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

At-a-Glance

• Swollen ankles and feet (edema) result from fluid accumulation in tissues
• Common benign causes include prolonged sitting/standing, hot weather, and pregnancy
• Can also indicate serious conditions like heart failure, kidney disease, or blood clots
• Sudden, one-sided swelling with pain may indicate a blood clot—seek immediate care
• Simple measures like elevation and compression can provide relief for mild cases

What It Feels Like

Swelling in the ankles and feet (peripheral edema) occurs when excess fluid accumulates in the tissues. The swelling may be mild or severe, affect one or both feet, and can range from barely noticeable to significantly limiting shoe fit and mobility.

Common descriptions include:

• Puffiness or swelling around ankles, feet, or lower legs
• Skin that looks stretched, shiny, or tight
• Indentation (pitting) when you press on the swollen area
• Shoes feeling tight or not fitting
• Socks leaving deep marks on legs
• Heaviness or aching in legs
• Reduced ankle mobility
• Swelling that worsens throughout the day

The swelling may improve overnight when legs are elevated and worsen during the day, especially with prolonged sitting or standing.

Common Causes

Prolonged Sitting or Standing

Gravity causes fluid to pool in the lower extremities when you sit or stand for extended periods without movement.

Signs this might be the cause:

• Swelling develops after long periods of sitting (flights, desk work) or standing
• Affects both feet equally
• Improves with elevation and movement
• No pain or other symptoms
• Happens occasionally, not constantly

What helps:

• Take walking breaks every hour
• Ankle pumps and circles while sitting
• Elevate feet when possible
• Compression socks for long flights or standing jobs
• Stay hydrated
• Avoid crossing legs when sitting

Hot Weather

Heat causes blood vessels to dilate, allowing fluid to leak into surrounding tissues. This is especially common in summer months.

Signs it's heat-related:

• Swelling worse in hot weather
• Improves in cooler temperatures or air conditioning
• Affects both feet
• No other symptoms
• Temporary and resolves with cooling

What helps:

• Stay in air-conditioned environments when possible
• Elevate feet
• Cool compresses
• Stay hydrated
• Avoid excessive salt
• Wear loose, breathable shoes

Pregnancy

Pregnancy causes increased blood volume and pressure on veins, leading to swelling, especially in the third trimester.

Signs it's pregnancy-related:

• Gradual onset during pregnancy
• Worse at end of day
• Affects both feet equally
• Improves with rest and elevation
• No severe pain

What helps:

• Elevate feet frequently
• Sleep on left side
• Avoid standing for long periods
• Compression stockings
• Stay hydrated
• Reduce sodium intake

Warning: Sudden, severe swelling with headache, vision changes, or upper abdominal pain may indicate preeclampsia—seek immediate medical care.

Medications

Many common medications can cause ankle and foot swelling as a side effect.

Common culprits:

• Calcium channel blockers (amlodipine, nifedipine) for blood pressure
• NSAIDs (ibuprofen, naproxen)
• Steroids (prednisone)
• Diabetes medications (thiazolidinediones)
• Hormone therapies (estrogen, testosterone)
• Antidepressants (some types)

What helps:

• Discuss with your doctor—never stop medications without guidance
• Ask about alternative medications
• Lowest effective dose
• Timing of doses may help

Venous Insufficiency

Chronic venous insufficiency occurs when leg veins don't efficiently return blood to the heart, causing fluid to pool in lower legs.

Signs it might be venous insufficiency:

• Swelling worse at end of day, improves overnight
• Aching or heaviness in legs
• Skin changes (darkening, thickening)
• Varicose veins
• Affects both legs, but may be asymmetric
• Chronic, ongoing problem

What helps:

• Compression stockings (20-30 mmHg)
• Elevate legs above heart level
• Regular exercise, especially walking
• Avoid prolonged sitting or standing
• Weight loss if overweight
• Vein procedures in severe cases

Lymphedema

Lymphedema occurs when the lymphatic system can't adequately drain lymph fluid, causing swelling.

Signs it might be lymphedema:

• Swelling in one or both legs
• Feeling of heaviness or tightness
• Reduced range of motion
• Skin thickening or hardening
• History of cancer treatment, surgery, or radiation
• Recurrent infections

What helps:

• Manual lymphatic drainage massage
• Compression garments
• Complete decongestive therapy
• Exercise
• Skin care to prevent infections
• Avoid injury to affected limb

Heart Failure

When the heart can't pump effectively, fluid backs up into the body, causing swelling in the legs, ankles, and feet.

Warning signs of heart failure:

• Swelling in both legs, ankles, and feet
• Shortness of breath, especially when lying flat
• Fatigue and weakness
• Rapid or irregular heartbeat
• Persistent cough or wheezing
• Rapid weight gain (2-3 pounds in a day)
• Reduced exercise tolerance

Action: Seek medical evaluation promptly. Heart failure requires medical management.

Kidney Disease

Kidneys regulate fluid balance. When they're not functioning properly, fluid accumulates in the body.

