What are Causes of Swollen Ankles and Feet in the Elderly

Do you or an elderly loved one suffer from swollen ankles and feet? You’re not alone. Swelling in the lower extremities, known as edema, is a common issue among older adults. While it can be uncomfortable and concerning, understanding the potential causes can help you manage this condition effectively. In this article, we’ll explore 12 reasons why seniors may experience swollen ankles and feet, and what steps you can take to find relief.

Causes of Swollen Ankles and Feet in the Elderly
Causes of Swollen Ankles and Feet in the Elderly

12 Causes of Swollen Ankles and Feet in the Elderly

1. Venous Insufficiency: The Most Common Culprit

Chronic venous insufficiency (CVI) is the leading cause of swollen legs and feet in the elderly, responsible for about 70% of cases. With CVI, the valves in the leg veins that normally keep blood flowing back to the heart become damaged or weakened over time. This allows blood to pool in the veins, causing fluid to leak into the surrounding tissues.

CVI is more likely to occur with aging due to wear and tear on the veins. Other risk factors include obesity, a sedentary lifestyle, and a history of blood clots. Symptoms of CVI include:

  • Swelling in the legs and ankles, especially after standing for long periods
  • Aching, cramping, or feeling of heaviness in the legs
  • Itchy, dry, or discolored skin on the legs
  • Varicose veins

If you suspect you have CVI, there are several things you can do to manage symptoms and prevent progression:

  • Wear compression stockings to promote blood flow and reduce swelling
  • Exercise regularly to improve circulation, such as walking or swimming
  • Elevate your legs above heart level for 30 minutes several times a day
  • Maintain a healthy weight to reduce pressure on your veins

In some cases, your doctor may recommend medications or procedures to treat underlying vein problems. Catching and managing CVI early can help prevent complications like skin ulcers and infections.

2. Heart Failure: When Your Heart Can’t Keep Up

Swollen ankles and feet, especially if the swelling worsens throughout the day, can be an early warning sign of heart failure. When the heart isn’t pumping blood efficiently, fluid can back up in the veins and leak into the tissues of the legs and feet.

Heart failure can develop slowly over time or come on suddenly after a heart attack or other cardiac event. In addition to swelling, other symptoms of heart failure include:

  • Shortness of breath, especially when lying down
  • Fatigue and weakness
  • Rapid or irregular heartbeat
  • Persistent cough or wheezing
  • Sudden weight gain from fluid retention
  • Nausea and loss of appetite

If you have swelling along with any of these symptoms, don’t delay in seeing your doctor. Heart failure is a serious condition that requires prompt treatment to prevent complications and improve quality of life.

Treatment for heart failure typically includes a combination of medications to strengthen the heart muscle, reduce fluid buildup, and control symptoms. Lifestyle changes like following a low-sodium diet, limiting fluid intake, and getting regular exercise can also help manage the condition.

3. Kidney Disease: The Silent Threat

The kidneys play a vital role in filtering waste and excess fluid from the blood. When kidney function declines, as often happens with aging, fluid can build up in the body, leading to swelling in the legs, feet, and ankles.

Kidney disease often develops slowly and may not cause symptoms in the early stages. As it progresses, you may notice:

  • Swelling in the legs, feet, and around the eyes
  • Fatigue and weakness
  • Loss of appetite
  • Nausea and vomiting
  • Changes in urination (more frequent, foamy, or bloody)
  • Dry, itchy skin
  • Muscle cramps
  • Trouble concentrating

Regular check-ups and screening tests can help detect kidney problems early when treatment is most effective. If you have diabetes or high blood pressure, you’re at increased risk for kidney disease and should be monitored closely.

4. Liver Disease: A Hidden Cause of Swelling

Liver diseases like cirrhosis, hepatitis, and liver cancer can cause fluid retention and swelling, not just in the legs and feet but also in the abdomen and chest. The liver produces albumin, a protein that helps keep fluid in the bloodstream. When liver function is impaired, low albumin levels allow fluid to seep out into the tissues.

Liver disease has many potential causes, including viral infections, alcohol abuse, and non-alcoholic fatty liver disease. Symptoms can be nonspecific and may include:

  • Swelling in the legs, feet, and abdomen
  • Yellowing of the skin and eyes (jaundice)
  • Fatigue and weakness
  • Loss of appetite and weight loss
  • Nausea and vomiting
  • Dark urine and pale stools
  • Easy bruising or bleeding

If you have risk factors for liver disease or notice any of these symptoms, see your doctor for an evaluation. Early diagnosis and treatment can help prevent serious complications.

