You take your shoes off at the end of the day and suddenly notice something you hadn’t really paid attention to before.
Your ankles look puffy.
You press your finger into the skin and, for a few seconds, it leaves a little dent.
Then you look at your socks and realise they’ve left deep marks around your ankles.
Sound familiar?
Swollen feet and ankles are incredibly common, particularly after spending hours sitting or standing. The medical term is oedema, which simply means that fluid has built up in the tissues.
Often it is temporary and harmless.
But sometimes swollen ankles are your body’s way of telling you that something needs checking.
And this is one of those symptoms where the important question isn’t simply “How do I get rid of the swelling?”
It is “Why are my ankles swollen in the first place?”
Sometimes it’s simply gravity
If you’ve spent most of the day sitting at a desk, travelling, standing at work or simply not moving around very much, fluid can collect around your feet and ankles.
The NHS lists prolonged sitting or standing as common causes of oedema. Eating too much salt, being overweight, varicose veins and some hormonal or thyroid problems can also contribute. NHS – Swollen ankles, feet and legs
This is why you may notice your ankles looking relatively normal in the morning but considerably puffier by bedtime.
Gravity has been doing its job all day.
Moving your legs helps the muscles push blood back towards the heart, which is one reason gentle walking can help circulation and reduce swelling. NHS – Swollen ankles, feet and legs
Your medicine could be responsible
This is where I would always look at the medicines.
Some medicines can cause ankle and leg swelling as a side effect.
These include certain blood-pressure medicines, contraceptive pills, hormone therapy, antidepressants and steroids. NHS – Swollen ankles, feet and legs
One particularly common example is the calcium-channel blocker amlodipine.
Peripheral ankle oedema is a recognised side effect of calcium-channel blockers and commonly develops over the first few weeks or months after starting treatment or increasing the dose. Specialist Pharmacy Service – Managing peripheral oedema caused by calcium channel blockers
This is something I have seen many times in community pharmacy.
Someone notices their ankles swelling and assumes they have suddenly developed a problem with their heart or kidneys.
Sometimes the explanation is sitting in their medication box.
But don’t stop the medicine yourself.
If you think a medicine may be causing the swelling, speak to your pharmacist or doctor. Sometimes the medicine, dose or treatment approach can be reviewed.
Varicose veins can play a part
If you have varicose veins, you may also notice swelling, aching or a heavy feeling in your legs.
This can be worse after standing for long periods and may improve when you rest with your legs elevated. NHS – Varicose veins
Again, it is partly about how efficiently blood is returning from the legs.
Putting your feet up when you can and keeping physically active can help with symptoms.
But don’t assume every swollen ankle is simply “bad circulation”.
There are several possible causes.
When swelling needs more investigation
Oedema can also occur with conditions affecting the heart, kidneys or liver.
It can also be associated with infection, injury or a blood clot. NHS – Swollen ankles, feet and legs
This doesn’t mean that swollen ankles automatically mean something serious.
It means that persistent or unexplained swelling deserves an explanation.
If both ankles remain swollen for several days, become increasingly swollen or you already have a condition affecting your heart, kidneys or leg veins, the NHS advises seeking medical advice. NHS – Swollen ankles, feet and legs
One swollen leg is different
This is something I would particularly want people to remember.
If one leg suddenly becomes swollen and there is no obvious explanation, don’t simply wait for it to disappear.
A blood clot in a deep vein — a deep vein thrombosis (DVT) — can cause swelling and pain, usually in one leg. NHS – Pulmonary embolism
The swelling may be accompanied by pain, redness or warmth.
Sudden or severe swelling, particularly when affecting one leg, warrants urgent medical assessment. NHS – Swollen ankles, feet and legs
And there is an even more important warning.
If leg swelling is accompanied by sudden breathlessness, chest pain or coughing up blood, call 999.
A blood clot can travel from the leg to the lungs and cause a pulmonary embolism, which can be life-threatening. NHS – Pulmonary embolism
That is not a “wait and see” situation.
What can you do yourself?
If the swelling is mild and you have no worrying symptoms, there are several simple measures that may help.
Try not to sit or stand in exactly the same position for long periods.
Get up and walk around regularly.
When sitting down, elevate your legs on a chair or cushions where practical.
Wear comfortable shoes rather than anything tight around the feet.
Looking after the skin on your feet is also important because swollen, stretched skin can become uncomfortable and vulnerable. The NHS recommends washing, drying and moisturising the feet to help prevent skin problems. NHS – Swollen ankles, feet and legs
And don’t forget salt.
A high-salt diet can contribute to fluid retention, so reducing excessive salt intake is sensible if swelling is a recurring problem. NHS – Swollen ankles, feet and legs
What about “water tablets”?
This is where I would caution against treating the symptom without finding the cause.
Diuretics, often called water tablets, make you pass more urine and can be used to treat some forms of oedema.
But whether they are appropriate depends entirely on why the swelling is happening.
For example, medicines such as bumetanide may be prescribed for oedema associated with certain heart, kidney or liver conditions. NHS – Bumetanide
So if your ankles are swollen, don’t assume that you simply need to “get rid of the water”.
Sometimes the answer is movement.
Sometimes it is reviewing a medicine.
Sometimes it is treating varicose veins.
And sometimes there is an underlying medical condition that needs attention.
My pharmacist’s approach
When someone comes into the pharmacy and says, “My ankles have suddenly started swelling,” I don’t immediately recommend something for the swelling.
I want to know:
When did it start?
Is it one leg or both?
Is there any pain?
Is the area red or hot?
Does it improve overnight?
Have you recently started or increased any medicines?
Have you been sitting or standing for long periods?
Any breathlessness or chest pain?
Those questions can completely change the advice.
Because swollen ankles aren’t really a diagnosis.
They’re a symptom.
And sometimes the simplest explanation is the correct one — a long day on your feet, too much sitting, warm weather or a medication side effect.
But if the swelling is sudden, severe, painful, one-sided or accompanied by other symptoms, it deserves proper assessment.
So the next time you notice those familiar sock marks around your ankles, don’t automatically blame getting older.
Take a closer look.
Your ankles may simply be asking you to put your feet up — or they may be telling you that it’s time to find out why they’re swelling.
Until next time…
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