The ankle: Let’s begin with respect for this humble but powerful joint.
It lifts a ballet dancer into relevé, absorbs the shock of a runner’s foot striking pavement, and allows a gymnast to stick that landing. Ankles ensure you take every sure-footed step.
But what happens when it’s swollen or just bigger than you think it should be?
Read on to learn more about why some ankles are larger than others, and if you need to do anything about it.
Ankles vary in size and shape. For the most part, genetics determine the dimensions of your ankles. There’s nothing inherently dangerous or unhealthy about having large ankle bones and plenty of space between them.
Given that ankle injuries are very common, a sturdy ankle may actually be beneficial.
Several health conditions can enlarge otherwise typically sized ankles, however. Since some of these conditions are serious, it’s a good idea to find out more about what can make your ankles bigger.
Lipedema is a painful condition that causes fat to be stored beneath the skin on your legs. It generally occurs on both legs from the hips down, but doesn’t affect how your skin looks.
It affects more women than men; around 11 percent of women have lipedema.
People with lipedema tend to bruise easily because the blood vessels in their legs are extremely sensitive to pressure. As the disease progresses, people with lipedema may have difficulty walking.
Lipedema can also present social and emotional difficulties.
What causes lipedema?
Genetics play an important role in whether or not someone develops lipedema. Hormones often trigger the condition. During puberty, pregnancy, or menopause — which all involve hormones — the legs enlarge, and the skin can lose some of its elasticity.
Your doctor can diagnose lipedema using an MRI scan or ultrasound. Your doctor may also use a lymphangiogram or lymphoscintigraphy to capture images of your lymphatic system.
How is lipedema treated?
There are several ways to relieve the pain and discomfort of lipedema.
Eat a diet that limits sugar spikes
When you eat sugary foods, your body releases the hormone insulin. Insulin is known to stimulate fat storage and can cause fluid retention, which isn’t good for people with lipedema.
Exercise — especially in the water
Experts recommend swimming, water aerobics, or other forms of aquatic exercise. Water pressure helps drain lymphatic fluid, which is important in later stages of the disease.
Complete decongestive therapy
In advanced stages of lipedema, lymphatic fluid can build up in the legs. If that happens, your doctor may prescribe complete decongestive therapy (CDT).
CDT involves working with a specialist to manually drain lymphatic fluid from your legs using:
- compression bandages
- attentive skin care
Tumescent fluid anesthesia (TLA) or water-assisted liposuction (WAL)
Dry liposuction, the kind ordinarily used for cosmetic fat removal, isn’t recommended for lipedema because it can damage the lymphatic system.
Instead, your surgeon can inject large volumes of fluid under your skin to firm up and separate the fat tissue so it can be more easily removed.
If the extra fat tissue is keeping you from safely walking, your doctor may advise surgically removing the fat deposits with a procedure called lipectomy.
Lymphedema is swelling, usually in the arms or legs, that occurs from a problem somewhere in the lymphatic system. If you have lymphedema, your ankles can become enlarged when lymphatic fluid builds up in your body.
The lymphatic system is crucial to the healthy functioning of your organs. As plasma circulates through your body, it collects waste products from your cells. The waste products pass through the walls of your blood vessels into a web-like network of lymph vessels.
The fluid in the lymphatic system, called lymph, helps maintain fluid balance in your body. Lymph fluid also absorbs excess fat from your intestines and produces white blood cells that your body uses to fight germs and infections.
When your lymph system is damaged, lymph fluid doesn’t drain properly, and parts of your body can swell up.
One of the most common ways the lymph system gets damaged is through cancer treatment, when lymph nodes are removed. It’s also possible for cancer to develop in your lymph system (lymphoma).
How is lymphedema diagnosed?
Your doctor may be able to diagnose lymphedema by observing your symptoms, especially if you’ve recently had cancer treatments. If further tests are necessary to confirm a diagnosis, your doctor might order the following imaging tests:
- MRI scan
- CT scan
- lymphoscintigraphy (a test that tracks radioactive dye in your system)
These tests can find where in your lymph system a blockage has occurred.
How is lymphedema treated?
