Ankle swelling can sneak up on you. One minute your shoes fit fine—then suddenly, your ankles feel stiff, look puffy, and leave you wondering if something’s wrong.
You’re not imagining it. Swollen ankles are common and while sometimes it’s nothing to worry about, other times it’s your body’s way of signaling that something’s off.
It could be due to how long you’ve been on your feet. It could be an injury, a circulation issue, or even a side effect of something completely unrelated—like medication or posture.
As a physical therapist, I’ve helped many patients figure out exactly why their ankles are swollen—and more importantly, how to reduce the swelling and prevent it from coming back.
In this blog, we’ll cover 7 of the most common causes of ankle swelling—so you can stop guessing and start addressing it the right way.
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Table of Contents
1. You’ve Been Sitting or Standing Too Long
One of the most common—and easily overlooked—reasons for ankle swelling is that you haven’t been moving enough.
When you sit or stand in one position for long periods of time (think long workdays, travel, or even watching a movie marathon), gravity causes fluid to pool in your lower legs. That fluid buildup leads to swelling, especially around the ankles where there’s less muscle activity to help pump it back up.
This kind of swelling is usually:
- Mild and painless
- Worse at the end of the day
- Symmetrical (affecting both ankles)
- Reduced after elevating your feet or moving around
2. Ankle Injury or Sprain
If your ankle is swollen, painful, and maybe a little bruised—an injury might be to blame. Even a mild sprain or twist can cause noticeable swelling as your body responds with inflammation to protect the joint.
You don’t always need a dramatic fall or accident for this to happen. Sometimes, stepping off a curb awkwardly or landing a little off during a workout is enough to stretch the ligaments that support your ankle.
Signs it might be an injury:
- Swelling that comes on suddenly
- Pain when bearing weight or moving the ankle
- Localized tenderness or bruising
- One ankle is clearly more swollen than the other
3. Poor Circulation or Venous Insufficiency
If your ankles are consistently swollen by the end of the day and feel heavy or tired, your veins might be having a hard time moving blood back up toward your heart. This condition is called chronic venous insufficiency, and it’s more common than you might think—especially in people who sit or stand for long periods.
When blood pools in the lower legs, it causes fluid to leak into surrounding tissues. This leads to puffy ankles, sometimes along with visible veins, skin discoloration, or a feeling of pressure in the legs.
Common risk factors include:
- Sedentary lifestyle
- Obesity
- Pregnancy
- History of blood clots or vein conditions
- Family history of venous issues
4. Heart, Kidney, or Liver Conditions
Sometimes, ankle swelling isn’t just about the legs—it’s about what’s happening internally. Systemic health issues, such as congestive heart failure, kidney disease, or liver problems, can all cause fluid retention that shows up in your ankles.
What sets this type of swelling apart is that it’s:
- Often symmetrical (both ankles or feet)
- More persistent, not going away easily with elevation
- Sometimes accompanied by other symptoms, like shortness of breath, fatigue, or swelling in other parts of the body
These conditions can affect how your body handles fluid and sodium, leading to excess fluid in the tissues—especially in gravity-dependent areas like your ankles. (This type of swelling should be looked at by a Doctor).
5. Side Effects from Medication
Sometimes, your swollen ankles aren’t caused by anything you’re doing—but by something you’re taking. Certain medications can cause fluid retention, leading to mild to moderate swelling around the ankles and feet.
This is a common side effect of:
- Blood pressure medications (especially calcium channel blockers)
- Steroids
- Hormone therapies (like birth control or HRT)
- Certain antidepressants or diabetes medications
You might notice the swelling is:
- Gradual and painless
- Symmetrical
- More noticeable in the evenings or after long periods of sitting
6. Lymphedema
If your ankle or leg swelling is persistent, feels dense or “rubbery,” and doesn’t go down overnight, it could be lymphedema—a condition where lymphatic fluid builds up due to a blockage or damage in the lymph system.
Lymphedema often:
- Affects only one leg (though it can be both)
- Causes a heavy or tight feeling
- Leads to skin changes like thickening or a “leathery” texture
- May occur after surgery, cancer treatment, or injury to lymph nodes
What helps:
- Early intervention is key—this type of swelling doesn’t go away on its own
- Certified lymphedema therapists (often physical therapists) use special techniques like manual lymphatic drainage, compression therapy, and movement plans
- Compression garments can help manage symptoms once swelling is under control
7. Pregnancy
During pregnancy, it’s common to experience mild swelling in the ankles and feet, especially in the second and third trimesters. Your body is holding more fluid, and the growing uterus puts pressure on blood vessels, making it harder for fluid to return from your lower legs.
This kind of swelling is usually:
- Gradual and mild
- Worse at the end of the day
- Relieved by rest, elevation, and hydration
However, sudden or severe swelling, especially when paired with headache, visual changes, or high blood pressure, needs immediate medical attention.
What helps:
- Elevate your legs when possible
- Wear compression socks for extra support
- Stay active—gentle walking or prenatal-safe exercises help promote circulation
- Hydrate and reduce salt intake to minimize fluid retention
- Always check in with your OB if anything feels off
When Should You See a Physical Therapist for Swollen Ankles?
If ankle swelling is:
- Persistent or getting worse over time
- Accompanied by pain, stiffness, or limited motion
- Recurrent, even with rest or elevation
- Or caused by an injury that hasn’t fully healed
A physical therapist can help. We’ll look at how you move, assess your circulation, check for underlying joint issues, and create a plan to get the swelling down and keep it from coming back.
Treatment might include:
- Manual therapy to reduce fluid buildup
- Targeted exercises to improve strength and movement
- Circulatory support through elevation, compression, and breathwork
- Education on habits that support long-term joint health and fluid balance
If you need some help, please click here to get in touch and we’ll get back to you ASAP!
FAQs
When should I be concerned about swollen ankles?
If your ankle swelling is sudden, severe, only on one side, or accompanied by symptoms like shortness of breath, chest pain, fatigue, or redness and warmth, it’s time to see a healthcare provider. Also, if the swelling doesn’t improve with rest, elevation, or basic home care, you should get it checked out.
Does drinking water help swollen ankles?
Yes—hydration actually helps flush excess sodium and fluids out of your body. When you’re dehydrated, your body may retain fluid, which can make swelling worse. Drinking enough water throughout the day supports circulation, kidney function, and helps reduce fluid buildup in your lower legs.
How do I get rid of the swelling in my ankles?
Start with the basics:
– Elevate your feet above heart level for 15–20 minutes, a few times a day
– Move more—even light walking or ankle pumps can improve circulation
– Wear compression socks to support fluid return
– Avoid sitting or standing too long without breaks
– Stay hydrated and limit high-sodium foods
If swelling continues, worsens, or interferes with your daily life, a physical therapist can help identify the root cause and create a custom plan to reduce and manage it.
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