Oedema (ankle / leg swelling)

Ankle and leg swelling — *soojan* — is a classic OPD presentation. The location, symmetry, and what makes it better or worse all matter. Pitting oedema (where pressing leaves a dent that stays for several seconds) usually indicates fluid retention from a systemic cause; non-pitting suggests a local cause.

Common causes

• Kidney disease (CKD) — protein loss in urine drops the blood's ability to hold fluid in the vessels. Often face + ankle swelling, foamy urine, fatigue. Classic in long-standing untreated diabetes / BP.
• Heart failure — the heart can't push blood forward efficiently; fluid backs up. Both ankles swollen, worse in the evening, often with breathlessness lying flat at night and a dry cough.
• Liver disease — cirrhosis causes leg swelling and sometimes abdominal swelling (ascites).
• Hypothyroidism — generalised puffiness, especially around the eyes.
• Drug side-effect — calcium channel blockers (amlodipine) commonly cause ankle swelling without any disease underneath.
• Pregnancy — late-pregnancy ankle swelling is usually normal but can sometimes signal pre-eclampsia (with high BP) — needs urgent obstetric review.
• Varicose veins / venous insufficiency — often one leg, worse on standing, better on elevation.
• Lymphoedema — chronic non-pitting swelling, often after lymph-node surgery or radiotherapy.

Workup

History: bilateral or unilateral, how long, worse at the end of day, any breathlessness, foamy urine, weight gain, past medical history, medications. Examination: pitting test, abdominal examination for fluid, lung examination for crackles, BP. Standard tests: urine routine (looking for protein), creatinine + eGFR (kidney function), liver function, thyroid, ECG, sometimes ECHO and abdominal ultrasound.