Ankle Swelling

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Ankle Swelling: A Nuisance of Gravity, Or a Sign of Problems?
Left Leg Swelling More Common in Women

Swelling of the legs, ankles and feet, also called peripheral edema, is a common complaint. In most situations, this is more of a nuisance than a sign of a significant problem. However, one should be aware there are many potential causes that should be considered and excluded before considering it a benign condition.

Many are concerned peripheral edema may reflect "bad circulation". Circulation to the legs is carried by arteries, carrying oxygen- rich blood from the left side of the heart to the extremities. The veins then take the "used" oxygen-poor blood from the legs back to the right side of the heart which sends the blood to the lungs to become oxygen-rich again. Peripheral edema does not usually indicate poor circulation and is most commonly due to the veins taking blood from the legs back to the heart, rather than the arteries taking blood from the heart to the legs.

The walls of the arteries are more muscular and elastic whereas the veins are a more thin-walled structure and more prone to stress. Gravity itself can create a back pressure on veins which can cause swelling. Often one reports that swelling in the ankles is worse by the end of the day and resolved when getting out of bed the next morning. Simple elevation of the legs will reverse the effects of gravity and reduce swelling. If we walked around all day on our hands rather than our feet, we would notice swelling in our arms, wrists, hands and head!

Peripheral edema is especially common in women. The increase in blood volume associated with pregnancies, along with gravity, stretches the veins causing incompetency of the vein valves and their ability to propel blood back to the heart. This can become a chronic problem following pregnancy. Commonly, swelling is noted in both legs. However, in women, the left leg may be the only one involved or be more swollen than the right. This is felt to be related to increased pressure from the pelvic organs as the main left lower extremity vein crosses over to join the right lower extremity vein, as together they form the inferior vena cava which is the main vein that carries blood back to the heart.

Varicose veins are another common cause of peripheral edema. Genetics play an important role here. One is most likely to also develop varicose veins if they were present in a parent. Swelling may worsen with prolonged standing and especially with prolonged sitting, as not only are the veins fighting gravity but are also being "pinched" at the knees and hips, which creates even more of a back pressure. Long car rides, plane trips and sitting at the computer are common culprits of peripheral edema. Warm temperatures, especially the hot summers in Kansas City, can make swelling worse.

Blood clots in the legs can obstruct blood flow in the veins. Your body finds other veins to get the blood back to the heart, but these usually aren't as efficient and can result in chronic swelling. Likewise, swelling can be present when the larger veins are taken from the legs for heart bypass surgery. Swelling also may be a sign of heart, liver, kidney or throid problems. If one has had a major illness or stress to the body, malnutrition which is associated with a low protein state may also cause edema. Medications, such as the family of calcium channel blockers which are often prescribed to treat high blood pressure, may commonly cause peripheral edema as well.

It is important to recognize the cause of peripheral edema and discuss this with your healthcare provider. The specific treatment will be directed at whatever underlying cause is found. Simple measures to treat edema are to avoid prolonged standing or sitting and elevate legs. Support stockings may be a challenge to put on, but do provide support to the thin-walled veins. Avoiding excess salt may reduce fluid retention and diuretics may be prescribed. Exercise and maintaining ideal body weight are also imperative!

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