Oedema means abnormal swelling of the tissue due to accumulation of fluids as in the ankles, joint capsules, pericardial sac (space between the two coverings of the heart), peritonial cavity and pleural cavity.

Ankle oedema is a common symptom we physicians come across in our day-to-day clinical practice and it may be a manifestation of a disorder of the heart, the kidneys, the liver, the gut and the lymphatics and may result from thrombosis of leg veins, allergy or inflammation. Sometimes ankle oedema may occur in people who stand up for a long time (postural oedema) and is unimportant. Ankle oedema also occurs commonly in patients with varicose veins, those from casts and tight bandages. Ankle oedema is also common in patients with Cushings syndrome and those who are on long term treatment with drugs, such as prednisolone.

Oedema of ankles usually is pitting type (pitting oedema) i.e. pitting of the skin occurs when firm pressure is applied for a few minutes with the thumb. Myxodedema in contrast to pitting oedema is characterized by non-pitting oedema and occurs in patients with thyroid hormone deficiency (hypothyroidism). Another type of non-pitting oedema occurs in patients with elephantiasis (fiilariasis) and this type of ankle oedema is rare nowadays due to health measurers taken by the Ministry of Health and Nutrition. In filariasis the oedema is due to obstruction of lymphatics by filarial worms.

Inflammatory Causes

As a result of damage to tissues by injury or infection (as in cellulites) testing for pitting oedema causes pain in above conditions.

Oedema Due To Low Proteins

This type of ankle oedema occurs because of low serum proteins as in (a) nephrotic syndrome (b) Chronic diarrhoea and in c Malnutrition (kwarshiorkor) which is rare in Sri Lanka now due to improvement is the standard of living.

Common Cause Of Ankle Oedema

(a) Heart Failure

This is one of the commonest causes of ankle oedema we physicians come across in our day-to-day practice. In heart failure, the kidney function is impaired and kidneys are unable to get rid of excess of fluid and fluid retention occurs and heart failure patients collect excess fluid in the chest and in the abdomen. Ankle oedema due to heart failure (C.C.F.) is a condition which has a poor prognosis and should never be missed by a physician. Tests such as chest x’ray, and 2D-Echo test are very useful in assessing the degree of C.C.F.

Common causes of CCF are coronary heart disease (heart attacks) high blood pressure and rheumatic heart disease. Race causes are cardiomyopathy (heart muscle disease) and congenital heart disease. Patients with CCF are unable to pump sufficient blood according to the metabolic requirements of the body. Patients with CCF usually have difficulty in breathing on mild exertion and physicians treat heart failure patients with water tablets (such as frusemide and spironolactone), digitalis and A.C.E. Inhibitors such as captopril and enclepril. Ideally patients suffering from CCF should be admitted to a hospital for full assessment and control of CCF.

(b) Liver Failure

Ankle oedema is quite common in patients suffering from cirrhosis of liver, which is common in persons who consume excess alcohol. These patients also have enlarged liver and ascites (fluid in peritoneal cavity). Once the alcoholic patient develops oedema they have a very poor prognosis especially if they continue to consume alcohol.

Varicose Veins

Varicose veins sometimes present to the surgeon with ankle oedema and the oedema is limited to the lower limb affected by the varicose veins. Varicose veins are tortuous veins which are abnormally dilated and may be due to congenital defects of the valves of the veins. Keeping the affected leg elevated helps to decrease the oedema.

Renal Causes

As mentioned earlier patients suffering from kidney ailments such as nephrotic syndrome and chronic nephritis too have ankle oedema.