Swollen ankles upon waking up can be caused by a variety of factors, ranging from simple lifestyle issues to more serious medical conditions. Understanding why your ankles are swollen in the morning requires looking at how fluid moves and accumulates in your body, as well as potential underlying health problems.
One common reason for swollen ankles in the morning is **fluid retention**. When you lie down to sleep, gravity no longer pulls fluid down into your legs and feet as strongly as when you are standing or sitting. This can cause fluid to redistribute throughout your body, sometimes leading to swelling in the ankles and feet when you wake up. However, if the swelling is persistent or severe, it may indicate a medical issue.
**Venous insufficiency** is a frequent cause of ankle swelling. Your veins have one-way valves that help return blood from your legs back to your heart. If these valves become weak or damaged, blood can pool in the lower legs, increasing pressure in the veins and causing fluid to leak into surrounding tissues, resulting in swelling. This condition often worsens throughout the day but can also cause morning swelling if the veins are significantly compromised[2][5].
**Lymphedema** is another cause. The lymphatic system normally drains excess fluid from tissues. If it is damaged or overwhelmed, fluid builds up, causing swelling. Lymphedema swelling often starts subtly and can become constant if untreated. It may be related to surgery, radiation, infection, or chronic venous problems[1][2][6].
**Heart, kidney, or liver problems** can also cause swelling in the ankles. For example, **congestive heart failure** can lead to fluid buildup in the legs (cardiac edema), often accompanied by other symptoms like shortness of breath and weight gain. Kidney disease can impair the body’s ability to remove excess fluid, and liver disease can cause low protein levels in the blood, leading to fluid leakage into tissues[1][2][5].
Certain **medications** may cause swelling as a side effect. These include calcium channel blockers (used for high blood pressure), nonsteroidal anti-inflammatory drugs (NSAIDs), and hormone therapies. These drugs can cause fluid retention or affect blood vessel function, leading to swollen ankles[1].
**Deep vein thrombosis (DVT)** is a serious condition where a blood clot forms in a deep vein, usually in one leg. This causes sudden, painful swelling, often with redness and warmth. DVT is a medical emergency because the clot can travel to the lungs and cause a pulmonary embolism. If swelling is accompanied by these symptoms, immediate medical attention is necessary[1].
Other causes include **inflammatory conditions** such as bursitis or gout, which can cause swelling and pain without injury. Osteoarthritis can also cause ankle swelling due to joint inflammation and cartilage wear[3].
Lifestyle factors like prolonged sitting or standing, pregnancy, and obesity can contribute to ankle swelling by increasing pressure on veins and reducing circulation. Elevating the legs and moving regularly can help reduce this type of swelling[1][5].
Infections such as **cellulitis**, a bacterial skin infection, can cause swelling, redness, warmth, and pain in the affected area. This requires prompt medical treatment to prevent complications[4].
If your ankles are swollen when you wake up, it is important to observe other symptoms such as pain, redness, warmth, shortness of breath, or if the swelling is only on one side. Persistent or worsening swelling should be evaluated by a healthcare professional to rule out serious conditions and to receive appropriate treatment.
Sources:
[1] Center for Vein Restoration
[2] Legs Matter – Lymphoedema and Oedema
[3] RAD Clinics – Ankle Pain and Swelling
[4] Legs Matter – Cellulitis
[5] Better Health While Aging – Leg Swelling
[6] Lupus Foundation of America
