What Causes Swollen Ankles and Feet?

Foot swelling occurs due to fluid accumulation in tissues, often resulting from circulatory, renal, or musculoskeletal conditions. It may be temporary or indicate a more serious underlying disorder.

Common causes include venous insufficiency, heart failure, kidney disease, and prolonged standing. Trauma, infections, and allergic reactions can also lead to swelling in the feet and ankles.

Management depends on the underlying cause; diuretics, compression therapy, or surgical options may be considered. Early medical evaluation is necessary to determine appropriate treatment.

Preventive measures include reducing salt intake, elevating the legs, wearing comfortable shoes, and maintaining a healthy weight. Persistent swelling should always be investigated by a healthcare professional.

Medical Name	Peripheral Edema (Foot/Leg Edema)
Common Symptoms	– Swelling in the foot and ankle- Tightness or shine in the skin- Edema that dimples with pressure- Feeling of heaviness- Limitation of movement
Causes	– Heart failure- Kidney diseases- Liver diseases- Venous insufficiency- Lymphedema- Medications (some blood pressure and diabetes medications)- Prolonged standing or inactivity
Risk Factors	– Old age- History of heart, kidney or liver disease- Pregnancy- Obesity- Prolonged sitting or standing
Complications	– Risk of skin wounds and infection- Restriction of movement- Deep vein thrombosis in severe cases
Diagnostic Methods	– Physical examination- Blood tests (kidney, liver, heart function)- Ultrasound or Doppler- ECG- Chest X-ray
Treatment Methods	– Treatment of the underlying disease- Salt restriction- Diuretic drugs- Keeping the legs elevated- Use of compression stockings
Prevention Methods	– Regular exercise- Reducing salt consumption- Avoiding long periods of inactivity- Weight control- Keeping legs elevated from time to time

Why is the delicate fluid balance in the body disturbed and why does foot swelling occur?

You can think of our body as a garden with a complex irrigation and drainage system. Our blood vessels are the pipes that water this garden and our tissues are the soil that is watered. In this system, there is a constant exchange of fluid between the vessels and tissues and there are two main forces governing this exchange:

The first is the pressure that pushes the fluid out of the vessel (hydrostatic pressure). The second is a kind of suction force created by the proteins in the blood that pulls the fluid back into the vessel (oncotic pressure). Normally these two forces are in balance. Excess fluid leaking out of the vein is collected by a special drainage network called the lymphatic system and re-enters the circulation.

Foot swelling occurs when this delicate balance is disturbed at one or more points. Either too much fluid leaks from the vein into the tissue, the vein cannot retract the fluid sufficiently, or the drainage system, the lymph network, cannot do its job.

Is Foot Swelling Single or Double, Why Does This Matter?

One of the first questions doctors ask to understand the cause of swelling is which leg the swelling is in. Because this simple question greatly narrows down the possible causes.

Single Foot Swelling: If the swelling is only in one leg, for example a swollen left foot or a swollen right foot, the problem is usually due to a local condition specific to that leg.

Double Foot Swelling: If there is a symmetrical swelling in both legs, this can often be a sign of a systemic disease affecting the whole body, for example heart, kidney or liver failure.

Why Does Heart Failure Make Feet Swollen?

Heart failure is one of the first and most important systemic causes of swollen feet, especially in the elderly. The heart is the engine of the body and when the pumping power of this engine decreases, serious disruptions in blood circulation begin. Swelling develops through two basic mechanisms.

First, the heart, especially the right side of the heart, cannot collect dirty blood from the body strongly enough to send it to the lungs. This causes the blood to pool in the veins in the legs like a traffic jam. This increase in pressure inside the vein causes fluid to leak out of the vessel wall and accumulate in the ankles and legs.

Secondly, when the pumping power of the heart drops, the kidneys perceive this as a lack of blood or fluid in the body. In response to this false alarm, the kidneys begin to retain water and salt to protect the body. However, this further increases the load on the vessels, which are already under increased pressure due to blood pooling, and exacerbates the swelling.

Here are some typical symptoms of swelling due to heart failure:

• Symmetrical swelling in both legs
• When the swelling is pressed with a finger, it remains hollow for a while (gode-leaving edema)
• Increased swelling as you stand during the day
• Reduction of swelling when lying down and resting at night
• Shortness of breath (especially with exertion or lying on your back)
• Extreme fatigue and weakness
• Frequent urination at night

Do Problems in Leg Veins Cause Foot Swelling?

