Why do my feet swell at the ankles?

In terms of the frequency of occurrence of osteophytes that cause complaints, the ankle joint ranks second after the elbow.

Etiology

Most often, osteophytes are degenerative changes due to repeated direct or indirect injuries. The cause of the formation of osteophytes of the tibia in football players is often direct trauma to the anterior parts of the ankle joint during plantar flexion. Athletes who are susceptible to injuries from forced dorsiflexion or twisting of the foot (javelin throwers, high jumpers, long jumpers) are also at risk.

Clinical picture

The main symptoms are: pain in the anterior ankle joint and limited dorsiflexion. Osteophytes on the medial or lateral malleolus can cause pain on the medial or lateral side of the joint, respectively.

Diagnostics

In the zone of osteophytes, there is pain in the joint capsule caused by reactive synovitis. Large osteophytes can be palpated. Forced dorsiflexion is painful due to impingement of the synovium or joint capsule between the tibial osteophyte and the talus, or between the tibial and talus osteophytes. When palpating the anterior capsule during dorsiflexion, the pain intensifies.

The size of osteophytes in the anterior talus and tibia can be assessed using lateral radiography. It is much more difficult to detect medial or lateral osteophytes , and especially osteophytes of the talus .

Normally, the angle between the anterior edge of the tibia and the neck of the talus when x-rayed in a lateral projection is 60° (talo-tibial angle). An angle less than 60° indicates the presence of osteophytes on the talus or tibia.

If osteophytes cannot be identified, an x-ray of the ankle joint on the opposite side should be performed for comparison in order to more accurately determine the talotibial angle.

Classification

Scranton and McDermott developed the following classification of talotibial osteophytes:

Grade 1 – synovial impingement (bone reaction with the formation of osteophytes up to 3 mm in size on the anterior surface of the tibia).

Grade 2 – osteophytes on the anterior edge of the tibia measuring more than 3 mm without osteophytes on the talus.

Grade 3 – large fragmented or non-fragmented osteophytes of the anterior tibia in combination with osteophytes of the neck of the talus, often fragmented.

4th degree – deformation of the anterior area of the ankle joint as a result of osteoarthritis . X-rays reveal degenerative changes in the medial, lateral or posterior parts of the joint.

MRI can accurately assess the size of small and medium-sized osteophytes. Osteophytes of the anterior ankle joint can also be detected by radiography. MRI can detect and evaluate osteophytes in the anteromedial, anterolateral, and posterior ankle .

What is edema?

Edema is the accumulation of fluid in tissues.
Many believe that the main mechanism for the occurrence of edema is the “accumulation of salts” in tissues that attract water. However, in reality, the formation of edema in detail looks somewhat more complicated. Edema can occur due to the following disorders:

disturbances in the permeability of cell membranes. In this case, the cells seem to begin to “release” more fluid outward than normal.
protein metabolism disorders. Not only salts, but also protein molecules have the ability to attract water. That is why a violation of their metabolism (for example, with an unbalanced diet) can lead to edema.
pressure gradient changes. The hydrostatic processes occurring in the body are quite complex. Therefore, the fact that our ankles are swollen may mean that the correct difference in fluid pressure in the vessels and in the surrounding tissues has been disrupted.
blockage of small vessels, most often capillaries. This leads to the fact that the normal circulation of blood or lymph is disrupted, and we complain of swelling of the ankles.

All these mechanisms can be triggered in various diseases and conditions. Below we list the main ones.

In what cases is surgery prescribed?

Indications for surgery are divided into absolute and relative. To carry out osteosynthesis, one must remember that absolute indications are the presence of such injuries that the healing process without fastening the fragments will become impossible. According to them, metal plates are selected for an ankle fracture . These include injuries:

with the possibility of breaking the skin with bone fragments;
damage to the bone structure, which is accompanied by pinching of muscle tissue between bone fragments;
injuries that damage large vessels or nerve fibers.

Relative indications of circumstances when plates are required are:

inability to perform closed reduction of fragments;
secondary change in the position of bone fragments during conservative treatment;
slow bone healing;
lack of fusion of fragments;
formation of false joints.

