Ankle Swelling: Causes of a Swollen Ankle

The ankle can swell for various reasons — from sitting too long to heart and kidney diseases. We explain what may underlie ankle swelling, how swelling with pain differs from swelling without pain, and in which cases you should not delay.

Ankle swelling: what happens in the ankle area

The ankle joint is the articulation of the tibia, fibula, and talus: the tibial bones surround the talus like a fork, and movement occurs around one axis — flexion and extension of the foot. The joint is reinforced on the sides by ligaments: laterally by the anterior and posterior talofibular and calcaneofibular ligaments, medially by the deltoid ligament.

Swelling is the accumulation of fluid in the tissues. In the ankle area, it appears as puffiness; the skin stretches and shines, may change color and become dry, discomfort and stiffness occur, and a pit remains when pressed with a finger. Swelling can be in one leg or both.

Causes of swelling with pain: injuries and inflammation

Injuries — contusion, dislocation, fracture, sprain — occur more often from direct force in contusions and falls from height. In sprains, swelling develops quickly due to hemorrhage on the inner or outer side of the joint, sharp pain occurs when the foot turns inward, and palpation under the ankles reveals sharp tenderness. Dislocations and subluxations in this joint are often combined with ankle fractures.

Two other causes of puffiness are an insect bite and infection.

Arthrosis and arthritis as causes of ankle swelling

Ankle arthritis is an acute or chronic inflammatory process with pain syndrome and impaired mobility, a feeling of stiffness. The joint area becomes swollen, red, and hot to the touch.

Osteoarthrosis is a degenerative-dystrophic disease due to damage to the cartilage tissue of the articular surfaces; it occurs alongside pathology of the hip and knee joints and is associated with limitations in work activity.

Ankle swelling without pain: what it may mean

Swelling without pain may be associated with fluid accumulation in the tissues of the feet, ankles, and lower legs (edema); causes cited by reference books:

• prolonged standing or sitting in one position;
• a lot of salt in food, excess body weight, pregnancy;
• some medications — certain blood pressure drugs, contraceptives, hormone therapy, antidepressants, steroids;
• varicose veins, thyroid problems;
• heart, kidney, and liver diseases, thrombus.

Injury, such as a sprain or ligament strain, and an insect bite are also mentioned among the causes.

Swelling and redness of the joint: which signs are concerning

Redness and heat in the ankle area occur with inflammation and infection. Concerning signs should include swelling in only one leg without a clear cause, puffiness after injury or its increase, sharp pain and sudden onset, swelling of the face or abdomen along with leg swelling, high fever and chills, diabetes in the history.

Ankle swelling by itself is not a reason to call an ambulance. Call 103 or 112 if shortness of breath or difficulty breathing appears, a feeling of tightness, heaviness, or pain in the chest, blood when coughing, noticeable palpitations, faintness, pre-syncope, confusion, nausea, or cold sweat: this may be a manifestation of a thrombus in the lungs, which requires immediate hospital care.

How doctors look for the cause of swelling and when to seek help

Examination begins with history taking and physical examination: the doctor palpates the joint, compares both legs, and clarifies what happened before the swelling. Among instrumental methods, X-ray of the ankle joint in direct, lateral, and oblique projections is widely used; arthroscopy is also used. Further tests depend on the picture — for example, if heart, kidney, or vein diseases are suspected.

See a doctor if the swelling persists for several days, increases, or if heart, kidney, or leg vein disease is already known. The doctor usually clarifies when the puffiness was first noticed, what preceded it, and what medications the person is taking.

What to ask the doctor: is one leg swollen or both, does the swelling subside by morning, does a pit remain when pressed, are there heart, kidney, and vein diseases, is an X-ray needed, and who to go to next.

This material is for reference: it describes possible causes, does not make a diagnosis, and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer