Swollen ankles in older people.

• Swollen legs in older people and swollen ankles are not normal.

• “Old age” does not cause swollen legs in older people.

• Swollen legs and feet in elderly may indicate serious underlying medical conditions that require treatment.

• The commonest causes of swollen ankles are:

  ·       Dependent oedema from lack of walking and sitting around all day, just like on a long plane flight.  This is caused by impaired circulation including venous and lymphatic return of fluid. 

  • Heart failure, causing leg swelling.  Ankle swelling may be the first sign of heart failure.

  • Malnutrition is also a common but under-recognised cause of ankle swelling in the elderly.  Those elderly who have inadequate intake of protein and calories can eventually get a low level of albumin (serum protein) in the blood which helps to keep fluid in the blood vessels.  With malnutrition the liver which normally produces protein can't keep up, so the combination of a lack of protein synthesis in the body, lack of protein (serum albumin) keeping fluid in the blood vessels allow it to leach out into the ankles.

  • Protein loss in the urine from progressive kidney failure and protein loss from progressive liver failure. This causes fluid to leak out into the tissues.

  • Underlying cancer with malnutrition.

  • Unilateral (only one) leg swelling could be associated with a clot in the leg, although it is very hard to diagnose a DVT (venous thrombosis/clot) without a Doppler ultrasound examination.

  • Pulmonary emboli (blood clots on the lungs) can be a silent cause of worsening lower limb and ankle swelling.  Pulmonary emboli usually present with chest pain and breathlessness, but in older people they can just present with lethargy, lack of energy and swollen ankles.  The risk factor of this is particularly in older ladies who sit around all day, don’t drink much and don’t walk much.

  • Swollen ankles in older people should be investigated, diagnosed and treated, not ignored!

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.