Your mother's ankles have been puffy for weeks. Her shoes are tight by evening, and when you press on her shin, a dent stays for a few seconds. She says it's just age. You're not sure whether it's harmless or a sign of something more serious.
Leg and foot swelling is common in older adults, and the cause matters. Here's what families should know.
What edema is
Edema means swelling caused by fluid in the body's tissues1. It most often shows up in the feet, ankles and legs, where gravity pulls fluid down, but it can affect the hands, belly, face or lungs too. Pressing on swollen skin may leave a dent, called pitting edema.
Foot, leg and ankle swelling is more common in people who are older, overweight, have a blood clot or leg infection, or have veins that can't properly move blood back to the heart2.
Common causes in older adults
| Cause | Clues |
|---|---|
| Sitting or standing a long time | Worse at day's end, better overnight |
| Venous insufficiency | Varicose veins, skin darkening near ankles |
| Heart failure | Shortness of breath, tiredness, weight gain |
| Kidney disease | Swelling around eyes too, changes in urination |
| Liver disease | Swollen belly, yellow skin or eyes |
| Medicines | Started after a new drug |
| Blood clot | Usually one leg, with pain or warmth |
| Infection | Red, warm, tender skin |
Warm weather and a lot of standing or walking can also add to swelling1. Low protein from poor nutrition can contribute too; see when an elderly parent isn't eating.
When to get help right away
Call 911 if your parent feels short of breath, has chest pain (especially if it feels like pressure or tightness), or is coughing up frothy or bloody mucus2. These can be signs of fluid in the lungs, a heart problem or a blood clot that has moved to the lungs.
Call the doctor right away if swelling is in one leg only, especially with pain, warmth or redness, which may mean a clot or infection; if swelling gets worse quickly; if your parent has heart, kidney or liver disease and swelling increases; or if they have a fever2.
Blood clots
A deep vein thrombosis, or DVT, is a blood clot in a deep vein, usually in the leg. It often causes swelling, pain, warmth and redness in one leg2. Older adults are at higher risk after surgery, a hospital stay, an injury, or long periods of sitting or lying in bed. A DVT can break loose and travel to the lungs, which is a medical emergency. Don't rub or massage a leg you think has a clot; get it checked quickly, the same day if possible, or go to urgent care.
Heart failure
When the heart doesn't pump well, fluid can back up into the legs, belly and lungs. Swelling from heart failure often comes with shortness of breath, tiredness, waking up at night short of breath, or needing more pillows to sleep. Rapid weight gain of a few pounds in a day or two can be an early warning. See congestive heart failure in the elderly for daily weight checks and warning signs.
Kidney and liver problems
Kidneys that aren't working well can't remove extra fluid and salt, leading to swelling in the legs and around the eyes. See kidney failure in the elderly. Liver disease can cause fluid buildup in the belly and legs, along with yellow skin or eyes. Both need medical care, and swelling can be one way the doctor tracks how the condition is doing.
Vein problems
Venous insufficiency is very common with age. Valves in the leg veins weaken, so blood pools in the lower legs. Swelling may come with aching, heaviness, varicose veins, and darker or thickened skin near the ankles. Over time, the skin may break down into sores. Compression stockings, raising the legs and walking help. Skin care matters too; see skin tears in the elderly.
Medicines that cause swelling
Certain medicines may cause leg swelling2. Common ones include some blood pressure medicines, especially calcium channel blockers, steroids, some diabetes medicines, hormones, some antidepressants, and anti-inflammatory pain relievers like ibuprofen. If swelling started after a new medicine, tell the doctor. Never stop taking a medicine you think may be causing swelling without first talking to your health care provider2. See polypharmacy in the elderly.
What the doctor will check
The doctor will ask when the swelling started, whether it's in one or both legs, what makes it better or worse, and about other symptoms. They'll review medicines, check the heart, lungs, belly and legs, and may order blood and urine tests, an ultrasound for clots, an ECG or an echocardiogram. Bring a list of medicines and note any recent weight changes.
What helps at home
Depending on the cause, the doctor may recommend keeping the legs raised when sitting, wearing support stockings, limiting salt, or taking a water pill, also called a diuretic1. Raise the legs above the level of the heart while lying down when possible2. A low-salt diet may reduce fluid buildup2. Gentle walking helps the leg muscles pump fluid back toward the heart, even a few short walks a day. Avoid sitting with legs crossed, and avoid tight garters or socks that leave marks.
Support stockings are sold at most drugstores and medical supply stores2. Ask the doctor what pressure level is safe, especially if your parent has diabetes or poor circulation, since tight stockings aren't right for everyone.
Getting compression stockings on
Compression stockings can be hard to put on, especially for someone with arthritis or a bad back. Put them on first thing in the morning, before swelling builds. Rubber gloves help with grip, and a stocking donner, a frame that holds the stocking open, makes it easier. Some families find zippered or wraparound styles simpler. Check the skin each evening for redness or marks. See arthritis in the elderly for other tools that help weak hands.
Cutting back on salt
Much of the salt older adults eat comes from packaged and restaurant foods, not the salt shaker. Soups, deli meats, frozen meals, bread, cheese and sauces are common sources. Read labels for sodium, cook simple meals at home when possible, and season with herbs, lemon and spices. If your parent gets home-delivered meals, ask whether low-sodium options are available.
Protecting the skin
Swollen skin is stretched and fragile, and it heals slowly. Keep it clean and moisturized, check daily for cracks, sores or redness, and protect legs from bumps. Make sure shoes fit well, since swollen feet can rub. Report any open sore or signs of infection, like warmth, redness spreading, or fever. Wounds on swollen legs can become serious, especially in people with diabetes; see diabetes in the elderly.
Water pills
If the doctor prescribes a diuretic, your parent will urinate more, usually within a few hours. Taking it in the morning avoids nighttime bathroom trips and falls. Diuretics can cause dehydration, low potassium, dizziness and confusion in older adults, so the doctor may check blood tests. Watch for lightheadedness when standing; see dizziness in the elderly and dehydration in the elderly.
Limited mobility
Older adults who sit most of the day or are bedridden are especially prone to swelling. Change positions often, raise the legs on a stool or pillows, and do simple ankle pumps and circles several times a day. A physical therapist can suggest safe exercises. See caring for a bedridden parent at home.
Tracking swelling at home
A few simple checks help you and the doctor see whether swelling is improving or getting worse. Weigh your parent at the same time each morning, after using the bathroom and before breakfast, and write it down. Sudden weight gain often means fluid is building up. Press gently on the shin or top of the foot and note whether a dent stays and for how long. Notice whether shoes and socks are tighter by evening, and take a photo of the ankles once a week to compare.
Bring the log to appointments. If your parent has heart failure, the doctor may give a specific weight gain that should prompt a call. Keep that number on the fridge so everyone knows it.
In assisted living or a nursing home
If your parent lives in a care community, ask staff how they monitor swelling and weight, who helps with compression stockings, and whether your parent's legs are raised during the day. Make sure shoes and slippers still fit; swollen feet in tight shoes can cause sores and falls. Share the doctor's instructions in writing, and raise any new swelling with the nurse. See assisted living levels of care for what help is typically available.
An example
Maria noticed her father's ankles swelling after he started a new blood pressure pill. She brought it up at his next visit. The doctor confirmed the medicine could cause swelling and switched him to a different one. She also suggested he raise his legs in the afternoons, walk a little after lunch, and cut back on canned soup. Within a few weeks the swelling was much better, and his shoes fit comfortably again by evening. This is an illustration; the cause of swelling must be checked by a doctor.
