- How long have you had the ankle swelling?
Why: to establish if acute or chronic.
- Did the ankle swelling start after an injury?
Why: may indicate ankle sprain or fracture.
- Do you have any swelling in any of the other joints?
Why: If single joint may indicate that ankle pain is from a local condition; if many joints involved many indicate part of a generalized disease e.g. Rheumatoid arthritis.
- Is the ankle swelling worse at any particular time of the day?
Why: Ankle edema is usually worse in the evenings, with improvement during the night.
- Past medical history?
Why: Of psoriasis, chronic diarrhea, colitis, urethritis or iritis may indicate arthritic cause of ankle swelling.
- Past medical history?
Why: Of Congestive cardiac failure, liver cirrhosis, renal disease, deep venous thrombosis and hypothyroidism may indicate cause of ankle edema.
- Recent medical history? Of hepatitis, streptococcal pharyngitis, rubella, dysentery, gonorrhea, tuberculosis or tick bite
- Past history of ankle fracture? Osteoarthritis may occur years after a badly damaged or inaccurately restored ankle fracture
- Recent overseas travel or period of immobility?
Why: may increase risk of deep venous thrombosis.
- Alcohol history?
Why: may indicate increased risk of gout or cirrhosis.
- Family history?
Why: some diseases with chronic arthritis run in families including Rheumatoid arthritis , the seronegative spondyloarthropathies and inflammatory bowel disease.
- Medications?
Why: diuretics can aggravate gout, contraceptive pill and hormone replacement therapy can increase the risk of Deep venous thrombosis.
- Have you experienced any pain with the ankle swelling?
Why: This may be an indication of some joint trauma or inflammatory disease process, e.g., gout.
- Have you ever been diagnosed with heart failure?
Why: This heart condition can result in ankle swelling or ankle oedema.
- Does your ankle swelling change over time?
Why: Ankle swelling which fluctuates over a long period of time is more indicative of circulatory dysfunction, or of a chronic systemic inflammatory condition.
- When did you first notice your ankle swelling?
Why: Ankle swelling of recent onset is more likely to be as a result of a trauma, acute inflammation, or it may be the result of acute heart failure.
- Have you noticed any increase in the size of your abdomen (abdominal swelling)?
Why: Whilst also causing ankle swelling, heart failure can also result in enlargement of your liver (hepatomegaly) as well as the collection of fluid in your abdominal/peritoneal cavity (ascites). Even if you feel that your abdomen hasn't drastically changed in size recently, in retrospect you may have noticed some increase in the size of your abdomen over a long period of time.
- Do you ever feel short of breath (dyspnea)?
Why: Heart failure may also result in shortness of breath.
- How far can you walk before you begin to experience shortness of breath (dyspnea)?
Why: Your Health Professional may enquire about how much activity you can do before you begin to have any change in your breathing. This may seem trivial but it gives some indication of the current severity of any heart failure that you may have, and it may also give an indication of your current functional state, i.e., do you require more help than usual o complete your activities of daily living.
- Have you noticed any fluid "leaking" from your feet, ankles or legs?
Why: Ankle swelling caused by peripheral oedema may become severe and result in the leakage of interstitial fluid through otherwise minor cuts/abrasions.
- Have you recently had any cough/wheeze, and if so has it produced anything?
Why: Heart Failure can result in the accumulation of excess fluid in tissues where it would not otherwise normally collect. This fluid accumulation can result in ankle swelling as well as abnormal fluid accumulation in the lungs (pulmonary oedema). Pulmonary oedema can cause cough, and in acute circumstances may result in frothy (sometimes pink-tinged) whitish sputum. At the same time heart failure can result in a wheeze similar to that experienced with asthma.
- Have you had any episodes where you have lost consciousness, noticed yourself not passing any urine (anuria), felt confused or drowsy?
Why: These are severe symptoms which when associated with ankle swelling and other signs of heart failure can indicate shock secondary to extremely inadequate cardiac function (cardiogenic shock).
- Do you ever wake up at night short of breath (paroxysmal nocturnal dyspnea)?
Why: This is a symptom which in combination with fluctuating ankle swelling can indicate early heart failure.
- Have you ever suffered from gout or pseudogout?
Why: These are conditions which can cause very painful joint swelling (including the ankles) as a result of abnormal crystal deposition in and around the joint.
- Do you have any varicose veins?
Why: These can indicate some dysfunction of the veins of your lower limb, and may explain coexistent ankle swelling.
- Do you take any medications?
Why: Some medications such as some antihypertensives can result in ankle swelling or worsened heart failure symptoms.
- Do you have any heart disease such as ischemic heart disease, pericarditis, cardiac arrhythmia (e.g., atrial arrhythmia), or problems with your heart valves (mitral valve regurgitation, aortic stenosis)?
Why: This can be a cause of heart failure and some instances of ankle swelling.
- Do you drink alcohol? If so how much do you drink, how often and for how long have you been consuming this amount?
Why: Chronic and excessive consumption of alcohol can cause problems with many body systems, such as your heart. Alcoholism can cause heart failure via an alcoholic cardiomyopathy which can lead to ankle swelling.
- Have you ever been diagnosed with high blood pressure/hypertension?
Why: Chronically this can be a cause of heart failure. Ankle swelling and chronic hypertension may lead your health professional to suspect a diagnosis of heart failure.
- Have you ever been told that you have renal failure or any renal disease/kidney disease?
Why: Ineffective function of your kidneys can prevent your body from being able to normally excrete fluids and metabolites. This can result in an excess of body fluid can create much more work for your heart to do. Over a long period of time (or in severe acute renal failure) this can cause heart failure and ankle swelling.
- Have you ever been diagnosed with anemia, thyroid disease (hyperthyroidism, thyrotoxicosis) or any heart murmurs?
Why: These are all conditions which can cause your heart to have to do more work than normal, and so cause heart failure. Anemia can mean your blood is less able to carry oxygen, and so your heart will work harder to provide enough oxygen to your tissues. An overactive thyroid gland can excite your heart and make it work so hard that it "decompensates", or ceases to be able to function normally. A heart murmur can cause abnormalities of how blood flows through your heart, and so some areas of your heart have to pump increased volumes of blood. This can put undue strain on some parts of the heart and cause it to fail.
- Have you recently had surgery or been on a long flight?
Why: Unilateral ankle/leg swelling can be caused by Deep Vein Thrombosis.
