin, often with redness of the skin. Pain often is present where infection is located.

Clinical observation and examination is the way swollen feet and ankles are diagnosed. A health care professional will likely ask questions about the swelling 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 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;
  • a 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 to be ordered in some patients to help diagnose underlying causes of the swelling.

The treatment for swollen feet and ankles depends on the underlying cause(s). For many people, simply raising their feet above their heart or simply getting off their feet regularly during the day will reduce or eliminate the swelling. However, for many other people, treatment of the underlying cause of the swelling may include antibiotics for infections, a splint or wrap for a sprain, taking appropriate medications for CHF or gout.

Emergent and urgent treatment is infrequent for foot or ankle swelling itself, but does occur for certain underlying causes where feet and ankle swelling or localized swelling is an important symptom and sometimes the major symptom. Examples include:

  • preeclampsia in pregnancy,
  • congestive heart failure exacerbations,
  • liver failure,
  • kidney failure,
  • foot and ankle fractures,
  • abscesses,
  • cellulitis and gout exacerbations.

Anytime the swelling is accompanied by other major symptoms such as shortness of breath , chest pain or fever contact a health care professional immediately.

One of the best home remedies for swollen ankles, feet, and toes is to elevate the swollen extremity slightly above the level of the heart. This is easily done by having the person lie down face up on a bed or couch, and then place pillows under the heels so the feet and ankles so they are higher than the person’s chest.

Sitting on a plane seat or on the office chair (or for hours at a time anywhere!) may cause lower extremity swelling. Periodic leg muscle movement by extension and contraction by simply by occasionally walking will help. Some physicians also recommend wearing support hose. Other suggestions are listed in the prevention section below.

What are the complications of swollen ankles and swollen feet?

Swollen feet and ankles can lead to discomfort and pain when walking or running is attempted. Chronic swelling can lead to skin color changes and skin ulcers. The skin ulcers can occasionally become infected. The skin infections can be further complicated by abscess formation, cellulitis, necrotizing fasciitis, and death.

In many situations, the swelling in feet and ankles can be reduced or prevented. The following is a list of ways to reduce or prevent ankle and feet swelling:

  • Exercise to improve circulation and fluid distribution
  • Eat a healthy diet; too much salt may cause fluid retention, hypertension and swelling
  • Interrupt sitting or standing several times a day and elevate the feet and ankles above the heart
  • Lose excess weight to retain less fluid and decrease pressure on muscles and joints
  • Consider using support stockings or hose
  • Examine prescription and other medications; consult with the doctor if medication may be responsible for fluid retention
  • Avoid smoking, alcohol and other substances that can lead to underlying causes of swelling

Because there are so many underlying causes of feet and ankle swelling, there are numerous ways to avoid or reduce the chances for their development. The reader is urged to follow up on this article by reading about ways to prevent underlying causes of swelling.

What is the prognosis (outcome) for swollen feet and swollen ankles?

The majority of people with swollen feet and ankles have a good to excellent outcome because the swelling is usually reversible and has no lasting complications. However, a significant number of patients who have underlying causes that are chronic and refractory to treatment have a wider range of prognosis (good to poor) depending on how well the patient responds to both lifestyle changes and medications.

 

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