There are 2 types of operations:

Internal or submersible osteosynthesis is a method in which bone fusion is ensured by implanting various implants into the injured limb. These devices secure fragmented bone elements inside the patient's body. They can be in the form of pins, plates for osteosynthesis , and other types of fastenings. They are made from metal alloys that are resistant to the environment inside the body. These alloys include: stainless steels, titanium, molybdenum-chromium-nickel alloys. Bone implants can have a smooth, polished or porous surface, which facilitates better ingrowth of the products into the bone.
The external or transosseous type of osteosynthesis includes the method of connecting fragments with distraction-compression external fixation devices. This is the Ilizarov apparatus and other devices.

Immersion osteosynthesis of the ankle has its contraindications. This method of surgical intervention is not suitable in the case of:

open fractures of the bones of the limb, when large areas of damaged or contaminated muscle and other soft tissue are formed as a result of trauma;
infection of the body;
large blood loss, serious condition of the patient;
the presence of chronic diseases of internal organs;
diagnosing developed osteoporosis;
manifestations of decompensated cardiovascular failure.

This list of contraindications for installing a plate for an ankle fracture is not exhaustive, therefore, a comprehensive examination of the patient is required before the operation.

Why does one leg swell?

You can often hear the complaint that only one leg is swollen at the ankle. There may be several reasons for this.

Injury . Sometimes a person can get injured in the ankle joint and not even pay attention to it (what we commonly call “twisted his ankle”). And only when the ankle in the area of the injured one begins to swell, do we remember that there really was an injury.

Joint damage, including arthrosis. If you have a serious ankle condition, such as osteoarthritis, circulation may be impaired, leading to swelling of the foot and ankle.

Insect bite or allergic reaction. Swelling of one ankle, especially in the warm season, can often be associated with an allergic reaction.

Infection . If you injure your leg and do not treat the wound, it may become infected and subsequently develop unilateral edema.

Thrombosis. This is a very dangerous condition, and if you notice any signs of it, we recommend that you consult a doctor immediately. Unilateral swelling may indicate blockage of the vessel by a thrombus. Self-treatment in this case is impossible; only specialists can cope with this condition. Also, with thrombosis, redness may be observed on the skin, which spreads along the course of the vessel.

Varicose veins In addition to the listed conditions, complaints about swelling of the right or left leg at the ankle may be associated with the development of varicose veins. Swelling is one of the first signs of this disease. In the early stages, this is not constant swelling that goes away after a night's sleep, rest or some exercise. At a later stage, they begin to spread from the ankle higher and become permanent.

Lymphedema. Another dangerous disease for the body, in which only one ankle may swell, is lymphedema, a violation of the outflow of lymph. When the disease first begins, lymphedema is mild. As lymphedema progresses, the swelling becomes firm and you can no longer apply pressure to the area of swelling with your finger. If you notice that the nature of the swelling is changing, be sure to consult a doctor - lymphatic swelling can only be removed with the participation of a specialist and with constant treatment.

Osteosynthesis for ankle fracture

An ankle fracture is a very common leg injury.
It occurs more often than others because the bone in the ankle area is thinner and more often subject to mechanical stress. In case of such damage, contact a traumatologist to perform osteosynthesis surgery. Osteosynthesis is a surgical procedure in which a broken bone is fixed with a titanium plate or screws for an ankle fracture . It is performed for displaced fractures. When starting treatment, fixation is attempted using the method of closed reduction (in the case of a closed fracture). Surgical intervention is indicated in the presence of an open fracture, after two unsuccessful attempts at closed reduction, secondary displacement of bone fragments, ingrowth of soft tissue into the space between the fragments, in case of improper bone fusion or complete absence of fusion. These are the main reasons why plates are placed on the bones after an ankle fracture .

What does bilateral edema indicate?

Bilateral edema can indicate both serious disruptions in the functioning of a number of organs and systems, and improper distribution of load during the day. Let's consider the second option first.

Incorrect distribution of the load is a long stay in one position, for example, static work on the legs throughout the day. But it can also be too much physical activity that is unusual for you, sitting still for a long time (for example, after an air flight) and even uncomfortable shoes. All these reasons can lead to the formation of edema in both legs. As a rule, this swelling goes away after some time.

