Why do our ankles swell?

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Painless or painful swelling in the ankle and foot, are a common problem, in different individuals, across all ages and gender. Such swellings may arise due to physiological dysfunction or injuries or consumption of certain medications. Swelling in the ankle and foot, might signal certain underlying disorders within our body which might be critical. The common causes of swelling in the ankle and foot are discussed below.

During pregnancy swelling in the ankle and foot is quite common. The swelling is attributed to preeclampsia which is a serious condition featured by high blood pressure and proteinuria. It develops after approximately 20th week of pregnancy. Swelling of the ankles is accompanied by abdominal pain, headache, painful and infrequent urination, and nausea or vomiting. In preeclampsia, there is inadequate perfusion of the placenta, due to improper trophoblastic invasion. This causes an increase in blood pressure due to oxidative stress in the mother and leads to greater blood distribution to the periphery like the ankles.

Further, an increased protein content of the blood pulls excess fluid in the blood vessels, causing increased blood pressure and swelling in the ankles. The swelling or oedema in the ankles associated with preeclampsia is ‘œPitting’ type; meaning pressing on the swelled portion and removing the pressure, causes immediate swelling again. The treatment plan must involve antihypertensive treatment with methyldopa or alpha blockers.

Ankle injury is common in contact sporting events like soccer and basketball. The common cause of swelling is a sprain in the ankles. This causes the ligament in the ankles to become stretched and inflamed leading to swelling. The treatment plan includes proper rest, elevation of the legs over the head, application of ice on the sprained ankle and compression with bandage. Lymphedema is another cause of a swelled ankle. Lymph is a protein rich fluid which effectively traps and destroys bacteria. Lymph flows through lymphatic vessels. Whenever there is a blockage or obstruction of these vessels, lymph builds up and manifests as a peripheral swelling in ankles. Lymphedema is common amongst cancer patients treated with radiotherapy.

Venous insufficiency or decreased venous return is another cause of swelling in the ankles. Normally, the gravitational pull of the earth pulls blood towards the periphery like the ankles, away from the heart. The problem aggravates during prolonged standing which causes pulling of blood into lower extremities including ankles, which results in swelling. Moreover, a defect in the valve of the great veins and insufficient contraction of calf muscles to aid in venous return impairs delivery of blood towards the heart. There can also be an incidence of deep vein thrombosis, which refers to development of blood clot within the great veins, impairing blood supply to the heart. All the above conditions lead to pulling of blood into lower extremities, including ankles, which results in the characteristic swelling.

Infection and inflammation in the ankle or foot is common in diabetes. The infection mostly anaerobic develops from lack of oxygen to the nerve tissues. This causes diabetic neuropathy or damage of peripheral nerves leading to inflammation and swelling in the ankles.

Swelling in ankles can be vital symptoms for end organ diseases like heart, liver and kidneys. Ankle oedema may be caused due to right ventricular failure (inability of heart to pump blood in pulmonary arteries, leading to back pressure in right atrium and subsequently on great veins impairing blood flow to the heart. Liver failure cause insufficient albumin content in blood vessels. Albumin holds water in blood vessels and prevents water from diffusing into extracellular spaces. Hence, insufficiency of albumin leads to fluid accumulation or swelling in the ankles. Moreover kidney failure cause increased retention of fluid within the body, leading to ankle oedema.
Apart from the physiological causes, consumption of anti-hypertensive like amlodipine and other calcium channel blockers, anti-diabetic medications, hormone replacement therapy with estrogens are also the common causes of ankle oedema. To treat swelling of ankles, the underlying pathophysiological basis must be deeply introspected.

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