What causes swollen ankles in older adults?

Ageing often occurs alongside changes that affect swelling, such as spending more time seated, weaker calf-muscle pumping, or varicose veins. Swelling that is worse by evening and improves with leg elevation may reflect reduced vein return. Obesity can add pressure to the veins. Heart failure may cause ankle swelling with breathlessness or reduced stamina, while chronic kidney disease can disturb fluid balance and cause swelling in other areas. A new medicine, a sprain, infection, or a clot can also produce swelling, so one explanation should not be assumed without considering the full pattern.

Record when the swelling began, whether one or both ankles are affected, and any recent medicine change, fall, travel, or change in walking. If safe, take short walks and move the ankles while seated; raise the legs during rest without pressing on painful areas. Avoid tight footwear and do not start water tablets or compression without clinical advice. A clinician can review medicines and circulation, examine the skin, and decide whether testing is needed.

Seek urgent help for sudden one-sided swelling with pain, warmth, or colour change; chest pain or severe breathlessness; faintness; or rapidly spreading redness. Arrange prompt assessment for new persistent swelling, skin ulcers, fever, reduced urination, or breathlessness when lying down. Extra care is needed when the person has heart, kidney, or circulation disease.

Ask whether the swelling could be medicine-related, whether compression is safe, which activity is suitable, and which changes require same-day help.