But there are edema caused by disruption of various organs, in particular the heart and kidneys. Cardiac edema occurs due to the fact that the heart cannot cope with pumping blood, and its stagnation occurs. These swellings are soft to the touch, the skin in the area of the swelling is pale, may acquire a bluish tint, and is cool. If you press on the swollen area, a dent remains in the area of pressure. Cardiac edema is not constant; during night sleep it decreases or subsides. Swelling of both ankles can be associated with impaired kidney function, but more often renal edema appears on the face. But if, simultaneously with swelling, you notice problems with urination, then contact a nephrologist. It is possible that you are dealing with a malfunction of the excretory system.

It is important to pay attention to one more significant point. Swelling of the ankles in men is most often associated with increased stress on the legs. Swelling of the ankles in women can be caused by hormonal changes, for example, during pregnancy or before the onset of menstruation. Also, a similar reaction can be caused by taking hormonal drugs.

How does ankle osteosynthesis surgery work?

Surgical intervention for osteosynthesis of the ankle is called open reduction and internal fixation. Prescribed for a broken ankle . To perform it, access to the bone is required, which is provided by incisions away from the passage of large neurovascular bundles.

After exposing the bone, the bone fragments are compared, temporary fastening of the elements is arranged, for which bone holders, knitting needles, and bone pins are used. Osteosynthesis is performed on the fixed fragments and screws, after which the temporary holders are removed.

Once the plate for an ankle fracture is completely installed, the surgeon performs hemostasis and sutures the wound layer by layer. Aseptic treatment is carried out, bandaging and elastic compression are performed.

What to do if your ankles are swollen?

Of course, if you notice that your legs are regularly swelling, you should consult a doctor.

Swelling in your feet and ankles may indicate overuse of your legs during the day, or it may be a sign of a serious medical condition such as varicose veins or lymphedema. What is the true cause of edema can only be determined by a specialist. And by following all his recommendations, you will be able to maintain the beauty and health of your feet for as long as possible.

And some traditional medicine recipes can help quickly relieve an unpleasant condition:

take a contrast shower or bath. Sometimes such activation of blood circulation is enough to relieve swelling, especially if it is caused by tired legs.
A compress with blue clay helps improve the condition of your feet. Dilute blue clay (it is sold at the pharmacy) with water to the consistency of sour cream and apply to the area of swelling. Let dry and leave for about an hour. You can wrap your leg in film so that the clay does not crumble when it dries.
baths with sea salt, mint, birch and juniper leaves relieve tired legs and help reduce swelling.

If swelling is constantly observed, introduce into your diet foods that have a diuretic effect: watermelon, cucumbers, parsley, it is also recommended to drink pumpkin juice.

Treatment of ostiophytes

The preferred treatment for isolated symptomatic osteophytes is arthroscopic resection. In patients with clinical and/or radiological signs of significant degenerative changes, the indication for resection should be assessed with particular care. It is possible that osteophytes may re-form within a few months after surgery; the likelihood of recurrence depends on the patient's level of physical activity.

Removal of osteophytes is often performed as an additional intervention (when eliminating an osteochondral defect of the talus).

The purpose of treatment must be explained to the patient before surgery. In patients complaining of intense pain, the main goal of treatment is pain relief or elimination. The goal of treating patients with limited movement is to increase range of motion. The patient should be advised of the possibility of re-formation of osteophytes.

Osteophytes of the posterior surface of the tibia rarely cause limitation of movement, so they should be removed only if certain clinical symptoms are present. Resection of osteophytes on the posterior surface of the tibia is also technically challenging.

Is platinum removal required?

Implant elements used in modern osteosynthesis are made from materials that are highly chemically inert. These include titanium alloys and surgical steels. used for ankle osteosynthesis are highly resistant to corrosion and do not cause a body rejection reaction.

Implants should be removed:

in case of irritation or mechanical damage to soft tissue implants by plates during a fracture;
the occurrence of infectious complications;
clearly expressed wishes of the patient.

Removing ankle anchors before one year after installation is not recommended, but traumatologists advise removing lower limb implants after one year due to the increasing risk of re-injury in the area of ankle osteosynthesis .