Swollen feet and ankles in older adults are caused by a variety of medical conditions and physiological changes that affect circulation, fluid balance, and tissue health. The swelling, medically known as edema, occurs when excess fluid accumulates in the tissues of the lower extremities. This is a common issue in aging populations due to several underlying factors.
One of the most frequent causes of swollen feet and ankles in older adults is **chronic venous insufficiency (CVI)**. CVI happens when the valves in the leg veins, which normally prevent blood from flowing backward, become weak or damaged. This leads to blood pooling in the veins, increasing pressure and causing fluid to leak into surrounding tissues, resulting in swelling. CVI is particularly common in older adults because vein walls and valves weaken with age. Symptoms often include swelling, aching, and sometimes skin changes or ulcers on the legs. Management typically involves lifestyle changes such as leg elevation, compression stockings, and exercise to improve circulation[2][3].
Another major cause is **heart failure**, a condition where the heart muscle becomes too weak to pump blood effectively. When the heart cannot pump efficiently, blood backs up in the veins, causing fluid to leak into the legs, ankles, and feet. This swelling is often accompanied by other symptoms such as fatigue, shortness of breath, and sudden weight gain. Heart failure is common in older adults due to age-related changes in the heart and the presence of other cardiovascular diseases. Early recognition and management of heart failure symptoms are crucial to prevent worsening edema and maintain quality of life[6].
**Kidney disease** can also lead to swollen feet and ankles. The kidneys regulate fluid balance in the body, and when they are not functioning properly, fluid can accumulate in the tissues. This is often seen in older adults with chronic kidney disease, where the kidneys fail to remove excess fluid and salt efficiently. Kidney-related edema is usually accompanied by other signs such as changes in urine output and blood pressure abnormalities[2].
**Liver disease**, particularly cirrhosis, can cause swelling in the lower limbs due to low levels of albumin (a protein that helps keep fluid in the bloodstream) and increased pressure in the veins of the abdomen. This leads to fluid leaking into the legs and abdomen (ascites). Diuretics and careful management of fluid and electrolytes are often used to treat this type of edema[2].
Poor **circulation problems**, including peripheral artery disease (PAD), can cause swelling and discoloration in the feet and ankles. PAD involves narrowing or hardening of the arteries, reducing blood flow to the extremities. This can cause symptoms such as cold feet, numbness, pain, and swelling. In severe cases, poor circulation can lead to tissue damage and conditions like gangrene, which require urgent medical attention[1].
Other contributing factors to swollen feet and ankles in older adults include:
– **Inactivity or prolonged sitting/standing**, which reduces the muscle pump action that helps return blood to the heart, leading to fluid pooling in the legs.
– **Obesity**, which increases pressure on leg veins and can worsen venous insufficiency and edema[4].
– **Medications** such as calcium channel blockers, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause fluid retention.
– **Infections** like cellulitis can cause localized swelling, redness, and pain in the feet and ankles[1].
– **Lymphedema**, a condition where lymphatic fluid accumulates due to impaired lymph drainage, can also cause swelling, though it is less common than venous causes.
In clinical practice, when an older adult presents with swollen feet and ankles, healthcare providers perform a thorough evaluation to identify the underlying cause. This includes physical examination, checking for signs of heart, kidney, or liver disease, assessing circulation, and sometimes ordering blood tests or imaging studies. If swelling is sudden, painful, or associated with other symptoms like shortness of breath or chest pain, urgent medical evaluation is necessary to rule out serious conditions such as deep vein thrombosis or heart failure exacerbation[2][3][6].
Treatment depends on the cause but often involves a combination of:
– **Leg elevation** to reduce fluid accumulation.
– **Compression therapy** using stockings to improve venous return.
– **Medications** such as diuretics to remove excess fluid in cases of heart, kidney, or liver disease.
– **Lifestyle modifications** including exercise, weight management, and reducing salt intake.
– **Managing underlying conditions** like heart failure, kidney disease, or venous insufficiency.
Proper management of swollen feet and ankles in older adults is essential to prevent complications such as skin ulcers, infections, and reduced mobility, which can significantly impact quality of life.
Sources:
[1] Home Instead – Causes Of Purple Feet In The Elderly
[2] Better Health While Aging – Leg Swelling in Aging: What to Know & What to Do
[3] Yale New Haven Health – Interest Swells in Chronic Venous Insufficiency
[4] JMIR Aging – Exploring Risk Factors Related to Low Calf Circumference in Older Adults
[5] DrOracle.ai – Management of Chronic Bilateral Foot Swelling in a 64-Year-Old Female
[6] Central Coast VNA & Hospice – Symptoms of Heart Failure in Elderly: What to Watch For