There isn’t an immediate cure for lymphedema, but some treatments may reduce the swelling, get fluid moving again, and lessen any pain you’re experiencing.
Treatments may include:
- gentle exercises to stimulate fluid drainage
- compression bandages that press fluid into other parts of your body
- massage techniques aimed at encouraging lymph drainage
- compression clothing that can keep your limbs from swelling, either with or without a pneumatic pump
It’s a good idea to work with your doctor or a physical therapist specially trained in the treatment of lymphedema. They can ensure the proper fit of compression garments and decide whether massage is right for your condition.
Edema is the medical term for swelling. If you have edema, your ankles will appear puffy, and your skin may feel stretched, tight, and itchy. A number of health conditions can cause swollen ankles. Below are some to consider.
A review of 2016 Google trends in the United States and Australia found that searches for “ankle swelling” peak in the midsummer months both above and below the equator.
Your veins contain valves that keep blood from pooling in the lower part of your body. When these valves become damaged, either because of a blood clot, varicose veins, trauma, or some other kind of weakening, they don’t work efficiently.
Gravity pulls blood down into your ankles and feet, causing swelling.
Deep vein thrombosis (DVT)
Sometimes a blood clot can block the flow of blood in your veins. The blockage prevents your blood from returning to your heart.
DVT is especially dangerous because the blood clots can break free and travel through your blood vessels up to your lungs, where they can stop your breathing.
With DVT, you’ll notice swelling in just one of your ankles. It’s important to immediately call for medical help if you do.
Serious health alert
If your ankles suddenly swell, it’s important to talk to your doctor about it right away. Ankle swelling is a symptom of the following potentially life threatening conditions:
- blood clots
- heart failure
- kidney disease
- liver failure
If your ankles swell up and you have shortness of breath or chest pain, call 911 immediately.
Congestive heart failure
Congestive heart failure causes the heart to weaken. When your heart becomes too weak to pump blood efficiently, blood pressure can build up inside your veins. Fluid leaks out into your other tissues, causing them to swell.
A disease in your liver — such as hepatitis or cirrhosis — could stop the production of an important protein called albumin.
Without enough albumin, too much fluid can leak out of your blood vessels and into your surrounding tissues. Your ankles, feet, hands, and face can swell as a result.
Your kidneys remove waste products from your body by filtering out toxins and excess minerals like sodium.
When your kidneys aren’t functioning properly, too much water and sodium are left in your blood vessels, and the pressure inside the vessels rises. Your ankles and feet are likely to start swelling, as well as the area around your eyes.
Foot and ankle swelling are common during pregnancy, especially during the last trimester.
Your body’s hormone levels, the efficiency of your veins, and fluid retention are all affected by pregnancy. It’s important to talk to your doctor about foot swelling, especially if it’s sudden and accompanied by:
- severe headache
- difficulty breathing
These symptoms plus swollen feet can be a symptom of preeclampsia, which leads to dangerously high blood pressure.
Ankle swelling is a side effect of some medications, including:
- blood pressure medications (calcium channel blockers and ACE inhibitors)
- diabetes medications
- estrogen in birth control pills and hormone replacement therapy
- antidepressants (including MAO inhibitors and tricyclics)
- anti-inflammatory medications (like NSAIDs)
If your ankles are swollen because of a medical condition, talk to your doctor about the best plan for reducing the swelling. You can also consider these options:
- Cut down on sodium in your diet, which can cause fluid retention.
- Do calf exercises to strengthen your ankles and boost muscle in your calves.
- Elevate your feet.
- Break up long periods of sitting with movement.
Your ankles are a marvel of nature: complex, strong, and flexible. Genetics largely determine the size of your ankles, but some health conditions can cause them to swell.
Seek immediate medical attention if you notice sudden swelling, especially when it only occurs on one side of your body, or the swelling is accompanied by difficulty breathing or a quickened heart. These are signs of a potentially life threatening condition.
If your ankle size concerns you, consider making some lifestyle changes. You can exercise, reduce your dietary sodium, increase your fluid intake, or prop up your ankles to reduce any swelling. You can also talk to your doctor to see whether surgical options are appropriate.
But if no underlying health condition is causing your larger ankles, it may be best to simply accept them as a strength, not something to fix.