Swollen Ankles and Feet in Elderly Patients

Q: Swollen Ankles and Feet in Elderly Patients

Hello： It is difficult to determine a definitive diagnosis from your description; I recommend following up with a nephrologist to identify the correct underlying cause.

Swelling of the ankle and dorsum of the foot in the elderly?

Dear Doctor,
My mother is 72 years old and has a history of hypertension, gastrointestinal issues, and chronic severe constipation.
Recently, she has been experiencing swelling in her right ankle and the top of her foot.
She mentioned that two months ago, she suddenly had pain in her calf, and after applying a kinesiology tape, she felt some improvement; however, the swelling in her ankle and foot persists.
Could you please advise what might be causing this? What tests should she undergo at the hospital? Which department should she register with? Thank you very much!

Mei Hao, 70~79 year old female. Ask Date: 2021/09/11

Dr. Wu Hongjie reply Internal Medicine

Hello: It is difficult to determine a definitive diagnosis from your description; I recommend following up with a nephrologist to identify the correct underlying cause.

Reply Date: 2021/09/11

More Info

Swollen ankles and feet in elderly patients can be a concerning symptom, especially when accompanied by other health issues such as high blood pressure, gastrointestinal problems, and chronic constipation. In your mother's case, her age and existing medical conditions may contribute to the swelling in her right ankle and foot.
There are several potential causes for edema (swelling) in the lower extremities, particularly in elderly patients:
1. Heart Issues: Conditions such as congestive heart failure can lead to fluid retention, causing swelling in the legs and ankles. The heart's inability to pump blood effectively can result in fluid buildup in the lower extremities.

2. Kidney Problems: The kidneys play a crucial role in regulating fluid balance in the body. If they are not functioning properly, it can lead to fluid retention and swelling.

3. Venous Insufficiency: This occurs when the veins in the legs are unable to return blood to the heart effectively, leading to pooling of blood and fluid in the lower legs and feet.

4. Lymphatic Issues: Lymphedema, which is a blockage in the lymphatic system, can also cause swelling in the legs and feet.

5. Medication Side Effects: Certain medications, including those for high blood pressure or anti-inflammatory drugs, can cause fluid retention as a side effect.

6. Injury or Inflammation: The sudden onset of pain in the calf and subsequent swelling could indicate an injury or inflammation, such as a sprain or strain, or even a more serious condition like deep vein thrombosis (DVT), which is a blood clot in the deep veins of the leg.

Given your mother's symptoms, it is essential to seek medical attention promptly. Here are some steps you can take:
1. Consult a Physician: You should schedule an appointment with a primary care physician or a geriatric specialist. If the swelling is associated with pain, it may be advisable to see a vascular specialist or a cardiologist.

2. Diagnostic Tests: The doctor may recommend several tests to determine the underlying cause of the swelling. These could include:
- Blood tests to check kidney function, liver function, and electrolyte levels.

- An ultrasound of the legs to rule out DVT.

- An echocardiogram to assess heart function.

- A urinalysis to check for protein or other abnormalities that could indicate kidney issues.

3. Physical Examination: The physician will perform a thorough physical examination, focusing on the legs, heart, and abdomen, to assess for signs of fluid retention, heart failure, or other systemic issues.

4. Management of Underlying Conditions: Depending on the diagnosis, treatment may involve managing high blood pressure, adjusting medications, or addressing any underlying heart or kidney issues.

5. Lifestyle Modifications: Encourage your mother to elevate her legs when sitting or lying down, wear compression stockings if recommended by her doctor, and maintain a low-sodium diet to help reduce fluid retention.

In summary, the swelling in your mother's ankle and foot could be due to various factors, including heart, kidney, or venous issues, and it is crucial to seek medical evaluation to determine the exact cause and appropriate treatment. Early intervention can help manage symptoms and improve her quality of life.

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