Diabetes is a condition that affects how your body uses sugar, and over time, it can cause a wide range of health problems. One common question people with diabetes have is whether the disease can lead to swollen ankles and feet. The answer is yes, diabetes can cause swelling in the lower legs, ankles, and feet, but the reasons behind this swelling are complex and involve several different mechanisms in the body. Understanding these mechanisms can help you recognize the signs early and seek appropriate care.
## Why Does Diabetes Cause Swelling in the Ankles and Feet?
Swelling, also known as edema, happens when fluid builds up in the tissues. In people with diabetes, this can occur for several reasons, all related to how diabetes affects the body over time.
**Poor Blood Circulation**
High blood sugar levels can damage the lining of blood vessels, making them less flexible and more likely to become narrow or blocked[9]. This reduces blood flow to the feet and ankles, a condition known as peripheral arterial disease. When blood flow is poor, fluid can leak out of the blood vessels and accumulate in the surrounding tissues, causing swelling[9]. Poor circulation also makes it harder for wounds to heal, increasing the risk of infections and further complications.
**Nerve Damage (Neuropathy)**
Diabetes can damage the nerves, especially in the feet and legs, a condition called diabetic neuropathy[3]. When nerves are damaged, you might not feel pain, heat, or cold as well as you used to. This means you could injure your foot without realizing it. Repeated injuries or pressure on one area can lead to inflammation and swelling[3]. In some cases, this nerve damage can also affect the muscles and bones of the foot, leading to changes in the shape of the foot and abnormal pressure points, which further increase the risk of swelling and ulcers[3].
**Infections and Inflammation**
People with diabetes are more likely to get infections, especially in their feet. Even a small cut or blister can become infected because high blood sugar weakens the immune system and slows healing[1]. Infections cause inflammation, which leads to redness, warmth, and swelling. If not treated quickly, these infections can spread to the bones (osteomyelitis) and may even require amputation in severe cases[1][6].
**Charcot Foot**
A rare but serious complication of diabetes is Charcot foot, also known as Charcot arthropathy[2]. This condition happens when there is severe nerve damage, and the bones and joints in the foot become weak and can break or dislocate easily, often without the person feeling much pain. The foot becomes red, hot, and swollen, and if not treated, it can lead to permanent deformity and disability[2]. The swelling in Charcot foot is caused by a strong local inflammatory response, with the body releasing too many inflammatory chemicals like tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β)[2]. This inflammation is different from a typical infection because it usually does not cause a fever or make you feel sick overall.
**Kidney Problems**
Diabetes is a leading cause of kidney disease. When the kidneys are not working well, they cannot remove excess fluid and waste from the body effectively. This can lead to fluid buildup, especially in the legs, ankles, and feet, causing swelling. While this is not directly mentioned in the provided sources, it is a well-known complication of diabetes in general medical knowledge.
**Blood Clots**
People with diabetes are at higher risk of developing blood clots, especially if they have other health problems like high blood pressure or high cholesterol[9]. A blood clot in the leg (deep vein thrombosis) can block blood flow and cause sudden swelling, pain, and redness in the affected leg. This is a medical emergency and requires immediate attention.
## How Common Is Swelling in People with Diabetes?
Swelling in the feet and ankles is a common problem for people with diabetes, but not everyone with diabetes will experience it. The risk increases with the duration of diabetes, poor blood sugar control, and the presence of other complications like neuropathy or kidney disease. Diabetic foot ulcers, which often start with swelling and inflammation, affect about 15–20% of people with diabetes at some point in their lives[1]. Once an ulcer forms, the risk of serious complications, including amputation, goes up significantly[1][7].
## What Are the Signs to Watch For?
If you have diabetes, you should check your feet every day for any changes. Look for:
– Swelling that does not go away after elevating your feet or overnight
– Redness, warmth, or pain in the foot or ankle
– Sores, blisters, or cuts that do not heal
– Changes in the shape of your foot
– Numbness or tingling
If you notice any of these signs, contact your healthcare provider right away. Early treatment can prevent more serious problems.
## How Is Swelling in Diabetes Treated?
Treatment depends on the cause of the swelling. Here are some general approaches:
**Improving Blood Sugar Control**
Keeping your blood sugar levels as close to normal as possible is the most important step in preventing and managing complications, including swelling[3].
**Managing Blood Pressure and Cholesterol**
High blood pressure and high cholesterol can worsen circulation problems, so these should be controlled with medication and lifestyle changes.
**Wearing Proper Footwear**
Shoes that fit well and do not rub or press on any part of the foot can help prevent injuries and reduce pressure on swollen areas[3].
**Elevating the Feet**
Raising your feet above the level of your heart when sitting or lying down can help reduce swelling by allowing fluid to drain back toward the body.
**Compression Stockings**
In some cases, specially fitted compression stockings can help reduce swelling by improving blood flow in the legs.
**Treating Infections**
If an infection is present, antibiotics are usually needed. Severe infections may require hospitalization and, in some cases, surgery to remove infected tissue or even amputation[1][6].
**Managing Kidney Disease**
If kidney problems are contributing to swelling, your doctor may recommend medications to help your kidneys remove excess fluid or refer you to a kidney specialist.
**Physical Therapy**
For conditions like Charcot foot, physical therapy and custom braces or shoes may be needed to protect the foot and prevent further damage[2].
## Can Swelling Be Prevented?
While not all swelling can be prevented, you can reduce your risk by:
– Checking your feet daily for any changes
– Keeping your blood sugar, blood pressure, and cholesterol under control
– Avoiding smoking, which worsens circulation
– Staying active to improve blood flow
– Wearing shoes that fit well and protect your feet
– Seeing your healthcare provider regularly for foot exams
## When to Seek Medical Help
You should seek medical attention if you have:
– Sudden, severe swelling in one leg, which could be a blood clot
– Swelling with redness, warmth, or pain, which could be an infection
– Sores or ulcers that do not heal
– Changes in the shape of your foot
– Swelling that doe
