Maleolar Edema or Swelling of the Ankles: Causes and Treatments

Definition: Malleolar edema or swelling in the ankles is relatively standard, especially if you have traveled for an extended time.

It occurs due to the accumulation of excess fluid in the tissues of the ankle and foot, a condition known as ankle or malleolar edema.

As the fluid builds up, the swelling may shift toward the legs.

Due to the erect posture of the human being, blood in the veins of the leg has to move against gravity when it travels toward the heart.

This unidirectional flow of blood is guaranteed by the presence of the valves in the veins and the contractions of the leg muscles.

Any problem with the return of blood to the heart can increase blood pressure in the veins, resulting in fluid infiltration into the tissues and, therefore, ankle edema.

The malleolar edema can be described as stings or not bites. If a temporary depression forms on the skin when pressure is applied, the edema is known as foveal edema.


On the other hand, if depression is not formed, the edema is known as edema of no bites or no fovea. The edema is usually a pitting type.

The non-foveal edema can be observed in conditions such as hypothyroidism, where the tissues are thickening.

Many cases of ankle edema disappear with a simple elevation of the legs; The legs should be elevated above the level of the heart 3 to 4 times a day and while sleeping.

Compression stockings can be helpful in cases that occur due to reduced venous return of blood to the heart. In other conditions, the underlying cause has to be treated.

Cause of malleolar edema in both legs

Heart disease: a decrease in the pumping function of the heart leads to excessive pressure on the small blood vessels, resulting in a fluid loss in the tissues.

This fluid accumulates in the ankles due to gravity. Heart failure is a common cause of this edema.

The swelling is most prominent at night after a hard day’s work. In patients who can not move around and spend most of their time lying down, fluid accumulates in the lower back.

Another heart condition that can cause malleolar edema is when a pericardial effusion occurs. In this condition, fluid accumulates in the space just outside the heart and prevents proper heart function.

Kidney disease: conditions that affect the kidneys result in the accumulation of excess fluid in the body and the loss of protein in the urine, which contributes to edema.

Edema due to kidney disease is more frequent in the morning. Inflammation is observed throughout the body, especially on the face.

Liver diseaseliver disease can cause malleolar edema since there is a reduction in blood protein levels and compression of some of the blood vessels of the liver.

The patient usually has fluid accumulation in the abdomen as well.

Problem with veins: obstruction of blood flow in the inferior vena cava, the central vein that carries blood from the lower part of the body to the heart, results in the accumulation of blood in the legs, causing edema.

The flank veins are generally prominent.

Hypothyroidism: deficient thyroid hormone levels can cause a swollen appearance of the face, hands, and feet.

The patient may also complain of lethargy, weight gain, constipation, hoarseness of the voice, and dry and rough skin, among other symptoms.

Medications:  Drugs such as amlodipine and felodipine calcium channel blockers, in particular, are known to cause malleolar edema.

Other drugs associated with this type of edema include minoxidil and the antidiabetic medicines that belong to the pioglitazone group, such as pioglitazone and rosiglitazone.

Causes of malleolar edema in one leg

Conditions that obstruct the flow of the lymph: like blood, the lymph is a liquid that is transported by vessels called lymphatic vessels, which eventually bind to the blood.

Blockage of lymph flow in the leg can delay, resulting in edema.

Lymphatic obstruction in the leg can occur due to filariasis, pressure on the lymphatic blood vessels by a growth that could be cancerous, or radiation.

Fracture or sprain: A fracture or sprain of the ankle ligaments results in inflammation, pain, and difficulty with the movement of the ankle.

Varicose veins: dilation of the veins of the leg results in varicose veins. The veins can not perform their function of returning blood to the heart, resulting in edema.

The skin on the ankles may appear tense and itchy. An ulcer can form in some cases.


The edema is often temporary and goes away on its own. For example, if you have been standing too long on a hot day, your ankles may swell until the opportunity arrives to put your feet up and rest.

Similarly, you should follow some tips to treat malignant edema:

  • Lose weight (if you are overweight).
  • Exercise regularly, such as walking, swimming, or riding a bicycle.
  • Elevate your legs three to four times a day to improve circulation.
  • Avoid standing for long periods.
  • If an underlying condition is the cause of the fluid imbalance, it must be verified if the Malleolar Edema disappears after the disease has been diagnosed and treated.