Over the Counter Medications
Over the Counter Medications

5. Medications: An Overlooked Cause

Certain medications can cause swelling in the feet and ankles as a side effect. These include:

  • Calcium channel blockers for high blood pressure like amlodipine and nifedipine
  • Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone
  • Steroids like prednisone, used to treat inflammation and autoimmune diseases
  • Antidepressants like MAO inhibitors and tricyclics
  • NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen

If you notice increased swelling after starting a new medication, don’t stop taking it without talking to your doctor first. They may recommend an alternative drug or adjust your dosage to minimize side effects.

In some cases, the benefits of a medication may outweigh the risk of swelling. Your doctor can help you weigh the pros and cons and find the best treatment plan for your individual needs.

6. Deep Vein Thrombosis (DVT): A Dangerous Clot

A blood clot that forms in one of the deep veins of the leg, known as deep vein thrombosis (DVT), can cause sudden swelling, usually in just one leg. The affected leg may also be painful, tender, warm, and reddish in color.

DVT is a serious condition because the clot can break loose and travel to the lungs, causing a life-threatening pulmonary embolism. Risk factors for DVT include:

  • Prolonged immobility, such as during long car or plane trips, bed rest, or paralysis
  • Recent surgery, especially on the hips, knees, or legs
  • Certain cancers and cancer treatments
  • Inherited or acquired clotting disorders
  • Pregnancy and the postpartum period
  • Obesity and smoking

If you have symptoms of DVT, seek immediate medical care. Treatment involves blood thinners to prevent the clot from growing and reduce the risk of future clots. In some cases, a procedure to remove or dissolve the clot may be necessary.

To prevent DVT, try to move your legs frequently when sitting for long periods, maintain a healthy weight, and quit smoking. If you’re at high risk for clots, your doctor may prescribe blood thinners or recommend wearing compression stockings.

7. Infection: A Dangerous Complication

Skin infections like cellulitis can cause redness, swelling, and tenderness in the affected foot or leg. Older adults, especially those with diabetes or nerve damage in the feet, are at increased risk for foot infections.

Foot infections can develop from small cuts, blisters, or ingrown toenails that allow bacteria to enter the skin. If left untreated, the infection can spread to the underlying tissues and bone, leading to serious complications like sepsis or amputation.

Signs of a foot infection include:

  • Redness, swelling, and warmth in the affected area
  • Pain or tenderness
  • Pus or other drainage
  • Fever and chills
  • Red streaks extending from the affected area

If you suspect you have a foot infection, see your doctor right away. To prevent foot infections, practice good foot hygiene:

  • Wash your feet daily with soap and warm water
  • Dry your feet thoroughly, especially between the toes
  • Trim your toenails straight across to avoid ingrown nails
  • Wear clean, dry socks and well-fitting shoes
  • Check your feet daily for cuts, sores, and signs of infection, especially if you have diabetes

8. Injury: More Than Just a Sprain

An injury to the foot or ankle, such as a sprain or fracture, can cause sudden swelling and pain. Older adults are at increased risk for falls and injuries due to factors like poor vision, balance problems, and osteoporosis.

Common foot and ankle injuries include:

  • Sprains: stretching or tearing of the ligaments that support the joint
  • Strains: stretching or tearing of the muscles or tendons
  • Fractures: breaks in the bones of the foot or ankle
  • Dislocations: when a joint is forced out of its normal position

If you suffer a foot or ankle injury, follow the RICE protocol:

  • Rest: avoid putting weight on the affected foot
  • Ice: apply ice for 15-20 minutes at a time to reduce swelling and pain
  • Compression: wrap the foot with an elastic bandage to minimize swelling
  • Elevation: keep the foot elevated above heart level to reduce swelling

For more severe injuries, see your doctor. You may need additional treatment like a splint, cast, or physical therapy to promote proper healing and prevent long-term complications.

9. Lymphedema: When Lymph Fluid Builds Up

The lymphatic system helps drain excess fluid from the tissues back into the bloodstream. When lymph nodes are damaged or blocked, fluid can build up and cause swelling, usually in an arm or leg. This condition is known as lymphedema.