Yes, very often. Chronic venous insufficiency, i.e. improper functioning of the veins in the legs, is the most common cause of swollen feet, especially in middle and older age groups. The veins in our legs have small valves that allow blood to flow one way towards the heart against gravity. When we walk, our calf muscles contract, squeezing these veins and pumping the blood upwards.

In venous insufficiency, these valves are disrupted and blood flows back downwards instead of upwards as it should. We call this condition “reflux”. The constant pooling of blood in the legs chronically increases the pressure inside the vein. This high pressure allows the fluid to leak out of the vein and cause swelling.

For those wondering how swelling of the feet due to venous insufficiency goes down, the most typical feature is that the swelling changes with position. Some of the conditions observed in this type of swelling are as follows:

• Increases at the end of the day, especially when standing or sitting for long periods.
• It decreases markedly in the morning after waking up or when the legs are raised.

Other symptoms accompanying swelling may include

• Pain and feeling of fullness in the legs
• Feeling of heaviness and fatigue
• Night cramps
• Itching

In advanced cases, the following skin changes can be seen:

• Brown-purple discoloration of the skin around the ankle
• Dryness, scaling and hardening of the skin
• Non-healing wounds (venous ulcer)

Can Single Foot Swelling Be a Sign of a Clot?

Definition. Deep vein thrombosis (DVT), a blood clot in one of the deep veins of the leg, is the most urgent and dangerous cause of swollen feet. This clot blocks the vein like a plug, suddenly blocking the return of blood to the heart. In the vessels behind the blockage, the pressure rises rapidly and large amounts of fluid leak into the tissue.

This causes a painful and tight swelling that usually develops within hours. DVT is a serious threat not only to the leg but also to general health. This is because this clot can break off and reach the lungs through the bloodstream and cause a life-threatening condition called “pulmonary embolism”.

The critical symptoms that raise suspicion of DVT are the following:

• Sudden swelling, usually in one leg
• Pain and tenderness in the swollen leg
• Increased temperature felt in the calf or in the entire leg
• Redness or bruising of the skin
• Increased pain when walking

Why is Lymphedema Swelling Different from Others?

The lymph system is almost an invisible hero of the body. It is a drainage network that collects, filters and returns fluid containing large molecules such as proteins that leak from the veins back into the bloodstream. Lymphedema is the inability of this drainage system to function due to a congenital problem or subsequent damage (e.g. removal of lymph nodes after cancer surgery, radiotherapy, infections).

When the drainage system is disrupted, protein-rich lymph fluid begins to accumulate between the tissues. These proteins cause swelling by drawing water like a sponge. However, there is an important difference that distinguishes lymphedema from other swellings: Over time, the accumulated protein triggers a chronic inflammatory reaction in the tissue, which leads to hardening of the tissue, almost felting (fibrosis).

Typical features of lymphedema are:

• Initially there may be a soft swelling that leaves a gode.
• In time, the swelling hardens and no dimple is formed when pressed with the finger.
• It is usually painless.

When considering what is good for swollen feet at home, it should be known that lymphedema does not respond to diuretic drugs; because the problem is not excess water, but the deterioration of the structure of the tissue.

On the back of the foot, the inability of the skin to fold when you try to pinch the skin at the base of the second toe (positive Stemmer’s sign) is a very typical sign of advanced lymphedema.

What Are Other Causes of Swollen Feet?

Apart from cardiovascular and lymphatic problems, many other conditions can cause swollen feet.

Some common causes are:

Kidney Diseases: The kidneys are the body’s filter system. Especially in cases such as “nephrotic syndrome”, which causes excessive protein loss in the urine, the protein level in the blood drops. This causes the fluid to leak into the tissues instead of being kept in the veins. Usually both legs are swollen, as well as the eyelids and face.

Liver Diseases: In cirrhosis, advanced liver failure, the liver cannot produce enough protein. This leads to swelling in the legs and fluid accumulation in the abdomen (ascites).

Medicines Used: Many medications can cause swelling of the feet as a side effect. Among these are some frequently used groups:

• Blood pressure medications (especially calcium channel blockers)
• Diabetes medicines
• Non-steroidal anti-inflammatory drugs (used for rheumatism and pain)
• Hormone treatments (such as estrogen)

Pregnancy: During pregnancy, the growing uterus can put pressure on the large veins that bring blood back from the legs. Hormonal changes also increase fluid retention in the body.

