Swollen Ankles and Feet (Edema): Causes and When to Worry

At-a-Glance

• Swollen ankles and feet happen when fluid builds up in your tissues
• Often harmless (long flights, hot weather, pregnancy) but can signal serious problems
• Sudden one-sided swelling with pain could be a blood clot - get help immediately
• Simple fixes like elevation and compression socks help mild swelling
• See a doctor if swelling persists, worsens, or comes with other symptoms

What It Feels Like

Your ankles and feet feel puffy and tight. Your shoes don't fit right by the end of the day. When you press on the swollen area, your finger leaves an indent that takes a while to bounce back. Your socks leave deep grooves in your skin.

The swelling might start subtle in the morning and get progressively worse as the day goes on. By evening, your ankles might look noticeably puffy. The good news? If elevation overnight makes it better, that's usually a good sign.

Common Causes

Prolonged Sitting or Standing

Spending hours on a plane, at a desk, or on your feet makes fluid pool in your lower legs thanks to gravity. This is super common and usually nothing to worry about. Flight attendants, nurses, retail workers, and office workers know this problem well.

Pregnancy

Growing a baby puts pressure on the veins returning blood from your legs, causing fluid buildup. It's extremely common, especially in the third trimester and during hot weather. Usually normal, but sudden severe swelling can signal preeclampsia - tell your doctor right away.

Medications

Several common medications cause ankle swelling as a side effect: blood pressure meds (calcium channel blockers), NSAIDs (ibuprofen, naproxen), steroids, and some diabetes medications. Don't stop medications without talking to your doctor, but do mention if you notice swelling.

Venous Insufficiency

When valves in leg veins don't work properly, blood pools in your legs. You might notice varicose veins, aching legs that feel better when elevated, and brownish skin discoloration near ankles. Common in older adults and people who've had blood clots.

Heart Failure

This serious condition means your heart isn't pumping effectively, causing fluid backup. Swelling usually affects both legs and ankles, gets worse during the day, and comes with shortness of breath, fatigue, and sometimes frequent nighttime urination. Needs medical treatment.

Kidney Disease

Your kidneys regulate fluid balance. When they're not working well, fluid accumulates. Swelling tends to be more generalized (face, hands, legs) and might come with foamy urine, fatigue, and nausea.

Liver Disease

Advanced liver disease (cirrhosis) causes fluid retention in legs and abdomen. Usually accompanied by other symptoms like jaundice, abdominal swelling, and easy bruising.

Blood Clot (DVT)

Deep vein thrombosis is a medical emergency. It typically causes sudden swelling in one leg (not both), along with pain, warmth, and redness. Risk factors include recent surgery, long flights, prolonged bed rest, or birth control pills.

What You Can Do

Elevate your legs - Prop your feet up above heart level for 15-30 minutes several times daily. Lie down and put pillows under your feet and calves. Gravity is your friend here.

Move regularly - If you sit a lot, stand and walk every hour. If you stand a lot, sit and elevate periodically. Flex your ankles and wiggle your toes to keep blood moving.

Compression socks - These squeeze your legs gently to prevent fluid buildup. Get graduated compression (tighter at ankle, looser at calf). Start with 15-20 mmHg compression.

Reduce salt - Excess sodium makes you retain water. Limit processed foods, restaurant meals, and don't add salt to food.

Stay hydrated - Sounds backward, but drinking enough water helps your body regulate fluids better. Aim for 8 glasses daily.

Massage - Gently massage from feet toward knees to encourage fluid drainage.

When to See a Doctor

Make an appointment if:

• Swelling persists for more than a few days
• Swelling is getting worse
• One leg is significantly more swollen than the other
• You have shortness of breath or chest discomfort
• Swelling comes with abdominal bloating
• You're pregnant and swelling is sudden or severe
• You have other symptoms like fatigue, urine changes, or weight gain

Your doctor will examine you, ask about medications, and may order tests including blood work, urine tests, ultrasound, or echocardiogram.

Common Questions

The Bottom Line

Swollen ankles and feet are incredibly common and often harmless - caused by things like sitting too long, hot weather, or pregnancy. Simple measures like elevation, compression socks, regular movement, and reducing salt intake usually help.

But swelling can also signal serious conditions like heart failure, kidney disease, or blood clots. The key is recognizing warning signs: sudden one-sided swelling with pain, swelling accompanied by breathing problems, or persistent worsening swelling. These need medical evaluation.

If you're dealing with persistent swelling or have concerns, don't just live with it. See your doctor to identify the cause and appropriate treatment.