In seniors, lymphedema is often related to cancer treatment, especially if lymph nodes are removed or damaged by surgery or radiation. Other causes include infection, trauma, and inherited conditions that affect lymph drainage.

Symptoms of lymphedema include:

  • Swelling in an arm or leg, sometimes extending to the fingers or toes
  • A feeling of heaviness or tightness in the affected limb
  • Aching or discomfort
  • Recurring infections in the affected limb
  • Hardening or thickening of the skin (fibrosis)

If you’re at risk for lymphedema, ask your doctor about preventive measures like wearing a compression sleeve during air travel or avoiding blood draws and blood pressure readings in an at-risk arm.

10. Arthritis: A Pain in the Joints

Certain types of arthritis, such as rheumatoid arthritis, gout, and psoriatic arthritis, can cause joint inflammation and swelling. The ankles and feet are common sites of arthritis pain and stiffness.

Arthritis occurs when the protective cartilage that cushions the joints breaks down over time or becomes inflamed. Symptoms of arthritis in the feet and ankles may include:

  • Pain and stiffness, especially in the morning or after sitting for long periods
  • Swelling and warmth around the affected joint
  • Difficulty walking or bearing weight on the affected foot
  • Visible changes like knobby toe joints or skin rashes

Treatment for arthritis depends on the specific type but may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Disease-modifying antirheumatic drugs (DMARDs) to slow joint damage in inflammatory arthritis
  • Physical therapy to improve joint function and reduce pain
  • Assistive devices like braces or orthotics to support the affected joint
  • Surgery to repair or replace a severely damaged joint

Maintaining a healthy weight, exercising regularly, and using proper body mechanics can help reduce stress on your joints and manage arthritis symptoms. If you have persistent joint pain and swelling, see your doctor for an evaluation and individualized treatment plan.

11. Vascular Surgery: Recovering from Repair

Swelling in one or both legs is common after vascular surgery to treat problems with the arteries or veins, such as aneurysms, blockages, or varicose veins. The swelling may last a few weeks to a few months as the body heals and adjusts to improved circulation.

To manage post-surgical swelling and promote healing:

  • Follow your doctor’s instructions for incision care and activity restrictions
  • Wear compression stockings as directed to improve blood flow and reduce swelling
  • Elevate your legs above heart level for 30 minutes several times a day
  • Walk short distances frequently to improve circulation and prevent blood clots
  • Take pain medication as prescribed to control discomfort

While some swelling is normal after vascular surgery, contact your doctor if you have:

  • Severe pain or swelling that doesn’t improve with elevation and pain medication
  • Redness, warmth, or drainage from your incision site
  • Shortness of breath or chest pain
  • Numbness or tingling in your leg or foot

These could be signs of a complication that needs prompt medical attention, such as an infection or blood clot.

12. Obesity: A Weighty Issue

Excess body weight puts added pressure on the veins and lymph vessels, making it harder for them to move fluid back toward the heart. This can lead to fluid retention and swelling in the lower extremities, a condition called dependent edema.

Obesity also increases the risk of other conditions that can cause swelling, such as venous insufficiency, heart failure, and arthritis. Losing weight, even just 10% of your body weight, can significantly improve vein function and reduce swelling and discomfort.

To manage obesity and its related health risks:

  • Follow a balanced, reduced-calorie diet rich in fruits, vegetables, lean proteins, and whole grains
  • Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or swimming
  • Break up long periods of sitting with short walks or leg exercises
  • Work with your doctor or a registered dietitian to develop a safe and sustainable weight loss plan

Losing weight takes time and effort, but the benefits for your health and quality of life are well worth it. If you’re struggling to lose weight on your own, ask your doctor about medically supervised weight loss programs or bariatric surgery.

When to Seek Medical Help?

While mild swelling in the feet and ankles is often manageable at home, certain situations warrant immediate medical attention:

  • Sudden or severe swelling
  • Swelling accompanied by shortness of breath, chest pain, or cough
  • Swelling in only one leg, especially if it’s warm or painful
  • Swelling that doesn’t improve with home care
  • Skin that is red, warm, or painful to touch


Swollen ankles and feet are a common concern among the elderly. By understanding these underlying factors and taking proactive steps to manage swelling, seniors can find relief and maintain their quality of life.

Remember, your feet are your foundation – taking care of them is an important part of overall health and well-being. If you’re experiencing persistent or concerning swelling, don’t hesitate to see your doctor.