Swollen ankles result from an accumulation of lymphatic fluid, which helps carry nutrients and other substances to and from the organs of the body. This accumulation most often results from reduced activity of the muscles of the leg, which under normal circumstances help keep the fluid moving in the lymphatic channels and propel it upward toward the body cavity. When the fluid leaks out of its channels, gravity causes it to pool in the ankles and feet. This problem is common to many diseases in which the use of the legs is reduced. Unless the swelling is extreme, it usually is painless.
"Water pills" (diuretics) usually fail to reduce this type of swelling because they cannot move the fluid upward. If swelling is reduced, the fluid usually returns very soon, even if the medication is continued. Treatment is relatively simple and consists of keeping the feet sufficiently elevated so that gravity can begin to move the fluid toward the trunk. This means placing the feet higher than the hips for periods of time during the day and throughout the night. Support stockings may also be of assistance by helping to keep the fluid within its normal channels; these must be fitted properly to avoid pinching the muscles of the leg.
Special stockings that are worn at night during sleep actually pump the fluid back into the system by massaging the muscles of the legs. These are very effective but are expensive and should be reserved for special situations.
Despite the continued leakage of fluid, swollen ankles are essentially a nuisance, requiring looser shoes and so on, rather than a sign of a major problem. Swelling may be more noticeable in summer months because blood vessels and lymph channels dilate (swell) more when the temperature is higher. Sometimes the swelling is severe and does not go away and makes it hard to wear shoes and be comfortable. Specially trained physical therapists who are "lymphedema" specialists can be miraculous at getting the fluid mobilized.
Occasionally, extra fluid may accumulate in the body and pool in the ankles because the heart does not function properly. If a cardiac problem exists, swelling may be accompanied by shortness of breath, coughing, and a general feeling of being unwell. If swelling occurs rapidly, especially in one leg, and is accompanied by redness and pain, it is extremely important to rule out the possibility of thrombophlebitis (inflammation of the veins), which may lead to blood clots. This may require special testing. It is therefore important that a physician assess the cause of ankle swelling and determine proper treatment.
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