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Symptoms, Their Causes & Cures: Ankle Swelling

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Ankle Swelling

WHEN TO SEE YOUR DOCTOR

* See your doctor immediately if you twist your ankle and it causes swelling, bruising and pain.

* Any unexplained swelling lasts more than 72 hours.

* The swelling seems to be getting worse, or you cannot walk following an injury.

What Your Symptom Is Telling You

The human ankle is truly an astounding example of biomechanical engineering—an interactive network of bones, nerves, muscles and blood vessels working in precise harmony. But like most complex systems, if you disrupt that harmony, the whole system can suddenly go haywire.

When you severely injure an ankle, that once-quiet joint becomes a hotbed of activity, according to Gary M. Gordon, D.P.M., director of the Running and Walking Clinic at the University of Pennsylvania Sports Medicine Center in Philadelphia. "Nerves, muscles and other tissues become aggravated. Vessels and capillaries tear, leaking blood. More blood rushes to the area to begin the healing process. Fluids accumulate faster than they can be removed, and you have swelling."

The most common ankle injuries involve an inversion—or inward wrenching of the joint—resulting in a sprain (a tearing of the ligament), strain (a tearing of a muscle or tendon) or even bone fracture. All three can swell, hurt and leave an ugly bruise. Only a physician can properly diagnose which one you have.

In addition to injury, there are a number of other possible causes for a swollen ankle. And all of them are fairly common. Chronic overuse—doing too much, too soon, too fast—can lead to excess fluid accumulation and swelling. It can cause tendinitis, for example, an inflammation of the tendons. In tendinitis, stretching and repetitive action tear or irritate a tendon, causing it to swell. Underuse can also be a problem. If you're prone to water retention, just lazing around on a hot day can produce grapefruit-size ankles. So can certain medications.

Even something as commonplace as shoes can turn traitor and transform ankles into mini-replicas of the Hindenburg. "A shoe that's too loose or too tight, worn out, flimsy or inadequate for the way it's being used can swell an ankle well above it's normal size," says Michael Rask, M.D., chairman of the American Academy of Neurological and Orthopedic Surgeons in Las Vegas.

Circulatory and vascular diseases can also produce swelling. Venous insufficiency—a weakness in the valves of the veins—can cause blood to back up in the ankles, leading to an uncomfortable swelling. Swelling can also result from heart failure, which has many causes, such as high blood pressure, heart attack or anything that weakens the heart muscle.

Other common causes of chronic ankle swelling are lymphatic and kidney disease, diabetes, gout and rheumatoid arthritis.

Symptom Relief

Athletes usually make quick recoveries from sore or swollen ankles because they are properly diagnosed as soon as possible. Take a tip from the pros: Don't take chances when your ankle puffs up following an injury; see a doctor. Your doctor will order x-rays to rule out fractures. Here are some treatments your doctor may recommend as well as a few things you can try on your own.

Serve up some RICE. It's not the "San Francisco Treat," but an acronym for the most reliable treatment of injury and noninjury related swelling: rest—taking a load off
your feet; ice—15-minute applications several times a day to control bleeding and leaking of fluids; compression—using an elastic bandage or ankle brace to immobilize the joint; and elevation—propping up the ankle so gravity can pull the fluids away. Maintain RICE for three to five days.

Choose pain relievers carefully. Anti-inflammatory pain relievers, like aspirin and ibuprofen may reduce pain but must be avoided when an injury causes a swollen ankle, because they can promote bleeding, says Dr. Gordon. Acetaminophen, like Tylenol, is good for pain and does not have anti-inflammatory properties, he says.

Let your fingers do the walking. "As long as there is no pain, massaging the ankle is excellent," says Dr. Gordon. "It should be a gentle kneading with the fingers once or twice a day, pushing everything up toward the knee to force the fluids away from the joint."

Walk in the water. Strolling around in waist-deep water is an excellent and gentle means of exercising an ankle and reducing swelling, says Dr. Gordon. "The movement of water against the muscles helps pump out the fluids that accumulate."

Change your prescription. Puffy ankles are often the result of a reaction to a medication. Ask your doctor if any of your medications could be contributing to the problem and whether a different prescription or different dosage is appropriate.

Wear a running shoe. A worn, improper or poorly constructed shoe may be the culprit that caused your swelling in the first place. If you have to get around on swollen ankles, the best shoe is a quality running shoe, says Phillip J. Marone, M.D., director of the Jefferson Sports Medicine Center at Thomas Jefferson University Hospital in Philadelphia and physician for the Philadelphia Phillies professional baseball team. "It's light, comfortable and has the sole, arch and ankle support so as not to aggravate the situation."

Take a hike. Chronic swollen ankles are a way of life for the sedentary. The lack of muscle movement only causes fluids to accumulate, causing further decreases in activity. According to Dr. Gordon, a regular walking and exercise program can break this vicious cycle and bring ankles back to normal.

Go for the cold. Especially in the early stages of an injury. "Heat dilates the capillaries, but stimulates the leaking of blood and other fluids, making the swelling worse," says Dr. Gordon. Ice is much better at re-establishing a healthy blood flow, he says. Soaking your feet and ankles in cold water for 15 to 20 minutes at a time may provide some relief.

See also Ankle Pain; Water Retention

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