Ankle and dorsum edema refers to the abnormal accumulation of fluid in the ankle joint and dorsum of the foot, resulting in localized swelling. This phenomenon can be caused by a variety of factors, including non-disease factors such as medication, pregnancy, and prolonged sitting, as well as disease factors such as varicose veins in the lower limbs, kidney disease, right heart failure, and cirrhosis. The key to treatment is to identify the cause and provide appropriate treatment.
symptom
Typical manifestations
Typical symptoms of ankle and dorsum edema include noticeable swelling in the ankle and dorsum of the foot. The skin may become tight and shiny, and may indent when pressed, a condition known as “pitting edema.” This swelling may worsen after prolonged standing or walking and may be relieved by resting or elevating the lower limb. Patients may also experience a localized feeling of tightness or discomfort.
complication
This symptom generally has no obvious complications.
reason
Overview
Ankle and dorsum edema may be caused by a variety of reasons, including non-disease factors such as medication, pregnancy, and long-term sitting, as well as disease factors such as varicose veins in the lower limbs, kidney disease, right heart failure, and cirrhosis.
Cause of symptoms
1. Non-disease factors
(1) Drug factors: Certain drugs, such as nonsteroidal anti-inflammatory drugs, calcium channel blockers, and certain hormone drugs, may cause fluid retention in the body, thereby causing edema of the ankle and dorsum of the foot.
(2) Pregnancy: During pregnancy, many pregnant women will experience edema of the ankles and dorsum of the feet due to changes in hormone levels in the body and compression of the uterus on the inferior vena cava.
(3) Sitting for a long time: Sitting still for a long time, especially with incorrect sitting posture or crossing your legs for a long time, may lead to poor blood circulation in the lower limbs, which in turn may cause edema of the ankles and dorsum of the feet.
2. Disease factors
(1) Varicose veins of the lower limbs: When varicose veins occur in the lower limbs, venous blood return is blocked, causing blood to accumulate in the lower limbs, causing edema of the ankles and dorsum of the feet.
(2) Kidney disease: Kidney diseases such as glomerulonephritis and nephrotic syndrome may lead to an imbalance in fluid metabolism in the body, resulting in the inability to excrete water normally and accumulating in the body, causing edema of the ankles and dorsum of the feet.
(3) Right heart failure: In right heart failure, the heart’s pumping function decreases, and blood accumulates in the venous system, especially the veins of the lower limbs, leading to edema of the ankles and dorsum of the feet.
(4) Cirrhosis: In cirrhosis, liver function is impaired, resulting in reduced albumin synthesis and decreased plasma colloid osmotic pressure. Fluid easily seeps out of blood vessels, causing edema of the ankles and dorsum of the feet.
(5) Others: In addition to the above-mentioned disease factors, hypothyroidism, anemia, fractures, sprains, etc. may also cause ankle and dorsum edema.
Common diseases
Varicose veins of the lower limbs, glomerulonephritis, nephrotic syndrome, right heart failure, cirrhosis, hypothyroidism, anemia, fractures, sprains
Seeking medical treatment
Emergency (120) indications
1. When ankle and dorsum edema develops rapidly in a short period of time and is accompanied by difficulty breathing, acute right heart failure should be considered.
2. If the edema of the ankle and dorsum of the foot is caused by trauma such as a car accident or squeezing, and the pain is severe and movement is limited, consider the possibility of a fracture.
3. Other life-threatening symptoms occur.
In all of the above cases, you must call the emergency number or go to the emergency room immediately.
Outpatient indications
1. Ankle and dorsum edema persists and does not resolve on its own.
2. Accompanied by symptoms such as decreased urine volume and increased blood pressure.
3. Accompanied by symptoms such as fatigue, loss of appetite, and yellowing of the skin or sclera.
4. History of sprain.
5. Other severe, persistent or progressive symptoms and signs occur.
The above requires prompt medical consultation.
