Ankle and leg swelling (oedema) can result from heart failure, venous insufficiency, lymphoedema, hypoalbuminaemia, or medications. Cardiac assessment is important to rule out or diagnose heart failure as a contributing cause.
Ankle swelling, also called peripheral oedema, can have many causes — from standing too long to kidney or liver problems. However, it can also be a sign of heart disease, particularly right-sided heart failure. In heart failure, the heart’s reduced pumping ability causes fluid to back up in the veins and leak into surrounding tissues, affecting the ankles first due to gravity.
Bilateral swelling — affects both ankles
Swelling worsens throughout the day, improves overnight
Associated with breathlessness or fatigue
Difficulty lying flat comfortably
Rapid weight gain (more than 2 kg over 3 days)
Known heart disease, diabetes, or high blood pressure
Not all ankle swelling is related to the heart. The BNP blood test is a highly effective screening tool to distinguish cardiac from non-cardiac causes: an elevated BNP suggests fluid retention due to heart failure, while a normal BNP makes heart failure very unlikely and prompts investigation of other causes such as kidney, liver, or medication-related oedema.
An echocardiogram may follow a raised BNP to assess heart function and confirm the diagnosis.
Everything you need to know about Ankle Swelling FAQs and how private cardiac assessment works.
Yes. Swelling in both ankles can occur when the heart cannot pump effectively, causing fluid to build up in the legs. It is often accompanied by breathlessness and fatigue.
Doctors may perform blood tests such as BNP and imaging tests such as echocardiograms to evaluate heart function and confirm or exclude a cardiac cause.