Warning signs of kidney problems:

• Swelling in legs, ankles, feet, and sometimes face/hands
• Decreased urine output or changes in urine
• Fatigue
• Nausea
• Confusion
• Shortness of breath

Action: See a doctor for evaluation. Blood and urine tests can assess kidney function.

Liver Disease (Cirrhosis)

Advanced liver disease can cause fluid retention in the legs and abdomen.

Warning signs:

• Swelling in legs and abdomen
• Yellowing of skin or eyes (jaundice)
• Easy bruising or bleeding
• Fatigue
• Nausea
• Confusion

Action: Medical evaluation and treatment are essential.

Deep Vein Thrombosis (DVT)

A blood clot in a deep vein, usually in the leg, is a medical emergency that can cause sudden, one-sided swelling.

Warning signs of DVT:

• Sudden swelling in ONE leg (usually calf or thigh)
• Pain or tenderness in the leg
• Warmth in the affected area
• Red or discolored skin
• Swelling worsens rapidly
• Recent surgery, long flight, or prolonged immobility

Action: Seek emergency medical care immediately. DVT can lead to life-threatening pulmonary embolism if the clot travels to the lungs.

When to See a Doctor

Schedule a doctor's appointment if:

• Swelling persists for more than a few days
• Swelling is worsening or spreading
• You have other symptoms (shortness of breath, fatigue, decreased urination)
• Swelling is painful
• Skin changes (discoloration, ulcers)
• Swelling interferes with daily activities
• You have heart, kidney, or liver disease

Diagnosis

Your doctor may perform:

• Physical examination: Checking for pitting edema, skin changes, varicose veins
• Medical history: Medications, medical conditions, recent travel
• Blood tests: Kidney function, liver function, heart markers, thyroid
• Urinalysis: Check for protein (kidney disease)
• Chest X-ray: If heart or lung disease suspected
• Echocardiogram: Ultrasound of heart to check function
• Doppler ultrasound: Check for blood clots or venous insufficiency
• ECG: Check heart rhythm

Treatment and Management

Treatment depends on the underlying cause:

For Mild, Benign Swelling

Elevation:

• Elevate legs above heart level for 15-30 minutes, 3-4 times daily
• Prop feet on pillows when lying down
• Use footstool when sitting

Compression:

• Compression stockings (15-20 mmHg for mild swelling)
• Put on in morning before swelling develops
• Remove at night

Movement:

• Regular exercise, especially walking
• Ankle pumps and circles
• Avoid prolonged sitting or standing
• Swimming (water pressure helps reduce swelling)

Dietary Changes:

• Reduce sodium intake (aim for less than 2,300 mg daily)
• Stay hydrated
• Maintain healthy weight
• Limit alcohol

Lifestyle Modifications:

• Avoid tight clothing or shoes
• Wear comfortable, supportive footwear
• Avoid crossing legs
• Lose weight if overweight

For Underlying Medical Conditions

Heart Failure:

• Diuretics ("water pills")
• Heart medications
• Sodium restriction
• Fluid restriction
• Regular monitoring

Kidney Disease:

• Treat underlying cause
• Diuretics
• Dietary modifications
• Dialysis in severe cases

Venous Insufficiency:

• Compression therapy
• Vein procedures (ablation, sclerotherapy)
• Elevate legs regularly

Lymphedema:

• Complete decongestive therapy
• Compression garments
• Manual lymphatic drainage

Self-Care Strategies

Daily Habits

• Elevate feet when sitting
• Take walking breaks every hour
• Perform ankle exercises
• Wear compression socks if recommended
• Monitor weight daily (sudden gain may indicate fluid retention)

Exercise

• Walking (promotes circulation)
• Swimming (water pressure reduces swelling)
• Cycling
• Yoga (legs-up-the-wall pose)
• Avoid high-impact activities if swelling is severe

Foot Care

• Inspect feet daily for cuts, sores, or changes
• Keep skin moisturized
• Wear proper-fitting shoes
• Avoid going barefoot
• Treat any injuries promptly

Frequently Asked Questions

The Bottom Line

Swollen ankles and feet are common and often result from benign causes like prolonged sitting, hot weather, or pregnancy. Simple measures—elevation, compression, movement, and sodium reduction—can provide significant relief for mild cases.

However, ankle swelling can also indicate serious conditions such as heart failure, kidney disease, liver problems, or blood clots. The key is recognizing warning signs: sudden one-sided swelling, shortness of breath, chest pain, or rapidly worsening symptoms all warrant immediate medical attention.

For persistent or recurrent swelling, medical evaluation can identify underlying causes and guide appropriate treatment. Don't dismiss chronic ankle swelling as just a normal part of aging or standing all day—many treatable conditions present with this symptom.

Remember: This information is educational and doesn't replace professional medical advice. If you're experiencing persistent or concerning ankle swelling, consult a healthcare provider for proper evaluation and treatment.