Ankle Swelling

You want to be able to flash you ankles the way that the first Ziegfeld girls did when the star Anna Held first shocked the world with bearing her ankles on stage. But the problem you have is your ankles swell. If your ankles are thick, they may have temporary fluid retention: that’s edema, they may have varicose veins, they may have gotten heavier (fat), trauma (like a bruise), or a bite. Fluid on your ankle is easy to diagnose. Your ankles shouldn’t be particularly white (that might be lack of circulation) or look bruised (that could be due to chronic poor blood flow or varicose veins), be hot to the touch, have any significant limitation of the range of movement, or actually hurt much. Women with edema on their ankles can show an indentation after you firmly press your thumb where the dependent part of the circulation is.

There are many causes of fluid retention in the body. Fluid retention in the blood stream is different from edema which is fluid that has seeped from the circulation into the tissue itself, much like how a sponge holds water. If it’s in the lower legs it is called dependent edema. It means something very different when several parts of your body have swelling, verses just one’s ankles. And its also a different situation if you have a bit of fluid after a long hard day of standing at work, verses swelling that sticks around and is still present by morning. Getting a diagnosis of the causes of your ankle swelling may require a check on your heart, your liver, your kidneys, your lymph circulation, and any medication or herbs you may be on, but if those things aren’t the cause, see your gyno for advice.

Simple blood tests can figure out if you have low protein in your blood, if you have too much salt, if your kidneys are functioning well, and those tests are reasonable to have ordered early in the medical evaluation of swollen ankles. As a gyno we like to see if there is a hormonal drive for fluid retention, or a mass in the pelvis that is preventing the passage of fluid from the legs back to the heart. Cysts and fibroids and of course being pregnant are the three most common causes of ankle swelling we treat in gynecology, followed by PMS fluid retention. There are conditions of the heart that can prevent fluid from properly circulating, overly stressed joints, like ballet dancers, can have fluid that even backs up in the marrow of the bones of the ankle; but those kinds of conditions would not be expected in an otherwise healthy gyno patient.

Treatment of the minor causes of edema is quite straight forward, where medication may be required for other types. As with all things medical, the first thing is to get a diagnosis by seeing your gyno (or GP etc). As good as our circulation is, we are creatures who respond to the basic laws of gravity. So if your fluid accumulated by being on your feet, you can resolve some of it by propping your feet up, higher than your heart and yes, the fluid will just run down stream and resolve. It’s also possible to use temperature and hydrostatic pressure to drive the fluid away: soaking in a pool, even heated, is cool enough relative to your body and provides just enough water pressure to help push that circulation up. Also it is possible that support stockings, using that pressure gradient, can push that fluid up where you need it.

Why birth control pill users ankles swell

Women who use birth control pills can have more salt and water retention. Virtually all birth control pills contain estrogen which causes the liver to increase production of certain molecules called peptides, essentially proteins. These molecules in turn cause physiologic effects. The salt and water retention is due to the liver producing angiotensinogen, which then becomes angiotensin, which then increases water and fluid retention. some pills, those containing drospirenone will specifically counter this effect. Changing your diet and activity may specifically counter the effect. Over time it is also thought that our bodies, if healthy, can adjust and go back to the normal levels of these molecules. And within a range, we can stay healthy even if we do have slight alterations in the system. But for some pill users the physical effects include bloating, higher blood pressure, higher heart rate, and more leg swelling. If you have any of these side effects, it’s time to gab with your gyno and discuss the alternatives for your contraception.

Just elevating your legs is helpful

As I write I’m propping my legs. Getting off your feet and getting circulation going to the heart is important. Most of us assume that if we have swollen ankles or bulging veins we were just in the dancing shoes a bit too long and a bit of a prop is all we need. And yes those two extra smores (my homage to Girl Scouts everywhere since it was the first recorded recipe ever for them in the 1927 Handbook! Anyone want to sell me a copy?) I ate couldn’t have helped. Who knew chocolate and graham crackers have so much salt! As your gyno I tend to look even deeper for the source of your leg problems: ovarian cysts, constipation, blood clots, enlarged uteri, and cases of torsion or varicosities of the pelvic veins as well as deep venous disease or blood clots. But eventually if, more commonly, nothing is found but venous insufficiency syndrome and unsightly leg veins, we can talk about the fix. More on that later!

whphealth

Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

6 thoughts on “Ankle Swelling

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