Obesity: Excess weight not only increases intra-abdominal pressure, but also puts additional strain on the veins and lymphatic system, leading to swelling.

Thyroid Gland Problems: Underactive thyroid gland (hypothyroidism) can, in advanced cases, cause a non-marking, doughy swelling (myxedema) due to the accumulation of a special substance under the skin.

How is Foot Swelling Diagnosed?

The answer to the question, what should I do if my feet are swollen, starts with consulting a doctor for a proper diagnosis. Your doctor performs an assessment, which consists of a series of steps to find the cause behind the swelling.

First, he or she will talk to you in detail, take a history of your complaint and perform a thorough physical examination. This first step often paves the way to a diagnosis. Some tests may then be ordered for the suspected cause.

Commonly used diagnostic methods are:

Blood Tests: These tests provide valuable information about organ function:

• Kidney and liver function tests
• Thyroid hormone levels
• Blood protein (albumin) levels
• BNP or NT-proBNP test for suspected heart failure
• D-dimer test to exclude problems with coagulation

Urine Test It is done to check for protein leakage from the kidneys.

Doppler Ultrasonography: It is the gold standard method in the diagnosis of vascular swelling. However, there is a very important point to know here: Ultrasound to look for clots and ultrasound to look for vascular insufficiency (reflux) are completely different tests. In a patient with chronic swelling, simply reporting “no clot” does not mean that the veins are healthy. Venous insufficiency should also be evaluated.

Echocardiography (ECHO): When heart failure is thought to be the cause of the swelling, a heart ultrasound is performed to examine the heart’s structure, valves and pumping power in detail.

What is good for swollen feet and how to treat it?

The answer to the question of what is good for swollen feet depends entirely on the underlying cause. Treatment ranges from temporarily relieving symptoms to permanently resolving the underlying disease.

What are the methods that can be applied at home and alleviate complaints?

Regardless of medical treatment, some lifestyle changes and simple home remedies can make a big difference in controlling swelling. Here are some suggestions that can be applied at home what is good for swollen feet:

• Raising the legs above the level of the heart while resting
• Avoid standing still or sitting for long periods of time
• Reducing salt consumption (table salt, processed foods, pickles, etc.)
• Regular exercise, especially walking and swimming
• Getting rid of excess weight
• Wearing compression (compression) stockings of the pressure and size recommended by the doctor
• Choosing comfortable and non-squeezing shoes

What are the Medical Treatment Options?

Heart Failure Treatment: In this case, treatment is with diuretics to remove excess fluid from the body and modern cardiac medications that reduce the load on the heart and make it work more efficiently.

Treatment of Deep Vein Thrombosis (DVT): The mainstay of treatment is blood thinners (anticoagulants) that prevent the clot from growing and being thrown into the lung. Treatment usually lasts at least 3-6 months.

Treatment of Chronic Venous Insufficiency: In this case, treatment is planned according to the stage of the disease.

Conservative Treatment: Compression stockings, exercise and lifestyle changes form the basis of treatment.

Interventional Treatments: If the underlying cause is valve insufficiency (reflux) in the blood vessels, there are now very effective and comfortable non-surgical methods to solve this problem. These methods close the problematic vein from the inside, allowing the blood to be diverted to healthy veins:

• Endovenous Laser Ablation (EVLA)
• Radiofrequency Ablation (RFA)
• Medical Adhesive (Biocompatible Glue) Application
• Sclerotherapy (Foam Therapy)

Lymphedema Treatment: The aim of lymphedema treatment is to drain the accumulated lymph fluid and prevent it from accumulating again. This requires a special treatment approach known as “complex decongestive physiotherapy”. This approach includes:

• Manual lymph drainage (a special massage technique)
• Multi-layer bandaging
• Skin care
• Personalized exercises

In Which Situations Is Foot Swelling an Emergency?

Although foot swelling is usually a slow-developing condition, when it occurs with certain symptoms, it can be a sign of a life-threatening problem and requires immediate medical attention.

If any of the following symptoms accompany foot swelling, you should call 112 Emergency Service immediately:

• Sudden onset of chest pain or tightness
• Shortness of breath or difficulty breathing
• Fainting or severe dizziness
• Coughing up blood

In the following cases, it is important to contact a hospital emergency room:

• Swelling occurs suddenly and only in one leg
• Significant pain, redness and warmth in the swollen leg
• The swelling occurs after a trauma or accident.