Swollen ankles and feet are common complaints and are not usually cause for major concern, particularly if you have been standing or walking a lot. But feet and ankles that stay swollen or are accompanied by other symptoms could be a sign of serious health problems. Here are some possible causes of foot and ankle swelling, what to do about it, and when to see the doctor or podiatrist.
Pregnancy complications: All women know some swelling of the ankles and feet is normal during pregnancy. Sudden or excessive swelling, however, may be a sign of pre-eclampsia, a serious condition in which high blood pressure and protein in the urine develops after the 20th week of pregnancy. If you experience severe swelling or swelling accompanied by other symptoms such as abdominal pain, headaches, infrequent urination, nausea and vomiting, or vision changes, call your doctor immediately.
Foot or ankle injury: An injury to the foot or ankle can lead to swelling. The most common is a sprained ankle, which occurs when an injury or misstep causes the ligaments that hold the ankle in place to be stretched beyond their normal range. To reduce the swelling from a foot or ankle injury, rest to avoid walking on the injured ankle or foot, use ice packs, wrap the foot or ankle with a compression bandage, and elevate the foot on a pillow. If swelling and pain is severe or doesn’t improve with home treatment, see your podiatrist or doctor for an x-ray and more treatment.
Lymphedema: This is a collection of lymphatic fluid in the tissues that can develop because of the absence of, or problems with, the lymph vessels or after the removal of lymph nodes. Lymph is a protein-rich fluid that normally travels along an extensive network of vessels and capillaries. It is filtered through the lymph nodes, which trap and destroy unwanted substances, such as bacteria. When there is a problem with the vessels or lymph nodes, movement can be blocked. Untreated, lymph buildup can prevent wound healing and lead to infection and deformity. Lymphedema is common following radiation therapy or removal of the lymph nodes in patients with cancer. If you have undergone cancer treatment and experience swelling, see your doctor right away.
Venous insufficiency: Swelling of the ankles and feet is an early symptom of venous insufficiency, a condition where the veins do not work well and cannot effectively move blood from the legs and feet up to the heart. Normally, the veins keep blood flowing upward through one-way valves. When these valves become damaged or weakened, the blood leaks back down the vessels and into the soft tissue of the lower legs, especially the ankles and feet. Chronic venous insufficiency can lead to skin changes, skin ulcers, and infection and may be painful. If you experience signs of venous insufficiency, you should see your doctor or podiatrist immediately.
Blood clot: Blood clots that form in the veins of the legs can stop the return flow of blood back up to the heart and cause swelling in the ankles and feet. Blood clots can be either superficial (occurring in the veins just beneath the skin), or deep (a condition known as deep vein thrombosis). Deep clots can block one or more of the major veins of the legs. These can be life-threatening if they break loose and can travel to the heart and lungs. If you have swelling in one leg, along with pain, fever or change in the color of the affected leg, call your doctor immediately. Treatment with blood thinners or other medications may be necessary.
Infection: Swelling in the feet and ankles can be a sign of infection. People with diabetic neuropathy or other nerve problems of the feet are at greater risk for foot infections. If you have diabetes, it is important to inspect your feet daily for blisters and sores, because nerve damage can blunt the pain sensation and foot problems can progress quickly. If you notice a swollen foot or blister that appears to be infected, contact your doctor or podiatrist right away.
Heart, liver, or kidney disease: Sometimes, swelling can indicate a problem such as heart, liver, or kidney disease. Ankles that swell in the evening could be a sign of retaining salt and water because of right-sided heart failure. Kidney disease can also cause foot and ankle swelling. When kidneys are not functioning properly, fluid can build up in the body. Liver disease can affect the liver’s production of a protein called albumin, which keeps the blood from leaking out of the blood vessels into the tissues. Inadequate albumin production can lead to fluid leakage. Gravity causes fluid to accumulate more in the feet and ankles, but fluid can also accumulate in the abdomen and chest. If your swelling is accompanied by other symptoms, including fatigue, loss of appetite, and weight gain, see your doctor right away. If you feel short of breath or have chest pain, pressure, or tightness, call 911 or go to the emergency room as soon as possible.
Medication side effect: Many drugs can cause swelling in the feet and ankles as a possible side effect. They include:
• Hormones such as estrogen (found in oral contraceptives and hormone replacement therapy) and testosterone.
• Calcium channel blockers, a type of blood pressure medication, which includes nifedipine (Adalat, Afeditab, Nifediac, Nifedical, Procardia), amlodipine (Norvasc), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Tiazac), felodipine (Plendil), and verapamil (Calan, Covera-HS, Isoptin, Isoptin SR, Verelan.)
•Steroids, including androgenic and anabolic steroids and corticosteroids such as prednisone.
• Antidepressants, including: tricyclics, such as nortriptyline (Pamelor, Aventyl), desipramine (Norpramin), and amitriptyline (Elavil, Endep, Vanatrip); and monoamine oxidase (MAO) inhibitors such as phenelzine(Nardil) and tranylcypromine (Parnate.)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Diabetes medications
If you suspect swelling may be related to a medication you are taking, speak to your doctor, they may change the medication or its dosage.
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at foothealth242@gmail.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.
