Manor Field Blog Number 7 – Swollen Ankles

We call this, in the clinical world, ankle oedema, although, swollen ankles means exactly the same thing; I suspect nurses and doctors sometimes like to show-off with their fancy vocabulary.

This is quite a straightforward condition with a limited number of causes, which can be difficult to treat.

Ankle oedema (heck, I can’t help myself!) is something we tend to find amongst those who are older although I have seen it affecting young people too.

It can be so bad that people are unable to wear shoes, they can’t go out the house, their skin can literally tear, leak fluid and become infected.

Although few people complain specifically, it must also be very uncomfortable if not painful.

What are the causes?

Well, there are many, but for my simple approach to life there are three main ones –

Age – as people age, the valves in the veins of their legs become less effective and just like any valve that has been around for 70 or 80-odd years, this results in the previously efficient one-way flow, going the other way. When you are younger, say, 60 per cent of the blood in the veins of your leg gets back to the heart with each heartbeat, this might drop to 40 over time (certain conditions such as blood clots contribute in the longer-term too), so that for each beat, a proportion of the blood that would have left remains in the legs and increases the pressure.

When you have increase pressure in any part of the body, you get the condition called oedema, which is the result of fluid in the blood leaking into surrounding tissues.

Mmmmm. That wasn’t too straightforward – I’ll try a diagram.

Well, that was the first cause; you might call it ‘wearing-out’

The second relates to a condition commonly called ‘heart failure’ which in itself is a standalone subject.

Heart failure is the collective name for a variety of conditions where the heart becomes less effective at pumping blood.

It is an entire field of scientific research, so I will not try to do it justice here, suffice it to say, when the pump becomes inefficient, fluid (blood) accumulates in the peripheries (ankles and legs) that results in the same process I have just described; if you have worn-out leg-vein valves too, the situation can be worse.

The third (and, for the purpose of this blog, final) cause of swollen ankles (at least, that I see as a doctor) is from the long-term effects of smoking.

Well, COPD, that is chronic obstructive pulmonary disease (we used to call it ‘airways’ disease – COAD when I was young, but someone preferred the Latin – there you go…)

Smoking can have an effect on the lungs whereby the pressure is increased to the extent that blood leaving the heart (to get oxygen from the lungs, before it goes to the rest of the body) struggles to get-through – like squeezing liquid through a very narrow space – think kinked garden hose. The result is that the heart struggles to pump, not as much blood gets through and you have the same accumulation as I have just described.

I can’t go into the specifics of treatment here, as, for the heart-failure component it gets very complicated.

As a basic, you might say, first aid, here is what you can do.

You might have seen that a common theme to the three causes is pressure and, given that we walk upright, this pressure is greater than say a dog, you do get oedematous dogs, just less, commonly than humans.

Remedy one – elevate your legs. When sitting or resting, have them up on a stool so that they are level or higher than your waist; this can help redress some of the pressure problem that I have just described.

Remedy two – if your swelling isn’t too bad, some people wear compression stockings. You will have to forgive me, as I have never Googled this before and have become a little carried-away with the photos.

Remedy three – just as I wrote yesterday, are you drinking too much? Something to thing about, although probably not a major cause.

Remedy four – find a friend who will massage your legs.

If none of this works and things are getting worse, your doctor might prescribe water tablets, which really do the same as drinking less – they make you pee more, getting rid of a certain amount of fluid.

Most people hate these tablets as they make you go to the loo and the older you are, the more difficult this can be, particularly if you already go quite often.

Your doctor might conduct some other investigations such as determining the function of your heart and checking your kidneys.

Essentially however, this isn’t a blog with an answer; this is a very difficult area for everyone – patient and doctor and the solution is often a compromise.

My blog is a very superficial foray into the subject of swollen ankles; there is sometimes more going-on and, as with all of this advice, it would do no harm to run it by your doctor or nurse if things are not getting better.

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