Puffy ankles are the price you pay whenever you overindulge in potato chips or another salty snack… and simply putting your feet up soon alleviates the swelling. So while you may chide yourself for making a poor nutritional choice, you probably don’t worry about temporarily chubby ankles.

Yet dismissing ankle swelling as inconsequential can sometimes be a big mistake, I learned from Leo Galland, MD, a practicing physician, author and director of the Foundation for Integrated Medicine in New York City. He explained, “In some cases, ankle swelling is a warning sign of a serious underlying medical condition that requires a doctor’s attention or even emergency care.” Here’s what could be causing the problem… the warning signs to watch for… and what to do to protect yourself…



Congestive heart failure. This condition develops when the heart is unable to pump as efficiently as it should, so blood backs up in the veins and fluid accumulates in the lungs.

Watch for swelling that…

  • Affects both ankles.
  • Gradually worsens.
  • Causes little or no discomfort.
  • Leaves indentations when the skin is pressed (called “pitting edema”).

Accompanied by…

  • Chronic cough.
  • Increased heart rate.
  • Fatigue.
  • Shortness of breath that worsens with physical exertion or when lying down.

What to do: See your doctor. This is a serious condition that needs monitoring and may require treatment to avoid permanent damage to the heart.

Kidney disease. The kidneys’ job includes removing waste and excess fluids from the blood, maintaining the proper balance of salt and minerals in the blood, and helping regulate blood pressure. When kidney function is impaired, fluids build up in the body.

Watch for swelling that…

  • Affects both ankles.
  • Gradually worsens.
  • Also affects the hands, face and/or abdomen.

Accompanied by…

  • Increased or decreased urination.
  • Urine that is darker or foamier than usual.
  • Itchy skin.
  • A metallic or ammonia-like taste in the mouth.

What to do: Immediately alert your doctor — untreated kidney disease can lead to irreversible kidney failure.

Blood clot in the leg. The primary concern is that if a clot in a deep vein breaks off and travels to the lungs, it can be fatal.

Watch for swelling that…

  • Affects one ankle.
  • Appears suddenly.

Accompanied by…

  • Pain or tenderness in the calf.
  • Unusual warmth in the skin of the affected area.
  • A hardened spot beneath the skin.
  • Red or bluish skin discoloration.

What to do: If you have possible symptoms of a blood clot in the leg, alert your doctor immediately.

Cellulitis. This bacterial infection (which most commonly affects the lower leg but may occur elsewhere) can spread quickly from the skin to the lymph nodes and bloodstream — with potentially life-threatening consequences.

Watch for swelling that…

  • Affects one ankle.
  • Rapidly worsens.

Accompanied by…

  • Redness, tenderness and heat in the affected area.
  • Fever and/or chills.

What to do: Immediately alert your doctor. You need antibiotics to keep the infection from spreading.

Reassuring: Most cases of ankle swelling are not caused by any hidden dire condition, but instead have a harmless or obvious cause, such as…

  • Fluid retention — brought on by an impending menstrual period, a recent high-salt meal or too many hours spent sitting still. In this case, swelling affects both ankles, causes no discomfort, and goes away within a day or two. Helpful: Sit down and elevate your legs, ideally higher than the level of your heart, for 30 minutes.
  • Varicose veins — which develop when tiny, one-way valves inside veins don’t work well enough to keep blood circulating efficiently through the legs. One or both legs may be affected. Ask your doctor if you could benefit from wearing support stockings, which create a pressure gradient that helps prevent fluid from pooling in the legs.