Treatment department
1. If the condition is critical or the symptoms are severe, please go to the emergency department immediately.
2. If you suspect lower limb vascular disease, you can go to the vascular surgery department for treatment.
3. If you suspect kidney disease, you can go to the nephrology department for treatment.
4. If you suspect heart disease, you can go to the cardiovascular department for treatment.
5. If you suspect liver disease, you can go to the hepatology department for treatment.
6. If you suspect bone disease, you can go to an orthopedic department for treatment.
7. Special groups should go to specialized departments for treatment. For example, pregnant female patients can go to the obstetrics department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. When going to the doctor, try to stay calm, don’t be too nervous, and don’t run around or overwork, so as not to aggravate your condition.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Prepare a list of questions you want to ask in advance.
What questions might a doctor ask a patient?
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
7. Are you taking any medications?
What questions can patients ask their doctor?
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. What are the risks of these treatments?
5. If medication is used for treatment, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Scheduled inspection
The doctor will first perform a physical examination to gain a preliminary understanding of the patient’s condition. Afterwards, the doctor may optionally order additional diagnostic tests, including blood and urine routine tests, renal and liver function tests, BNP and NT-pro-BNP tests, echocardiograms, abdominal ultrasounds, electrocardiograms, X-rays, CT scans, and MRIs.
Physical examination
The doctor will conduct a preliminary assessment of the patient’s condition through inspection, touch, percussion, and auscultation, including observing the degree and distribution of edema, as well as the presence of other relevant signs, such as abnormal heart sounds and abdominal distension.
Laboratory tests
1. Blood routine test
Used to understand whether the patient has blood system problems such as infection, anemia, etc.
2. Urinalysis
Used to determine whether kidney disease is present.
3. Kidney function
By testing indicators such as blood creatinine and urea nitrogen, the filtration and excretion functions of the kidneys are evaluated to rule out edema caused by renal insufficiency.
4. Liver function
By testing indicators such as transaminase, bilirubin, and protein, we can understand whether the liver’s synthesis, detoxification and other functions are normal, because liver disease may also cause edema.
5. BNP and NT-pro-BNP examination
These tests are used to assess heart function, particularly the possibility of heart failure. BNP (brain natriuretic peptide) and NT-pro-BNP (N-terminal pro-brain natriuretic peptide) are hormones released by the heart when pressure overload increases.
Imaging examinations
1. Echocardiography
Ultrasound is used to examine the structure and function of the heart to determine whether there are structural abnormalities or functional impairments in the heart.
2. Abdominal ultrasound
Check abdominal organs, such as the liver and kidneys, to see if there are any abnormalities or diseases.
3. X-ray examination
Used to determine if there are abnormalities or lesions in bones and joints.
4. CT examination
Used to further evaluate the anatomy and abnormalities of the ankle and dorsum of the foot.
5. MRI
It has high accuracy in diagnosing soft tissue lesions.
Other tests
Electrocardiogram: By recording the electrical activity of the heart, we can understand heart rhythm, conduction, myocardial ischemia, etc.
diagnosis
Diagnostic principles
A diagnosis is generally easy to make by taking a detailed medical history, performing a physical examination, and combining the results of routine blood tests, urine tests, renal function tests, liver function tests, BNP and NT-pro-BNP tests, echocardiography, abdominal ultrasound, electrocardiogram, X-rays, CT scans, MRI scans, and other auxiliary tests. Common conditions that cause ankle and dorsum edema, such as varicose veins of the lower limbs, glomerulonephritis, right heart failure, and cirrhosis, must be identified during the diagnosis.
Differential diagnosis
1. Varicose veins in the lower limbs
Varicose veins in the lower extremities are caused by valvular incompetence in the lower extremities, which obstructs venous return and increases intravenous pressure, leading to dilation and tortuosity of the venous walls. Patients typically experience heaviness, fatigue, soreness, and swelling in the lower extremities, along with edema in the ankles and dorsum of the feet. Doctors can detect obvious varicose veins during a physical examination and confirm the diagnosis with ultrasound.
2. Glomerulonephritis
Glomerulonephritis is a glomerular disease caused by a variety of factors. Patients typically experience symptoms such as hematuria, proteinuria, edema, and hypertension. Ankle and dorsum edema is a common manifestation of glomerulonephritis. Doctors can confirm the diagnosis through urinalysis, renal function tests, and renal biopsy.
