From the Guidelines
Ankle swelling can be effectively managed with compression garments, such as knee-high stockings providing 15 to 20 mmHg of pressure, worn for 8 to 12 hours a day, as recommended by the most recent guidance from the ISTH SSC subcommittee on pediatric and neonatal thrombosis and hemostasis 1.
Management Options
The management of ankle swelling depends on the underlying cause, which can range from injury and arthritis to venous insufficiency and systemic conditions.
- For mild to moderate swelling, the RICE protocol is often recommended:
- Rest the affected ankle
- Apply Ice for 15-20 minutes every 2-3 hours
- Use Compression with an elastic bandage wrapped from the toes upward
- Elevate the ankle above heart level whenever possible
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can reduce inflammation and pain, as supported by evidence from studies on acute ankle sprains 1.
Medical Approaches
For swelling due to fluid retention, diuretics such as furosemide (20-40mg daily) may be prescribed, particularly if the swelling is related to heart failure or kidney disease.
- Compression stockings providing 15-20 mmHg of pressure can help manage chronic swelling, especially for venous insufficiency, as indicated by the guidance from the ISTH SSC subcommittee on pediatric and neonatal thrombosis and hemostasis 1.
- Regular ankle exercises like ankle circles and foot pumps improve circulation and reduce fluid buildup.
When to Seek Medical Attention
If swelling persists beyond 2-3 days, worsens significantly, or is accompanied by severe pain, shortness of breath, or fever, medical attention should be sought immediately, as these may indicate serious conditions like blood clots, infections, or heart problems. The effectiveness of these interventions varies based on whether the swelling is caused by injury, arthritis, venous issues, or systemic conditions, highlighting the importance of proper diagnosis and tailored treatment plans, as discussed in the update of an evidence-based clinical guideline on the diagnosis, treatment, and prevention of ankle sprains 1.
From the Research
Management Options for Ankle Swelling
- Compression therapy may be an effective tool in the management of ankle injuries and has been shown to reduce swelling and improve quality of life in single studies 2
- Intermittent pneumatic compression (IPC), elastic tubular bandage, and compression bandaging have been evaluated as potential treatments for ankle sprains, with some studies reporting improved recovery and reduced swelling 2
- The use of compression stockings versus ace-bandages in the treatment of acute ankle distortions has been studied, with no significant difference found between the two treatments 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and paracetamol have been evaluated for their effectiveness in reducing pain and edema in ankle sprains, with some studies suggesting that paracetamol may be more effective in reducing edema 4
- Ibuprofen has been studied as a potential treatment for acute ankle joint injuries, but has been found to have no effect on ankle swelling or pain 5
- Clinical practice guidelines recommend a range of treatments for ankle sprains, including manual therapy, cryotherapy, functional supports, early ambulation, short-term NSAIDs, and rehabilitation 6
Treatment Considerations
- The choice of treatment for ankle swelling will depend on the severity and cause of the swelling, as well as the individual patient's needs and medical history
- A combination of treatments, such as compression therapy and NSAIDs, may be more effective than a single treatment alone
- Further research is needed to determine the most effective form of compression to treat ankle sprains and to fully understand the role of NSAIDs in reducing pain and edema 2, 4, 5