Swollen ankles and swollen feet are a common symptom and do not cause severe inconvenience or cause for concern, especially if you have stood or walked a lot. Yet sometimes the legs and ankles, which remain swollen for a long time or are accompanied by other signs, may indicate a serious problem in the body. Below in the article are considered some possible causes of swelling of the foot and ankle.
What is puffiness?
In medical terms, puffiness is a transient abnormal increase in a part of the body or area that is not caused by cell proliferation. This is caused by the accumulation of fluid in the tissues. Puffiness may occur throughout the body (general swelling), or a specific part or organ may be affected (localized) by this problem. Edema is usually not dangerous and is a common reaction to inflammation or a bruise.
Swelling is considered one of the five characteristics of inflammation; along with pain, warmth, redness and loss of function. Part of the body may swell in response to injury, infection or illness. Swelling, especially of the ankle, can occur if the blood circulates poorly. If water retention progresses to a symptomatic degree, the result is puffiness. Generalized swelling or massive edema (also called anasarca) is a common symptom in critically ill people. Although mild swelling is difficult to detect, especially in an overweight person. In contrast, massive edema is very obvious.
Causes of ankle swelling
Pregnancy. When pregnancy occurs, ankles and feet swell. Sudden or excessive swelling, however, can be a sign of preeclampsia, a serious condition in which high blood pressure and protein in the urine develop in the twentieth week of pregnancy. If you experience severe swelling or edema, accompanied by other signs, such as abdominal pain, headaches, rare emptying of the bladder, nausea and vomiting, or blurred vision, you should consult a doctor.
Damage to the foot or ankle. Damage to the foot or ankle may cause swelling. The most common case is a sprained ankle, which occurs when the injury stretches the ligaments and the leg is in an unnatural position. To reduce swelling from injury to the foot or ankle, rest. Avoid movement on a swollen ankle or leg, use ice packs, it is worth wrapping a leg or ankle with a compression bandage and raise the leg on a stool or pillow. If swelling and pain do not go away with home treatment, seek medical attention.
Side effect of the drug. Many medicines cause swelling in the legs and ankles as a possible side effect. These include:
- hormones such as estrogen (found in oral contraceptives and hormone replacement therapy) and testosterone;
- calcium channel blockers, a type of blood pressure drug that includes nifedipine, amlodipine, diltiazem, felodipine and verapamil;
- steroids, including androgenic and anabolic steroids and corticosteroids, such as prednisone;
- antidepressants, including tricyclics such as nortriptyline, desipramine and amitriptyline (Elavil, Endep, Vanatrip); and monoamine oxidase (MAO) inhibitors, such as phenelzine and tranylcypromine;
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- diabetic drugs.
If you suspect that the swelling may be associated with a drug that you are taking, consult your doctor. Despite the fact that the benefits of the drug may justify edema, a more serious swelling suggests that you need to change the drug or dosage.
Lymphedema. This is a stagnation of lymphatic fluid in the tissues, which may occur due to problems with the lymphatic vessels or after surgery to remove lymph nodes. Lymph is a protein-rich fluid that is carried through an extensive network of vessels and capillaries. It is cleared through the lymph nodes that retain and destroy unwanted substances (such as bacteria). However, if the patient has problems with the lymph nodes, the circulation of the fluid stops. Lymph stasis impairs wound healing and can cause infectious diseases in the body. Lymphedema is common after radiation therapy or surgery to remove the lymph nodes. If you have been treated for cancer and are experiencing an accumulation of lymph, you should contact the doctors.
Venous insufficiency. Swelling of the ankles and feet often becomes the first sign of venous insufficiency - a condition where blood moves randomly through the veins from the legs to the heart. Normally, the veins support the direction of blood circulation upward with one-way valves. When they are damaged or weakened, blood flows back down through the vessels, and the fluid remains in the soft tissues of the legs, especially on the ankles. Chronic venous insufficiency leads to skin changes, skin ulcers and infections. If you experience symptoms of venous insufficiency, you should visit the hospital.
Infection. Swelling in the legs and ankles can be a symptom of an infection. People with a diagnosis of diabetic neuropathy and any other nervous diseases of the legs are at a higher risk of developing foot infections. If you have diabetes, it is important to examine your feet every day for blisters and ulcers, because nerve damage can reduce pain, and leg problems can develop rapidly. If you notice swelling in your legs, go to the hospital immediately.
Blood clot. Blood clots that form in the veins of the legs can trigger blood flow from the legs back to the heart and cause swelling in the ankles and legs. Blood clots can be either superficial (occurring in the veins under the skin, or deep (a condition defined as deep vein thrombosis). Large clots can clog one or more main veins in the legs. These blood clots can be life-threatening if they break off and go to the heart and lungs.If you have puffiness in one leg, accompanied by pain, fever, and possibly a change in the color of the affected leg, go to the doctor immediately. You may need blood thinners.
Heart, liver and kidney disease. Sometimes puffiness is a symptom of heart, kidney or liver disease. Ankles that swell closer to night (in the evening) are a sure sign of salt and water retention due to heart failure. Kidney disease can also cause swelling of the foot and ankle. When the kidneys do not function normally, fluid builds up in the body.
Liver disease can affect the production of liver protein - albumin, which inhibits blood from leaking from blood vessels into tissues. Irregular release of albumin can lead to fluid leakage. Gravity causes fluid to stagnate more in the legs and ankles, but it can also be in the stomach and chest. If your swelling is accompanied by other symptoms, including fatigue, loss of appetite and weight gain, consult a doctor immediately. If you feel short of breath or chest pain, pressure or tightness, call an ambulance.
Diagnosis of swelling
First of all, it is necessary to note the symptoms of edema, which are a prerequisite for the diagnosis:
- severe swelling
- local edema
- trophic skin disorders.
Consideration should be given to recent food intake, especially in hospitalized patients, which may be depleted due to long periods of anorexia, nausea, vomiting, gastrointestinal dysfunction, or starvation for research and treatment. Similarly, in hospitalized patients, the volume of intravenous infusions should be reviewed. The duration and speed of leg swelling should be established.
Family history of such problems may be relevant. The past history of varicose veins, malignant diseases, radiation therapy, surgery, previous episodes of a tumor or infection of the legs or deep vein thrombosis (possibly complications of surgery or childbirth) should be identified.
A complete physical examination must be carried out. General examination points include the patient’s nutritional status and abnormal pigmentation of the skin, sclera and mucous membranes. Examine the abdomen and lower limbs for suspicious skin lesions and vascular anomalies, surgical scars, and signs indicating radiation therapy (skin atrophy, telangiectasia, scaly skin).
Puffiness of one or both legs is confirmed by a medical examination and certain tests. Remember that a swollen part of the body can be sensitive to touch. Acute edema is determined by slow, gentle pressure over the ankle. Lymphedema is characterized by swelling of the legs and feet, as well as swelling of the fingers. In prolonged cases, intradermal vesicles, dry and scaly skin and the appearance of "ivory skin" occur. The legs are examined for signs of venous disease (varicose veins, venous outbreaks, pigmentation, liposclerosis, eczema, venous ulceration).
The Trendelenburg test is also performed in the diagnosis of edema. The hips, knees and ankles should be examined with the popliteal fossa. Groups of lymph nodes should also be examined. Your doctor may order an examination of your rectal and pelvic organs. It should be noted signs of inflammation (erythema, fever, swelling, decreased movement) with or without infection (pus).