3. Right heart failure
Right heart failure (RHF) is caused by a decrease in the right ventricle’s pumping function, leading to systemic congestion and, in turn, edema in the ankles and dorsum of the feet. Patients typically experience symptoms such as dyspnea, fatigue, and abdominal distension. Doctors can confirm the diagnosis through echocardiography, BNP, and NT-pro-BNP testing.
4. Cirrhosis
Cirrhosis is a terminal disease that develops from various chronic liver diseases. Patients typically experience symptoms such as decreased liver function and portal hypertension. Ankle and dorsum edema is a common manifestation of cirrhosis, primarily due to decreased albumin synthesis in the liver, which leads to decreased plasma colloid osmotic pressure and, in turn, fluid retention. Doctors can confirm the diagnosis through liver function tests and abdominal ultrasound.
treat
Expected treatment
For the treatment of ankle and dorsum of the foot edema, the doctor first determines the cause and then takes appropriate treatment measures, including general treatment, drug treatment, and surgical intervention if necessary.
Treatment of the cause
1. Treatment measures for non-disease factors
(1) Drug factors: If ankle and dorsum of the foot edema is related to medication, the doctor may recommend reducing the dosage of the relevant medication or replacing it with an alternative medication that does not cause edema.
(2) Pregnancy: Pregnant women can reduce edema by taking proper rest and raising their legs. After delivery, edema usually subsides naturally.
(3) Sitting for a long time: For edema caused by sitting for a long time, it is recommended to get up and move around regularly, improve your sitting posture, avoid crossing your legs, and promote blood circulation in the lower limbs by wearing elastic stockings.
2. Treatment measures for disease factors
(1) Varicose veins of the lower limbs: For ankle and dorsum edema caused by varicose veins of the lower limbs, treatment usually includes conservative treatment and surgical treatment. Conservative treatment includes avoiding standing or sitting for long periods of time, using elastic stockings or elastic bandages to increase venous pressure, and improving lifestyle habits, such as regular exercise and maintaining a healthy weight. In severe cases, surgical treatment such as vein stripping, intravenous laser therapy, or radiofrequency ablation may be required to eliminate varicose veins and prevent further development of edema.
(2) Kidney disease: Edema caused by kidney disease is usually related to impaired kidney function and decreased fluid excretion. Treatment should first target the underlying cause of the kidney disease, such as controlling chronic diseases such as hypertension and diabetes. At the same time, diuretics (such as hydrochlorothiazide) can be used to increase urine volume, help the body excrete excess water, and relieve edema symptoms. In severe cases, treatments such as dialysis or kidney transplantation may be required.
(3) Right heart failure: Edema caused by right heart failure is usually related to weakened heart pumping function and obstructed venous return. Treatment should first target the underlying cause of right heart failure, such as improving myocardial function and controlling arrhythmias. At the same time, diuretics (such as furosemide and spironolactone) can be used to increase urine volume and reduce fluid retention in the body. In some cases, cardiotonic drugs (such as digoxin and deacetylated schizonepeta) or vasodilators (such as sodium nitroprusside) may be needed to enhance the heart’s pumping function or reduce the heart’s workload.
(4) Cirrhosis: Edema caused by cirrhosis is usually related to impaired liver function and portal hypertension. Treatment should first target the underlying cause of cirrhosis, such as controlling hepatitis virus infection and quitting drinking. At the same time, diuretics (such as spironolactone, furosemide, etc.) can be used to increase urine volume and help the body excrete excess water. In some cases, drugs that reduce portal vein pressure (such as terlipressin, etc.) or surgical treatment such as liver transplantation or portal vein shunt surgery may be needed. In addition, maintaining a good nutritional status and avoiding excessive salt intake can also help alleviate edema symptoms.
Drug treatment
See treatment of cause for details.
Related drugs
Hydrochlorothiazide, furosemide, spironolactone, digoxin, lanosidase, sodium nitroprusside, terlipressin
Surgical treatment
See treatment of cause for details.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.